Vietnam Household Living Research Articles

The Healthcare Support Program and Healthcare Utilization of Older Adults in Ethnic Minority Areas in Vietnam

Over the past few decades, Vietnam has experienced a substantial improvement in health outcomes, providing an example of a low-income country that has achieved a major success in public health despite the lack of resources. However, inequalities in access to healthcare services persist among the poor, ethnic minorities, and other vulnerable groups. To address this issue, the Vietnamese government implemented a healthcare support program in ethnic minority areas in 2013. We examine the effects of this program on healthcare utilization among older individuals aged 55-74. Employing a difference-in-differences approach and data from the Vietnam Household Living Standards Survey from 2008-2018, we find that the program has a positive effect on inpatient visits at public health facilities. However, the program has no impact on outpatient visits. Additional analysis reveals that the program increases outpatient visits at commune health stations and inpatient visits at district hospitals. There is also suggestive evidence of a switch from private to public facilities. Our results suggest that providing healthcare resources to disadvantaged areas can increase healthcare utilization of older people, which can, in turn, improve their health outcomes.

The changing distribution of land in rural Vietnam, 2004–2014

This paper analyses the changing distribution of land in rural Vietnam based on plot-level information in the Vietnam Household Living Standards Surveys. Both agricultural and residential land holdings in Vietnam became more unequally distributed between 2004 and 2014, due to rising landlessness in the bottom quintile and land accumulation in the top quartile of the land distribution. Applying Fields’ regression-based inequality decomposition, we find the main drivers of land inequality were the share of household members working in agriculture and the shares of forestry and perennial crop land. In contrast, irrigation and off-farm employment contributed to reducing land inequality. Landlessness and near landlessness, which increased by almost two-fifths, is associated with similar factors, along with higher education of the household head. Taken together, these results underline the rapid structural transformation that has occurred in rural Vietnam. The rise in functional landlessness observed presents a challenge to the Vietnamese Government’s desire to promote growth with equity.

Trade liberalization and women's marriage and fertility decisions in Vietnam

This study investigates the impact of a large demand shock driven by the US-Vietnam Bilateral Trade Agreement (BTA) in 2001 on the timing of women's marital decisions and first childbirth experiences in Vietnam. We hypothesize that the reduction in women's and men's self-employment would delay family formation and childbirth, with the ultimate impact on marriage remaining ambiguous. Analyzing data from the Vietnam Household Living Standards Surveys, we find that both men and women are less likely to be self-employed in the face of a substantial trade shock. Notably, the decreasing impact on women's self-employment becomes more pronounced than that for men post-2012, a decade after the agreement's enforcement. Employing the Multiple Indicator Cluster Survey and survival analysis, we empirically demonstrate that increased exposure to trade postpones women's timing of marriage and first childbirth. On average, in 2013, the BTA resulted in a 7.39- and 7.42 %-point decrease in the probability of entering marriage and becoming a mother, respectively. We also present suggestive evidence that increased exposure to trade liberalization eventually increases the likelihood of marriage and the number of children among women over 40. The findings in this study imply that policy promoting trade liberalization should consider its extensive impacts on young labor force's family formation through change in their individual economic prospects.

Energy Poverty and Health Expenditure: Empirical Evidence from Vietnam

Utilizing data from the 2016 Vietnam Household Living Standard Survey, we undertake an empirical investigation into the influence of energy poverty on the health expenditure of Vietnamese households. Employing a double-hurdle model, our empirical findings reveal a negative relationship between energy poverty and health expenditure. Specifically, our results indicate that for each incremental unit increase in energy poverty, there is a substantial reduction of 42.5 percentage points in the overall health expenditure of the households. Furthermore, as energy poverty deepens, we observe declines of 24.6 percentage points and 45.5 percentage points in the expenses incurred for inpatient/outpatient care and self-treatment, respectively. To validate the robustness of our results, we conduct several sensitivity analyses, including propensity score matching, double/debiased machine learning. Across all these methods, our findings consistently underscore the significant and persistent adverse impact of energy poverty on the examined outcome variables. Additionally, to examine the underlying pathways, we conduct a structural equation modeling analysis and find that the relationship between energy poverty and health expenses is mediated by household hospitalization and expenditures on essential items, such as food and daily necessities.

