Health Care Payments in Vietnam: Patients' Quagmire of Caring for Health versus Economic Destitution

Abstract

In the last three decades many developing and middle-income nations' health care systems have been financed via out-of-pocket payments by individuals. User fees charges, however, may not be the best approach or thenmost equitable approach to finance and/or reform health services in developing nations. This study investigates the status of Vietnam's current health system as a result of implementing user fees policies. A recent mandate by the government to increase the universal cover to 100% attempts to tackle inadequate insurance cover, one of the four major factors contributing to the high and increasing probability of destitution for Vietnamese patients (the other three being: non-residency, long stay in hospital, and high cost of treatment). Empirical results however suggest that this may be catastrophic for low-income earners: if insurance cover reimbursement decreases below 50% of actual health expenditures, the probability of Vietnamese falling into destitution will rise further. Our findings provide policy implications and directions to improve Vietnam's health care system, in particular by ensuring the utilization of health services and financial protection for the people.

Keywords: Vietnam; health care; insurance cover; place of residence; user fees.

Figure 1

Distribution of patients towards (a) age and (b) the proportion of thank-you money in total treatment fee.

Figure 2

Daily total expenses in USD and daily cost in hospital.

Figure 3

Treatment outcomes in relation to average daily cost. Treatment outcomes. A—Full recovery; B—Partial recovery; C—Stopped in middle; D—Unsuccessful treatment, including mortality.

Figure 4

Contrasting financial welfare of patients as a function of status of residency and insurance status. NN—non-resident & uninsured; NY—non-resident & insured; YN—Resident & uninsured; YY—Resident & insured.

Figure 5

Contrasting financial risk as function of status of residency (N/Y) and actual insurance cover (nil/low/med/high). N—non-resident; Y—resident; Nil—uninsured; Lo—low insurance cover (low insurance reimbursement), Med—medium insurance cover (medium insurance reimbursement); Hi—high insurance cover (high insurance reimbursement).

Figure 6

Contrasting risks as a function of illness and average cost of treatment. C—Destitute, A—Minimally affected; Em—Emergency; Bad—Bad-illness; Light—Light-illness.

Figure 7

Changing probabilities of destitution for patients as a function of short versus long hospitalization. NN—non-resident & uninsured; NY—non-resident & insured; YN—Resident & uninsured; YY—Resident & insured.

Figure 8

Comparative probabilities of treatment outcome by insurance status and average cost. Notes: CD1—Probabilities of Stopped and Early quit of insured patients; CD2—probabilities of Stopped and Early quit of uninsured patients; A1—probabilities of Complete recovery of insured patients; A2—probabilities of Complete recovery of uninsured patients