Introduction

1. The use of health insurance (HI) by ethnic and household income status in the northern province of Vietnam

2. Introduction • Health insurance is a significant part of the Vietnamese health care system. • The percentage of people who had health insurance in 2007 was 49% and it increased to 58.5% in 2010 (MOH, 2011). • Over 40% Vietnamese population can not access to free health care coverage by health insurance  Government need to enhance awareness about health insurance for people

3. Introduction The current health insurance system consists of two parts: - Compulsory health insurance + Social health insurance (9%) + Health care funds for the poor (18%) + Programme of free health care for children under 6 years of age (11%) - Voluntary health insurance (11%)

4. Objectives • The overall purpose of this paper is to analyze key issues around challenges to the universalization of health insurance in 1 province of Viet Nam in order to inform the policy response in general and the revision of relevant circulars and decrees on the implementation of the Health Insurance Law in particular

5. Objectives • Describe the use of health insurance by education, ethnic and household income status. • Are these policies (measures) and health promotion programs of health insurance for poor and ethnic minorities appropriate and effective?

6. Data • The data of the study come from a population based survey conducted by Institute of Population, Health and Development in collaboration with The Population Council in Thai Nguyen province in northern Vietnam. • This survey samples 2695 individuals from 2490 households in 60 of 180 communes in Thai Nguyen. Men and women over the age of 18 years participated in this survey between May-June 2011

7. Methods Statistical analyses • Survey data analysis procedures with svy in Stata • Bivariate analysis • Multivariate analysis: logistic & multinomial regression • Sub-population

8. Methods • The dependent variables is having health insurance. Have health insurance was defined as people who have health insurance card. • The independent variables used in the study include education, ethnic, socio-economic status as measure by household income quintile, health status. • Control variables are - Economic environment: poor household - Individual socioeconomic characteristics: gender, age, marital status - Physical and social environment working status, place of residence

9. Background of health insurance status in Thai Nguyen • 78.49% was compulsory health insurance • 21.51% was voluntary health insurance • The percentage of poor people card was the highest at 52.72%, 17.57% for Voluntary Gov. Health insurance card and private health insurance was the lowest at 1.35%. • In the last illness 78.48% of people have health insurance card use it in medical care 31.43 68.57

10. Main reason of people none have health insurance

11. Characteristics of the study populations • 814938 were reported health insurance status. • 87.27% EM have health insurance. But 90.85% of people do not have health insurance is Kinh • Insured was much more common in age group 60+ (84.47%). • Household in richest income quintile more likely have health insurance than household in poorest income quintile. • The percentage of people do not working have health insurance (75.71%) is higher significant than people are still working (68%). • Poor household more likely have health insurance than non-poor household • People with poor health status and have chronic disease more likely have health insurance • People are still working less likely have health insurance • People with higher education more likely have health insurance

12. Coverage of HI by educational

13. Associations between Education, ethnic and household income w Health Insurance • Education has positive and statistically significant association with having health insurance. The people higher education are significant more likely to have health insurance (OR=10.87; p= 0.000) • Being ethnic minority has positive and statistically significant association with having health insurance (OR=6.84; p=0.000) • People in richest household income quintile has less likely to have health insurance compare to people in poorest household income quintile (OR=0.8, p=0.33)

14. Other variable are also association w health insurance status positively statistically significant such as: age (OR=3.12, p=0.001), place of resident (OR=3.03, p=0.000), poor health (OR=1.52, p=0.03), have chronic disease (OR=1.64, p=0.02)

15. Selected indicators of health insurance and health status by ethnicity Poor Does the government have focused on health promotion for ethnic ?

16. Selected indicators of health insurance and health status by poor household Poor Are these policies and health promotion programs of health insurance for poor appropriate and effective ?

17. Conclusions • The main reason of people do not have health insurance is “Do not have enough money” and “Do not know where to buy” • There are difference in health insurance status between EM and Kinh people was found after controlling for other covariates. Being ethnic minority has more likely have HI. But Kinh have worse health than EM • Higher education more likely have health insurance • Richest household income quintile has less likely have health insurance • Poor household income more likely have HI but the poor still have worse health than the non-poor • Having higher age, poor health, chronic disease and living in rural are associated with have health insurance

18. Discussions • Decision 139/2003/QD-TTg establishing a Health Care Fund for the Poor (HCFP). All poor people, people residing in extremely disadvantaged communes and ethnic minority groups, as defined by Ministry of Labor, Invalids and Social , they were provide free health care services (Duc et al, 2011). • The percentage of people in Thai Nguyen have health insurance was 68,57 is higher than the prevalence of national (58,5% MOH, 2010) • The results of this study also show that ethnic minority (87.27%) have health insurance higher than Kinh (63.11%) and 76.2% poor house hold is lower than the prevalence of national (96.9% MOH, 2010)

19. Discussion • Health insurance services should be extended to participate in the private health. This is will not only ensure a higher coverage rate because people can have much more choice on health center, but also financial viability of scheme, given their contribution rate and anticipate lower health care needs. • Financial reforms for the health sector in the general and health insurance in particular will be the key for success. Because the main reason of people does not have HI is “Don’t have enough money”. The current popular fee for service provider payment should be used only in special services and emergencies

20. Discussion • The government, Ministry of Health and other related ministries play important roles in ensuring accessibility of people to health services, and promoting quality of health care service to ensure people have health insurance will be treated by high quality health care system. • Mobilization all ministries and community on enhance the awareness, behavior, practice to increase equitable and effectiveness of health care service for people

21. Discussion • A key aim of health insurance is to protect people from financial loss when accessing health services. However, it is expected that health insurance would lead to better health outcomes as it increases health service utilization among the insured. • This paper will also establish background for deep researches.

22. Conclusion • Although Vietnam has obtained a lot of achievement in providing health care to its citizens, especially for poor and vulnerable group such as ethnic minority women and children, there are still many problem that can be impede further development of the health sector, including health insurance. Vietnam urgently needs to make a variety of decisions on health administration and financing in order to protect the past successful and provide more health accessibility and services to the people.