Educational Attainment, Household Income and Wealth Accumulation in Vietnam

This study examines the effects of educational attainment and household income on wealth accumulation in Vietnam using various Vietnam Household Living Standards Surveys (VHLSSs) in 2008, 2018 and 2020. We use the threshold regression to separate households into different groups depending on their assets. We find that owning a university degree is optimal to maximize wealth accumulation for households in 2008. However, post-graduate qualifications are needed for wealth accumulation in 2018 and 2020. For those household heads without a university degree, owning advanced training certificates provides the best opportunity to accumulate household wealth in all three surveys. Besides, our empirical results confirm that household income played no role in wealth accommodation in 2008. Interestingly, household income positively contributes to wealth accumulation for households with assets above the threshold of VND 634.40 m in 2020. However, the effect is negative for households with assets below the threshold of VND 440.25 m in 2018. We also find that households with widowed or divorced household heads are associated with lower wealth accumulation. Another interesting finding is that living in urban areas reduces wealth accumulation for households whose assets are below VND 440.25 m in 2018. These findings largely remain unchanged when Lewbel’s (Lewbel, Journal of Business and Economic Statistics 30:67–80, 2012) instrument variable estimator is used to ensure the robustness of the empirical results.

The Determinants of Internal Migration in an Emerging Market: Evidence from Vietnam

Internal migration has been a challenging issue for Vietnam in the past three decades, with swift industrialization and urbanization at the two ends of the country—the capital city, Hanoi, in the north and the largest city, Ho Chi Minh City, in the south. This study identifies the determinants of internal migration with a focus on the characteristics of Vietnamese households and the household heads, together with their living conditions. A logit model is used in our analysis in three scenarios: (a) the entire sample of 8,567 households, (b) a sub-sample of households in the rural regions and (c) a sub-sample of households in the urban regions using the latest 2020 Vietnam Household Living Standards Survey. Our empirical results indicate that migration decisions are strongly associated with the characteristics of the households and the household heads, including household income, size, age of the household heads and educational attainment. We also find that living conditions such as radiation and rainfall are inversely related to the decisions for internal migration in Vietnam, meaning that people living in locations with unfavourable rainfall are more likely to migrate to destinations with more favourable rainfall conditions.

Does gender and education of the households’ heads matter for wealth accumulation in Vietnam? Evidence from a recent decade

Asians believe that education plays a crucial role in earning higher income for individuals and accumulating larger wealth for households. Educational achievements have been generally considered an indicator of success. However, gender bias in favour of males as the household heads still exists in Asian societies due to the significant influence of Confucian belief. This study investigates the independent effect of education and gender of the households' heads and their joint effect on household wealth in the Vietnamese context in the most recent decade using data from the Vietnam Household Living Standards Surveys (VHLSSs) between 2010 and 2020. Our study uses quantile regression and propensity score matching methods to ensure the robustness of the empirical results. We find that the education of the household heads contributed to increased household wealth in Vietnam in 2010 and 2020. However, household wealth decreases across different wealth quantiles when the households' heads are females. These findings confirm the currently deep-rooted gender stereotypes and a ‘gendered structure’ economy in Vietnam and require attention from the Vietnamese government. In addition, our empirical results reveal that being a female as the household head with a degree/certificate from a general education will increase household wealth. Our empirical results have largely been consistent across different wealth distributions.

Impact of saltwater intrusion on poverty in rural households in the Mekong Delta, Vietnam

Purpose: The purpose of this study is to examine the causal relationship between saline intrusion and poverty in rural households in the Mekong Delta based on the 2018 Vietnam Household Living Standard Survey data.
 Design/Methodology/Approach: A sample of 344 rural households in the Mekong Delta is used to analyze the causal relationship between saline intrusion and poverty through income. This study employed the Ordinary Least Squares method and the oprobit model to investigate the causal relationship between saline intrusion and rural household income. Finally, this study estimates the impact of saline intrusion on poverty using different propensity score matching methods.
 Findings: 1) Saltwater intrusion has a significant negative impact on the income of rural households, making households more likely to fall into the lower income group; 2) Saltwater intrusion has a greater negative impact on the incomes of poorer households than non-poor households, while also having a negative impact on households with low education and farming; and 3) By reducing household income as well as income from farming activities, infiltration increases the risk of poverty for rural households and reduces the household's ability to escape poverty.
 Conclusion: This study demonstrates how saltwater intrusion affects household poverty by reducing income and raising the likelihood that households will fall below the Vietnamese government's designated poverty income threshold.

The Crowding-out Effect of Tobacco Expenditure on Health Expenditure: Evidence From a Lower-Middle-Income Country.

