DIFFERENTIAL IMPACT OF HEALTH INSURANCE ON OUT OF POCKET HEALTH EXPENDITURE BETWEEN HOUSEHOLD WITH AND WITHOUT NON-COMMUNICABLE DISEASES IN URBAN HANOI IN 2012

Abstract

Non-communicable diseases (NCDs) imposed a large economic burden in society and are having an increasing trend. The mortality rate of those with NCDs is remarkable and alarming: 75% of deaths were due to NCDs in Vietnam while cost for treatment of NCD patients is quite high. The current level of out-of-pocket (OOP) payment in Vietnam was very high ranging 50% - 70% of total health expenditure. Health Insurance Law was implemented in Vietnam in 2009 and the coverage of health insurance increases steadily through the year from 1998 to 2012 aimed to achieve Universal Coverage. Up to 31/12/2012, Vietnam has 59.3 million people covered by health insurance; account for around 67% of population. The main objective of this study is to determine the impact of health insurance on health expenditure of individual with and without NCDs. We used secondary data from survey conducted in urban districts of Hanoi in 2012. Tobit regression, quantile regression and logit regression were employed to identify the factors that affect OOP payment of individuals, OOP as a proportion of total consumption (OOP/TC) and catastrophic health spending of households. The main findings of this study are that compulsory health insurance can financially protect individuals, help them to reduce their OOP payment as well as the OOP spending as a proportion of total consumption, especially for those in upper tail of OOP distribution. Moreover, compulsory health insurance can help to protect hypertension patients for outpatient services and for diabetes patients when seek inpatients health care services. Individual with high educational level and used inpatient health care services will have higher OOP expenditure. Living in slum residential area, households have member used inpatient services and NCDs rate within a household are factors that increase the chances of incurring catastrophic health expenditure for households.