Key Issues in Viet Nam's Social Sectors.DOC

Population and Development Review, 1998

ARTICLE PRESENTS and illustrates the use of a standard simple economic framework for the evaluation of policies on population and reproductive health services and contrasts this framework with current discussions of several issues in these fields. There is a long tradition of economic analysis in the population and reproductive health fields. Nevertheless, a number of current policy discussions could benefit from some realignment to become more consistent with the broader field of human resource policy analysis.

2007

ABSTRACT Rational Vietnam's progress in achieving its goal of universal health insurance (HI) by 2010 to date remains slow. The majority of those currently insured are either covered with a compulsory plan as part of their employment or through government subsidies. Attempts to expand voluntary insurance among the rural population and the large urban informal sector have not had much success. A better understanding of the demand for HI is helpful to identify policies that would foster a more rapid expansion of HI coverage. Objective This paper assesses the demand for HI among school children in Vietnam. Although students are a rather special group, they are virtually the only ones so far who are exposed to HI not on a compulsory nor subsidized basis. Understanding their behavior helps shed light on the factors determining demand for HI among the general population. Methodology The main dataset used is the Vietnam National Health Survey 2002, which provides data on 54,574 children and youth aged 6-20, their insurance status, and commune-level premiums. It also provides data on a range of individual, household and health services indicators that are theoretically relevant to the demand for HI. In addition, data from the 1998-2000 Hospital Inventory Survey is used to construct indexes of quality and price for district and provincial hospitals in the locality. The demand for HI was modeled as a probit model. Results The demand for student HI increases sharply between the ages 6 and 7 but declines thereafter. Being male, coming from households headed by females or by a highly educated person and from higher income households are strongly positively related to student HI enrollment. The demand increases in health status and schooling level, suggesting that one motive of parents to purchase HI may be to protect the health of students who have already benefited from substantial human capital investments. The demand for HI increases with the level of the premium at low levels of premium but decreases with the premium at higher premium levels. No significant association was found between the demand for HI and commune level health service factors, including presence of polyclinic or hospital in the commune, the total number of health facilities, and the number of private providers in the commune. However, an increase of 10 points in the provincial hospital quality index is associated with a 5% higher probability of SHI enrollment at the sample means. Distance to provincial hospital is negatively and statistically associated with demand for HI. Conclusion The demand for voluntary student HI in Vietnam appears to be closely related to the demand for health and health care. There is no evidence of adverse selection in the demand for voluntary student HI. Demand is sensitive to the quality and accessibility of high level curative care services. Given differential access among population groups (urban/rural, rich/poor) to this service level, the findings suggest that the current range of premiums are probably too narrow. Unless premiums are set at levels that reflect expected benefits, the demand for HI will continue to be limited among presently uncovered groups.

2007

The purpose of this paper is to track the development of three components of the Vietnamese welfare state since the introduction of market-oriented economic reforms in the late 1980s: education, health, and social insurance. This is done with reference to Sweden's historical experiences of economic and social development. While Vietnam has achieved remarkable success in both the education and health sectors, with increasing literacy rates, school enrolment rates, and improving health indicators, it is clear that the Vietnamese ...

2007

The DEPOCEN WORKING PAPER SERIES disseminates research findings and promotes scholar exchanges in all branches of economic studies, with a special emphasis on Vietnam. The views and interpretations expressed in the paper are those of the author(s) and do not necessarily represent the views and policies of the DEPOCEN or its Management Board. The DEPOCEN does not guarantee the accuracy of findings, interpretations, and data associated with the paper, and accepts no responsibility whatsoever for any consequences of their use. The author(s) remains the copyright owner.

Vietnam's health indicators are better than would be expected for a country at its development level, and they continue to improve at rates that equal or surpass those in most neighboring countries. However, in the midst of a major program of poverty reduction and economic growth, Vietnam's health care system is in the midst of a dramatic transformation. Twenty years ago, it was firmly controlled by the central government. But the ability of the Ministry of Health (MOH) to shape activities has diminished significantly, due to the rapid growth of the private sector, the much larger role of out-of-pocket expenditures, and the ongoing process of fiscal decentralization. Over time, new policy tools have been developed, including user fees, health insurance and health-care funds for the poor. These tools all focus on the financing of health, but still fail to merge into a coherent health financing system. This paper outlines the current structure and effectiveness of Vietnam's health sector from the perspectives of public finance administration and macroeconomic tradeoffs. The paper will first compare Vietnam's health sector to those of other countries in Asia. A discussion of health spending in the context of overall public expenditure priorities in Vietnam will follow, with special attention to how the health sector is evolving within the context of Vietnam's Comprehensive Poverty Reduction and Growth Strategy (CPRGS) and longerterm planning framework.