Abstract
Much of the existing empirical literature on the association between health insurance and out-of-pocket (OOP) expenditures on facility-based delivery in low- and middle-income countries is cross sectional in nature. Comparatively little is known about the dynamic shifts in OOP expenditures and the health insurance nexus. Using seven biennial waves of Vietnam’s Household Living Standard Survey covering the period 2006–2018 and a generalized linear model this study examines trends in OOP expenditures on facility-based delivery and financial protection afforded by Vietnam’s social health insurance system. Over the period under consideration, the pattern of health facility utilization among the insured shifted steadily from commune health centers towards higher-level government hospitals. Real OOP for delivery was 52.7% higher in 2018 than in 2006–2008 and insurance reduced OOP expenditures by 28.5%. Compared to district hospitals, giving birth at higher-level government hospitals increased OOP expenditures by 72.3% while giving birth at commune health centers reduced OOP expenditures by 55.7%. Additional analysis involving interactions between insurance status, types of public health facility and year dummies suggested a drop in financial protection of insurance, from 48% to 26.9% among women delivering at district hospitals and from 31.2 to 18.7% among those delivering at higher-level government hospitals. The modest financial protection of health insurance and its declining trend calls for policy measures that would strengthen the quality of maternal care at primary care institutions, strengthen financial protection and curb the provision of two-tiered clinical services and charges.
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Availability of data and material
Seven biennial waves of Vietnam’s Household Living Standard Survey for the period 2006–2018 were used for this study. Vietnam’s Household Living Standard Survey (VHLSS) are available from General Statistical Office of Vietnam, https://www.gso.gov.vn/en/homepage.
Notes
Given the small number of observations on deliveries by the insured at commune health centers, only district and higher-level government hospitals were interacted with insurance and year dummies.
The small number of observations on the poor and near-poor women delivering at higher-level government hospitals did not allow us to interact year dummies and household expenditure quintiles with each type of public hospitals separately.
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All authors contributed to the study conception and design. PV contributed to material preparation, data collection, analysis, and preparation of the manuscript; AS contributed to the statistical analysis and review of the results; LT assisted with review and interpretation of the results. The corresponding author takes responsibility for the overall content. All authors read and approved the final manuscript.
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Vu, P.H., Sepehri, A. & Tran, L.T.T. Trends in out-of-pocket expenditure on facility-based delivery and financial protection of health insurance: findings from Vietnam’s Household Living Standard Survey 2006–2018. Int J Health Econ Manag. 23, 237–254 (2023). https://doi.org/10.1007/s10754-022-09330-z
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DOI: https://doi.org/10.1007/s10754-022-09330-z