నైరూప్య

Health insurance thresholds and policy implications: A Vietnamese medical survey in 2015

Quan Hoang Vuong, Ha Nguyen, Thu-Trang Vuong

Objective: Vietnam’s healthcare system has undergone numerous reforms while institutionalizing a market-based mechanism. Still the poor cite medical costs and inadequate insurance as the reason to destitution risks. The reality gives rise to evidence on: 1) Effects of residency status, socioeconomic status, medical costs, and insurance on patient satisfaction towards health insurance; 2) Existence of “psychological thresholds” toward cost and insurance coverage. The article addresses these two questions.

Materials and Method: A dataset containing 900 records was collected from a 2014-15 survey on Northern Vietnamese patients, 67% of which with insurance. Attributes include: a) medical expenditures; b) (in)eligibility for insurance coverage; c) dis/satisfaction with insurance; d) length of hospitalization; e) socioeconomic/residency status. The method of analysis is logistic regression techniques involving both discrete and continuous predictor/response variables. Estimations are then used to compute empirical probabilities and threshold values.

Results: Relations are found statistically significant at 5% level, suggesting that insurance coverage and medical expenditures contribute to higher probabilities of satisfaction. Insurance has a stronger influence. Threshold coverage and expenditures show that perceptions are heterogeneous. The poor and non-resident patients show lower threshold coverage of 63.4% (mean=58%).

Conclusions: An overemphasis on raising insurance coverage is unlikely to pay off. To promote the value of health insurance, the target group should be the poor and non-resident patients. It is better for policymakers to promote a diversity of insurance schemes, including micro-health insurance, and to lower medical costs for the target group. Thresholds can serve as a reference value for policy-making.