Do the more educated utilize more health care services? Evidence from Vietnam using a regression discontinuity design

  • Thang DangEmail author
Research Article


In 1991, Vietnam implemented a compulsory primary schooling reform that provides this study a natural experiment to estimate the causal effect of education on health care utilization with a regression discontinuity design. This paper finds that education causes statistically significant impacts on health care utilization, although the signs of the impacts change with specific types of health care services examined. In particular, education increases the inpatient utilization of the public health sector, but it reduces the outpatient utilization of both the public and private health sectors. The estimates are strongly robust to various windows of the sample choice. The paper also discovers that the links between education and the probability of health insurance and income play essential roles as potential mechanisms to explain the causal impact of education on health care utilization in Vietnam.


Education Health care utilization Regression discontinuity design Vietnam 

JEL Classification

I12 I21 J13 



The author would like to thank the editor, two anonymous reviewers and Thomas Cornelissen for helpful comments and suggestions.


  1. Albouy, V., & Lequien, L. (2009). Does compulsory education lower mortality? Journal of Health Economics, 28(1), 155–168.CrossRefPubMedGoogle Scholar
  2. Altindag, D., Cannonier, C., & Mocan, N. (2011). The impact of education on health knowledge. Economics of Education Review, 30(5), 792–812.CrossRefGoogle Scholar
  3. Angrist, J. D., & Pischke, J.-S. (2009). Mostly harmless econometrics: An empiricist’s companion. Princeton, NJ: Princeton University Press.Google Scholar
  4. Card, D., Dobkin, C., & Maestas, N. (2008). The impact of nearly universal insurance coverage on health care utilization: Evidence from medicare. American Economic Review, 98(5), 2242–2258.CrossRefPubMedGoogle Scholar
  5. Coxhead, I., & Phan, D. (2013). Princelings and paupers? State employment and the distribution of human capital investments among households in Viet Nam. Asian Development Review, 30(2), 26–48.CrossRefGoogle Scholar
  6. Cutler, D., & Lleras-Muney, A. (2008). Education and health: Evaluating theories and evidence. In J. House, R. Schoeni, G. Kaplan, & H. Pollack (Eds.), Making Americans healthier: Social and economic policy as health policy. New York: Russell Sage Foundation.Google Scholar
  7. Dang, T. (2017a). Quasi-experimental evidence on the political impacts of education in Vietnam. MPRA Paper 77641, University Library of Munich, Germany.Google Scholar
  8. Dang, T. (2017b). Education as protection? The effect of schooling on non-wage compensation in a developing country. MPRA Paper 79223, University Library of Munich, Germany.Google Scholar
  9. Dang, T. (2017c). The multiple effects of child health insurance in Vietnam. MPRA Paper 78614, University Library of Munich, Germany.Google Scholar
  10. Dickson, M., Gregg, P., & Robinson, H. (2016). Early, late or never? When does parental education impact child outcomes? The Economic Journal, 126, F184–F231.CrossRefPubMedGoogle Scholar
  11. Eide, E. R., & Showalter, M. H. (2011). Estimating the relation between health and education: What do we know and what do we need to know? Economics of Education Review, 30(5), 778–791.CrossRefGoogle Scholar
  12. Ettner, S. L. (1996). New evidence on the relationship between income and health. Journal of Health Economics, 15(1), 67–85.CrossRefPubMedGoogle Scholar
  13. Frijters, P., Haisken-DeNew, J. P., & Shields, M. A. (2005). The causal effect of income on health: Evidence from German reunification. Journal Health Economics, 24(5), 997–1017.CrossRefGoogle Scholar
