Impact of health insurance policies on health seeking decisions of users and the quality of services in Vietnam

The Vietnamese government aims to achieve universal health insurance coverage by 2010 through four complimentary schemes: i) compulsory insurance for government workers; ii) voluntary user financed insurance distributed through mass organizations and iii) government-provided insurance for the poor and iv) free health care for under-six children. This paper examines the effects of Vietnam's health insurance schemes on both users and health service providers, and presents recommendations for improving the schemes. The paper uses qualitative and quantitative data collected by a collaborative study of the Population Council, the Provincial Health Services in Thai Nguyen Province of northern Vietnam and Thua Thien Hue Province, and Medical Colleges in each province. Insurance schemes represent an important resource for health development in Vietnam, contributing directly to social and economic development. Nonetheless, results also show that health insurance schemes are not consistently addressing the goal of ensuring equitable access to health care. In particular, poor and the ethnic minorities are often not poor enough to be entitled to subsidized health care but are too poor to pay for their own plan. At the same time, the insurance schemes expand demand for health services so dramatically that quality of care is diminished and budget deficits are accelerated. These findings attest to the need for flexible payment schemes that more adequately serve the needs of currently uninsured groups. Promulgation of such schemes should go hand-in-hand with the trial and development of methods for maintaining quality of care and ensuring policy stability.