We applied an alternative conceptual framework for analyzing health insurance and financial protection grounded in the health capability paradigm. What is MEDSCAPE MEDICINE?
Through an original survey of 706 households in Dai Dong, Vietnam, we examined the impact of Vietnamese health insurance schemes on inpatient and outpatient health care access, costs, and health outcomes using bivariate and multivariable regression analyses. Insured respondents had lower outpatient and inpatient treatment costs and longer hospital stays but fewer days of missed work or school than the uninsured.
Insurance reform reduced household vulnerability to high health care costs through direct reduction of medical costs and indirect reduction of income lost to illness. However, from a normative perspective, out-of-pocket costs are still too high, and accessibility issues persist; a comprehensive insurance package and additional health system reforms are needed.
Health insurance reform is of utmost concern for low-income countries that rely on out-of-pocket payments to finance health treatment, but many new policies have not been sufficiently assessed for their impact on the health and economic stability of households. A review of the World Bank impact evaluation database found that of 41 health-related impact evaluations as of April 2005, health reform and financing studies were lacking. Many studies focus on a particular change within a system, rather than changes affecting the entire system.
For example, a Thai study investigated the impact of subsidizing the Thai health card scheme on insurance coverage and utilization. A Chinese study evaluated how changing hospital reimbursement from fee-for-service to prepayment affected health expenditure in China. Although these are important aspects of health insurance policy, they concern one change rather than system-wide reform. New insurance schemes constitute a major type of large-scale health care system reform, and require evaluation to determine whether they achieve their purpose. In this study, we employed a survey conducted in 2008 to assess the effects of reformed Vietnamese health insurance schemes on health care treatment and costs for households.