Abstract
BackgroundThe inequity caused by health financing in Vietnam, which mainly relies on out-of-pocket payments, has put pre-payment reform high on the political agenda. This paper reports on a study of the willingness to pay for health insurance among a rural population in northern Vietnam, exploring whether the Vietnamese are willing to pay enough to sufficiently finance a health insurance system.MethodsUsing the Epidemiological Field Laboratory for Health Systems Research in the Bavi district (FilaBavi), 2070 households were randomly selected for the study. Existing FilaBavi interviewers were trained especially for this study. The interview questionnaire was developed through a pilot study followed by focus group discussions among interviewers. Determinants of households' willingness to pay were studied through interval regression by which problems such as zero answers, skewness, outliers and the heaping effect may be solved.ResultsHouseholds' average willingness to pay (WTP) is higher than their costs for public health care and self-treatment. For 70–80% of the respondents, average WTP is also sufficient to pay the lower range of premiums in existing health insurance programmes. However, the average WTP would only be sufficient to finance about half of total household public, as well as private, health care costs. Variables that reflect income, health care need, age and educational level were significant determinants of households' willingness to pay. Contrary to expectations, age was negatively related to willingness to pay.ConclusionSince WTP is sufficient to cover household costs for public health care, it depends to what extent households would substitute private for public care and increase utilization as to whether WTP would also be sufficient enough to finance health insurance. This study highlights potential for public information schemes that may change the negative attitude towards health insurance, which this study has uncovered. A key task for policy makers is to win the trust of the population in relation to a health insurance system, particularly among the old and those with relatively low education.
Highlights
The inequity caused by health financing in Vietnam, which mainly relies on out-ofpocket payments, has put pre-payment reform high on the political agenda
This paper reports on a study of willingness to pay (WTP) for health insurance in Bavi, a rural district in northern Vietnam
To our knowledge there is no other study of willingness to pay for health insurance in Vietnam, and few other studies of WTP for health care in the country; we found only one estimating WTP for obstetric delivery preferences [7]
Summary
The inequity caused by health financing in Vietnam, which mainly relies on out-ofpocket payments, has put pre-payment reform high on the political agenda. Health financing in Vietnam relies mainly on out-ofpocket payments, which in 2000 were estimated to constitute as much as 80% of total health care expenditure [1]. The share of households facing catastrophic health care expenditure may be as high as 10% [3] In this context, the need for furthering prepayment reform in Vietnam has been highlighted by many, and it is the goal of the Vietnamese government to achieve health insurance coverage for all citizens by 2010 [4]. In addition there are two programs: Health Care Funds for the Poor, which in 2003 replaced the Free Health Care Cards for the Poor, and free health care for children 0–5 years of age, which was established in 1991 Today these programs cover 18% and 11% of the population, respectively [2,5]
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