  14. Gathmann, C., Jürges, H., & Reinhold, S. (2015). Compulsory schooling reforms, education and mortality in twentieth century Europe. Social Science & Medicine, 127, 74–82.CrossRefGoogle Scholar
  15. Grépina, K. A., & Bharadwaj, P. (2015). Maternal education and child mortality in Zimbabwe. Journal of Health Economics, 44, 97–117.CrossRefGoogle Scholar
  16. Grossman, M. (1972). On the concept of health capital and the demand for health. Journal of Political Economy, 80(2), 223–255.CrossRefGoogle Scholar
  17. Grossman, M. (1976). The correlation between Health and schooling. In Household production and consumption. National Bureau of Economic Research, pp. 147–224.Google Scholar
  18. Grossman, M. (2000). The human capital model. In A. J. Culyer & J. P. Newhouse (Eds.), Handbook of health economics. Amsterdam: Elsevier.Google Scholar
  19. Grossman, M. (2006). Education and nonmarket outcomes. In E. Hanushek & F. Welch (Eds.), Handbook of the economics of education. Amsterdam: North-Holland.Google Scholar
  20. Grossman, M. (2008). The relationship between health and schooling. Eastern Economic Journal, 34(3), 281–292.CrossRefGoogle Scholar
  21. Hoai, N. T., & Dang, T. (2017). The determinants of self-medication: Evidence from urban Vietnam. Social Work in Health Care, 56(4), 260–282.CrossRefPubMedGoogle Scholar
  22. Imbens, G. W., & Lemieux, T. (2008). Regression discontinuity designs: A guide to practice. Journal of Econometrics, 142, 615–635.CrossRefGoogle Scholar
  23. Kondo, A., & Shigeoka, H. (2013). Effects of universal health insurance on health care utilization, and supply-side responses: Evidence from Japan. Journal of Public Economics, 99, 1–23.CrossRefGoogle Scholar
  24. Kruk, M. E., & Freedman, L. P. (2008). Assessing health system performance in developing countries: A review of the literature. Health Policy, 85, 263–276.CrossRefPubMedGoogle Scholar
  25. Ladinsky, J. L., & Levine, R. E. (1985). The organization of health services in Vietnam. Journal of Public Health Policy, 6(2), 255–268.CrossRefPubMedGoogle Scholar
  26. Ladinsky, J. L., Nguyen, H. T., & Volk, N. D. (2000). Changes in the health care system of Vietnam in response to the emerging market economy. Journal of Public Health Policy, 21(1), 82–98.CrossRefPubMedGoogle Scholar
  27. Lee, D. S., & Lemieux, T. (2010). Regression discontinuity designs in economics. Journal of Economic Literature, 48, 281–355.CrossRefGoogle Scholar
  28. Leuven, E., Plug, E., & Rønning, M. (2016). Education and cancer risk. Labour Economics, 43, 106–121.CrossRefGoogle Scholar
  29. Li, J., & Powdthavee, N. (2015). Does more education lead to better health habits? Evidence from the school reforms in Australia. Social Science & Medicine, 127, 83–91.CrossRefGoogle Scholar
  30. Lönnroth, K., Thuong, L. M., Linh, P. D., & Diwan, V. (1998). Risks and benefits of private health care: exploring physicians’ views on private health care in Ho Chi Minh City, Vietnam. Health Policy, 45(2), 81–97.CrossRefPubMedGoogle Scholar
  31. Marmot, M. (2002). The influence of income on health: Views of an epidemiologist. Health Affairs, 21(2), 31–46.CrossRefPubMedGoogle Scholar
  32. Matsuda, S. (1997). An introduction to the health system in Vietnam. Environmental Health and Preventive Medicine, 2(3), 99–104.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Ministry of Health of Vietnam. (2007). Vietnam health care report 2006: Equity, efficiency, and development in new situation. Retrieved December 23, 2016 from:
  34. Ministry of Health of Vietnam and Health Partnership Group. (2008). Joint annual health review 2008. Health financing in Vietnam. Retrieved December 23, 2016 from:
