How public health insurance expansion affects healthcare utilizations in middle and low-income households: an observational study from national cross-section surveys in Vietnam
Abstract Public health insurance (PHI) has been implemented with different levels of participation in many countries, from voluntary to mandatory. In Vietnam, a law amendment made PHI compulsory nationwide in 2015 with a tolerance phase allowing people a flexible time to enroll. This study aims to e...
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12889-023-15500-6 |
| _version_ | 1797853519681683456 |
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| author | Chi M. Nguyen Mai P. Nguyen Lan D. P. Luc |
| author_facet | Chi M. Nguyen Mai P. Nguyen Lan D. P. Luc |
| author_sort | Chi M. Nguyen |
| collection | DOAJ |
| description | Abstract Public health insurance (PHI) has been implemented with different levels of participation in many countries, from voluntary to mandatory. In Vietnam, a law amendment made PHI compulsory nationwide in 2015 with a tolerance phase allowing people a flexible time to enroll. This study aims to examine mechanisms under which the amendment affected the enrollment, healthcare utilization, and out-of-pocket (OOP) expenditures by middle- and low-income households in this transitioning process. Using the biennial Vietnam Household Living Standard Surveys, the study applied the doubly robust difference-in-differences approach to compare outcomes in the post-amendment period from the 2016 survey with those in the pre-amendment period from the 2014 survey. The approach inheriting advantages from its predecessors, i.e., the difference-in-differences and the augmented inverse-probability weighting methods, can mitigate possible biases in policy evaluations due to the changes within the group and between groups over time in the cross-section observational study. The results showed health insurance expansion with extensive subsidies in premiums and medical coverage for persons other than the full-time employed, young children or elderly members in the family, significantly increased enrollments in the middle- and low-income groups by 9% and 8%, respectively. The number of visits for PHI-eligible services also increased, approximately 0.5 more visit per person in the middle-income and 1 more visit per person in the low-income. The amendment, however, so far did not show any significant effect on reducing OOP payments, neither for the low nor the middle-income groups. To further expand PHI coverage and financial protections, policymakers should focus on improving public health facilities, contracting PHI to more accredited private health providers, and motivating the high-income group’s enrollments. |
| first_indexed | 2024-04-09T19:51:57Z |
| format | Article |
| id | doaj.art-700aacc25a7c40c995cd5932296b11e9 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-04-09T19:51:57Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-700aacc25a7c40c995cd5932296b11e92023-04-03T05:43:31ZengBMCBMC Public Health1471-24582023-03-0123111510.1186/s12889-023-15500-6How public health insurance expansion affects healthcare utilizations in middle and low-income households: an observational study from national cross-section surveys in VietnamChi M. Nguyen0Mai P. Nguyen1Lan D. P. Luc2Indiana University School of Medicine, Indiana University – Purdue University IndianapolisQueensland University of TechnologyMacquarie Business School, Macquarie UniversityAbstract Public health insurance (PHI) has been implemented with different levels of participation in many countries, from voluntary to mandatory. In Vietnam, a law amendment made PHI compulsory nationwide in 2015 with a tolerance phase allowing people a flexible time to enroll. This study aims to examine mechanisms under which the amendment affected the enrollment, healthcare utilization, and out-of-pocket (OOP) expenditures by middle- and low-income households in this transitioning process. Using the biennial Vietnam Household Living Standard Surveys, the study applied the doubly robust difference-in-differences approach to compare outcomes in the post-amendment period from the 2016 survey with those in the pre-amendment period from the 2014 survey. The approach inheriting advantages from its predecessors, i.e., the difference-in-differences and the augmented inverse-probability weighting methods, can mitigate possible biases in policy evaluations due to the changes within the group and between groups over time in the cross-section observational study. The results showed health insurance expansion with extensive subsidies in premiums and medical coverage for persons other than the full-time employed, young children or elderly members in the family, significantly increased enrollments in the middle- and low-income groups by 9% and 8%, respectively. The number of visits for PHI-eligible services also increased, approximately 0.5 more visit per person in the middle-income and 1 more visit per person in the low-income. The amendment, however, so far did not show any significant effect on reducing OOP payments, neither for the low nor the middle-income groups. To further expand PHI coverage and financial protections, policymakers should focus on improving public health facilities, contracting PHI to more accredited private health providers, and motivating the high-income group’s enrollments.https://doi.org/10.1186/s12889-023-15500-6Public health insurance expansionMiddle-incomeLow-incomeVietnamDoubly-robust difference-in-differences |
| spellingShingle | Chi M. Nguyen Mai P. Nguyen Lan D. P. Luc How public health insurance expansion affects healthcare utilizations in middle and low-income households: an observational study from national cross-section surveys in Vietnam BMC Public Health Public health insurance expansion Middle-income Low-income Vietnam Doubly-robust difference-in-differences |
| title | How public health insurance expansion affects healthcare utilizations in middle and low-income households: an observational study from national cross-section surveys in Vietnam |
| title_full | How public health insurance expansion affects healthcare utilizations in middle and low-income households: an observational study from national cross-section surveys in Vietnam |
| title_fullStr | How public health insurance expansion affects healthcare utilizations in middle and low-income households: an observational study from national cross-section surveys in Vietnam |
| title_full_unstemmed | How public health insurance expansion affects healthcare utilizations in middle and low-income households: an observational study from national cross-section surveys in Vietnam |
| title_short | How public health insurance expansion affects healthcare utilizations in middle and low-income households: an observational study from national cross-section surveys in Vietnam |
| title_sort | how public health insurance expansion affects healthcare utilizations in middle and low income households an observational study from national cross section surveys in vietnam |
| topic | Public health insurance expansion Middle-income Low-income Vietnam Doubly-robust difference-in-differences |
| url | https://doi.org/10.1186/s12889-023-15500-6 |
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