Abstract
Accessing health services at an early age is important to future health and life outcomes. Yet, little is currently known on the role of health insurance in facilitating access to care for children. Exploiting a regression discontinuity design made possible through a policy to provide health insurance to pre-school aged children in Vietnam, this paper evaluates the impact of health insurance on the health care utilization outcomes of children at the eligibility threshold of six years. Using three rounds of the Vietnam Household Living Standards Survey, the study finds a positive impact on inpatient and outpatient visits and no significant impact on expenditures per visit at public facilities. We find moderately high use of private outpatient services and no evidence of a switch from private to covered public facilities under insurance. Results suggest that adopting public health insurance programs for children under age 6 may be an important vehicle to improving service utilization in a low- and middle-income country context. Challenges remain in providing adequate protections from the costs and other barriers to care.
Highlights
The impact of public health insurance programs has received a great amount of attention due to its importance to universal health coverage, a goal common to many low- and middle-income countries (LMICs) (Lagomarsino et al, 2012)
The drop in the level of insurance coverage at age six induced by the 2005 policy in Vietnam is clearly depicted in Fig. 1, and remained when we plotted the expected probability of being insured as a function of age (Appendix Fig. 1)
This study evaluates a 2005 reform to provide fully subsidized health insurance to children under the age of six in Vietnam
Summary
The impact of public health insurance programs has received a great amount of attention due to its importance to universal health coverage, a goal common to many low- and middle-income countries (LMICs) (Lagomarsino et al, 2012). Universal health coverage strives to provide equal access to the health care services that people need without causing financial hardship (World Health Organization, 2010). Little is known about the impact of public health insurance programs on the utilization outcomes for children in LMICs. Improving knowledge on the health seeking behaviors of children under insurance has important implications for policy makers in the design and financing of benefit packages. Many LMICs have expanded public health insurance coverage as a means to improving access to formal health care services for their populations, and providing financial protection from the costs of health care, on the path towards universal health coverage (World Health Organization, 2010). In the Philippines, as part of an expansion towards universal health insurance coverage, an insurance program was launched for school-aged children (Quimbo et al, 2011)
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