  35. Murray, C. J., & Frenk, J. A. (2000). Framework for assessing the performance of health systems. Bulletin of the World Health Organization, 78, 717–731.PubMedPubMedCentralGoogle Scholar
  36. Nguyen, C. (2016). The impact of health insurance programs for children: Evidence from Vietnam. Health Economics Review, 6(1), 6–34.CrossRefGoogle Scholar
  37. Nguyen, C. V. (2012). The impact of voluntary health insurance on health care utilization and out-of-pocket payments: new evidence for Vietnam. Health Economics, 21, 946–966.CrossRefPubMedGoogle Scholar
  38. O’Donnell, O., van Doorslaer, E., Rannan-Eliya, R. P., Somanathan, A., Adhikari, S. R., Akkazieva, B., et al. (2008). Who pays for health care in Asia? Journal of Health Economics, 27, 460–475.CrossRefPubMedGoogle Scholar
  39. Palmer, M., Mitra, S., Mont, D., & Groce, N. (2015). The impact of health insurance for children under age 6 in Vietnam: A regression discontinuity approach. Social Science & Medicine, 145, 217–226.CrossRefGoogle Scholar
  40. Sepehri, A., Simpson, W., & Sarma, S. (2006). The influence of health insurance on hospital admission and length of stay: The case of Vietnam. Social Science & Medicine, 63, 1757–1770.CrossRefGoogle Scholar
  41. Silles, M. A. (2009). The causal effect of education on health: Evidence from the United Kingdom. Economics of Education Review, 28(1), 122–128.CrossRefGoogle Scholar
  42. Stock, J. H., Wright, J. H., & Yogo, M. (2002). A survey of weak instruments and weak identification in generalized method of moments. Journal of Business and Economic Statistics, 20(4), 518–529.CrossRefGoogle Scholar
  43. Tat, S., & Barr, D. (2006). Healthcare in the New Vietnam: Comparing patients’ satisfaction with outpatient care in a traditional neighborhood clinic and a new, western-style clinic in Ho Chi Minh City. Social Science & Medicine, 62, 1229–1236.CrossRefGoogle Scholar
  44. Thanh, N. X., Tran, B. X., Waye, A., Harstall, C., & Lindholm, L. (2014). Socialization of health care in Vietnam: What is it and what are its pros and cons? Value in Health Regional, 3C, 24–26.CrossRefGoogle Scholar
  45. Thoa, N. T., Thanh, N. X., Chuc, N. T., & Lindholm, L. (2013). The impact of economic growth on health care utilization: A longitudinal study in rural Vietnam. International Journal for Equity in Health, 12(19), 1–6.Google Scholar
  46. United Nations. (2015). Millennium development goals and beyond 2015. Retrieved December 23, 2016 from:
  47. Uplekar, M. W. (2000). Private health care. Social Science & Medicine, 51(6), 897–904.CrossRefGoogle Scholar
  48. Webbink, D., Martin, N. G., & Visscher, P. M. (2010). Does education reduce the probability of being overweight? Journal of Health Economics, 29(1), 29–38.CrossRefPubMedGoogle Scholar
  49. Wolffers, I. (1995). The role of pharmaceuticals in the privatization process in Vietnam’s health-care system. Social Science & Medicine, 41(9), 1325–1332.CrossRefGoogle Scholar
  50. World Bank. (2007). Vietnam development report 2008: Social protection, joint donor report to the Vietnam consultative group meeting. Hanoi: World Bank.Google Scholar
  51. World Bank. (2017). The statistics for Vietnam.Google Scholar
  52. World Health Organization. (2011). Investing in health for Africa: The case for strengthening systems for better health outcomes.Google Scholar
  53. World Health Organization. (2017). Global health observatory: Vietnam. Retrieved November 21, 2017 from:

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Economics and Related StudiesUniversity of YorkYorkUK
  2. 2.School of EconomicsUniversity of Economics Ho Chi Minh City (UEH)Ho Chi Minh CityVietnam

Personalised recommendations