Impact Evaluation of Health Insurance for Children: Evidence from

Vietnam

Proposal PresentationPEP-AusAid Policy Impact Evaluation Research Initiative

Nguyen Viet CuongNguyen Thi Hanh

Pham Minh NguyetNguyen Thi Nga

Pham Minh Huong

Presentation Content Research background Research objectives and questions Policy relevance Program description Data sources Methodology and scientific contribution Dissemination strategy Team members and capacity building

Research Background Although reduced remarkably, poverty remain very

high in Vietnam, especially in rural and mountainous areas.

One of important reasons for poverty is health shocks (World Bank, 2002, 2004).

Children can be more vulnerable to illness. Without proper treatment, illness can have adverse impacts on children’s health and schooling.

Research Background (cont.) Children in low expenditure quintiles are more likely to be under

weight and height.

34

29

2421

13

26

34

25

1815

9

23

0

5

10

15

20

25

30

35

40

Poorest Nearpoorest

Middle Nearrichest

Richest Total

Per

centa

ge

Low weight for age Low height for age

Source: World Bank (2004)

Research Background (cont.) The poor children also tend to have under use of health care

services.

0.05 0.07

0.52

1.19

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

Poor Non-Poor

Thousa

nd V

ND

Inpatient treatment Outpatient treatment

Source: Estimation from VHLSS 2004

Research Background (cont.) Lower out-of-pocket spending on health care.

12

57

17

68

0

10

20

30

40

50

60

70

80

Poor Non-Poor

Thousa

nd V

ND

Inpatient spending Outpatient spending

Source: Estimation from VHLSS 2004

Research Background (cont.) Children in Vietnam are covered by two main types of

health insurances: School health insurance Free health insurance for the poor.

There are a large number of children not having health insurance in Vietnam (around 45 percent of children aged between 6 and 14 not having health insurance in 2004).

To improve health and medical care of people, the government aims to achieve full coverage of health insurance by 2015.

Research Background (cont.) Although these schemes of health insurance are

necessary, there exist questions on their effectiveness.

Empirical findings on impact of health insurance are still contradictory:

Positive impacts of health insurance on health care demand and utilization have been found in Newhouse (1993), Water (1999), Bertranou and (1998), Ron (1999), Harmon and Nolan (2001), Yip and Berman (2001), Wagstaff and Pradhan (2005).

Negligible effects found in Sapelli and Vial (2003), Ekman (2007), Carrin et al. (1999).

Research Background (cont.) Impact evaluation of current school health insurance

and free health insurance for children can provide the government with helpful information on expansion and modification of child health insurances.

Research Objectives The study has three main objectives:

Explore the individual and household factors associated with children’s receipt of school health insurance and free health insurance for the poor.

Examine how well school health insurance and free health insurance reach children (aged between 6 and 14) in Vietnam.

Measure to which extent these health insurances affect health care utilization and health care spending for children.

Research Questions How do school health insurance and free health

insurance cover children between 6 and 14 years old during the period 2004-2006? (disaggregated by boys/girls, poor/non-poor children, and urban/rural children)

What are the factors of individuals and households associated with school health insurance and free health insurance for children?

To which extent do school health insurance and free health insurance affect health care utilization and out-of-pocket health care spending of children?

Research Questions (cont.) Are the impacts of school health insurance different from

the impacts of free health insurance? Are impact estimates of health insurance robust to

different impact evaluation methods? What are policy implications for child health insurance,

child health care and poverty reduction in Vietnam?

Policy Relevance The government has prepared for full coverage of

health insurance by 2015. Information on the study’s evaluation of child health

insurance can be of interest to policymakers and researchers:

It informs how well different groups of children have been covered by school health insurance and free health insurance.

It might shed light on individual and household factors associated with children’s receipt of health insurance.

It provides information on health insurance impacts to determine whether the current health insurance schemes should be expanded or modified.

Program description School health insurance is voluntary and users must

pay for that. The average fee of school health insurance is around VND 80000 (approximately USD 5).

Children in poor households who are classified as the poor by commune authorities can be provided with free health insurance for the poor.

Program description (cont.)

Health insurance of children

No health insurance

45%

Poor health insurance

5%

School health

insurance48%

Other health

insurance2%

Source: Estimation from VHLSS 2004

Data sources Vietnam Household Living Standard Surveys (VHLSS)

were conducted by General Statistical Office (GSO) of Vietnam with technical support from WB in 2004 and 2006.

The surveys collected detailed information on household living standards, including the health insurance.

Each survey covered 9000 households, representative for the national, rural and urban, and regional levels.

The 2004 and 2006 VHLSSs set up a panel of 4000 households, which are representative for the whole country, and for the urban and rural population.

Methodology Assessing the coverage of child health insurance:

The coverage rate which is equal to the percentage of children having health insurance.

Distribution of the insured children across different groups of children.

Exploring factors associated with child health insurance: multinomial logit model to explain choices of health insurance (school health insurance, free health insurance for the poor children, other health insurance, and no health insurance).

Methodology (cont.) The parameter of interest is the Average Treatment

Effect on the Treated. Endogeneity of health insurance: unobserved

characteristics of children/parents such as risk attitude and health status can be correlated with both health insurance participation and health care utilization.

Methods measuring the impact of child health insurance:

Instrumental variables. Fixed-effect regression using panel data. Propensity score matching.

Scientific Contribution Contribute empirical findings to the debate on

impacts of general health insurance and child health insurance.

Provide more updated and comprehensive information on evaluation of child health insurance.

Compare the estimation results from different popular methods of impact evaluation.

Apply the method of matching with propensity score in the context of panel data

Dissemination Strategy Present findings in local conferences. Present the findings in at least one international

conference. Publish the findings in working papers and journals

(both local and international). Conduct training on impact evaluation for local

researchers from universities, institutes, ministries, etc.

Team members and capacity building Research team:

Nguyen Viet Cuong Nguyen Thi Hanh. Pham Minh Nguyet. Nguyen Thi Nga. Pham Minh Huong.

Capacity building: literature review skills, health insurance literature, impact evaluation theory, econometrics application, data process and analysis, English skills, group working, and relationship with State organizations.

Thank you very much for attention!

Your comments are welcome!