Poor people have remarkably lower health expenditures than rich people in Vietnam. According to the 2016 Vietnam Household Living Standard Survey (VHLSS), per capita health expenditure of the top quintile households is around 6 times higher than that of the bottom quintile households. We analyze economic inequalities in health expenditure using the concentration index approach and data from the VHLSS 2010-2016. Next, we use the instrumental-variable regression analysis to examine the crowding-out effect of tobacco expenditure on health expenditure. Finally, we use decomposition analysis to explore whether economic inequality in tobacco expenditure is associated with an economic inequality in health expenditure. We find a crowding-out effect of tobacco expenditure on health expenditure of households. The share of health expenditure of households with tobacco spending is 0.78% lower than that of households without tobacco spending. It is estimated that a one-VND increase in tobacco expenditure results in a 0.18 Vietnamese Dong (VND) (95% CI: -0.30 to -0.06) decrease in health expenditure. There is a negative association between economic inequality in tobacco expenditure and economic inequality in health expenditure. This means that if the poor consume less tobacco, their expenditure on health can be increased, resulting in a decrease in inequality in health expenditure. Findings from this study suggest that reducing tobacco expenditure could improve health care of the poor and reduce inequality in health care in Vietnam. Our study recommends that the government continuously increase the tobacco tax in order to effectively reduce tobacco consumption. Empirical studies show mixed results on the effect of tobacco expenditure on health expenditure. We find a crowding-out effect of tobacco expenditure on health expenditure of poor households in Vietnam. It implies that if the poor reduce their expenditure on tobacco, economic inequality in health expenditure can be reduced. Our findings suggest that reducing tobacco consumption in poor households can increase their health expenditure, therefore, decreasing inequality in health expenditure. Different policies to reduce tobacco consumption such as tobacco taxation, smoke-free areas, and tobacco advertisement bans should be strengthened.

The economic circumstances of widows in Vietnam.

Information on the living conditions of widows in Vietnam is limited. Prior studies of gender gaps have identified widows as vulnerable to the risks of poverty. However, widows are only included as a sub-group in broader studies of women's well-being. Large gaps remain in the knowledge based on the factors affecting both widows' susceptibility to poverty and the conditions or circumstances that might minimize these risks. This paper attempts to help redress these knowledge gaps by contributing an analysis of data from the 2018 Vietnam Household Living Standard Surveys. The paper compares the likelihood of poverty for widowed and other households using probit regression. It also assesses whether widows who head up their households face different risks of poverty from those who live in other households. Finally, the paper examines the effects on the risk of poverty of a range of social, demographic and locational characteristics of widow households in Vietnam. Our results indicate that widowed households have experienced a higher probability of falling into poverty. Moreover, widow-headed households have faced more vulnerability to fresh water and housing, especially among widowed households. Policy implications have emerged based on the findings of this paper.

Aquaculture, household income and inequality in Vietnam’s coastal region

Using data from the 2020 Vietnam Household Living Standards Survey, we examine the link between aquaculture, household income, and inequality in Vietnam’s coastal region. Using a two-step cluster analysis, we identify five clusters of livelihood strategies (LS) pursued by local households. We find that about 13% of the total number of households are engaged in aquaculture, but only 6% pursued an aquaculture LS, while half the number of households followed a wage-earning LS. Our regression analysis shows that, on average, those in the aquaculture LS cluster have higher incomes than those in the wage-earning or “other income” LS clusters. Interestingly, the quantile regression result reveals that in the top percentiles of income distribution, those adopting an aquaculture livelihood attain higher incomes than those in all other livelihood clusters. This implies that there is a positive link between the choice of aquaculture LS and household income. Also, we find that aquaculture land is positively associated with the likelihood of participation in aquaculture and deriving income from it. Notably, Gini decomposition analysis indicates that the distribution of aquaculture land and income from it are highly uneven and skew much more towards the well-off. Given the significant positive relationship between aquaculture land and the profitability of the aquaculture LS, our findings imply that expanding the aquaculture sector (e.g., granting access to aquaculture land or/and training in skills for aquaculture farmers) may help local households boost their income and reduce inequality in the coastal region.

Challenges in moving toward universal health coverage: rising cost of outpatient care among Vietnam's insured rural residents, 2006–2018

ObjectivesThe aim of this study was to assess temporal trends in out-of-pocket (OOP) expenditures per outpatient contact by the insured residents in rural Vietnam. Study designThis was a repeated cross-sectional study. MethodsSeven biennial waves from the Vietnam's Household Living Standard Survey covering the period 2006–2018 and a two-part model were used to assess temporal trends in OOP expenditures and its variations across various health facilities while controlling for a wide array of individual- and household-specific characteristics. ResultsThe pattern of health facility utilization shifted steadily from commune health centers toward higher level government hospitals and private health facilities between 2006 and 2018. The regression results indicated an upward trend in the amount of OOP expenditures, with the amount of OOP expenditures incurred per outpatient contact being 40.3% higher in 2010–2012 than in 2006–2008 and by as much as 155.5% higher in 2018. These high-cost pressures were attenuated by 63%–65% when accounting for the types of health facility contacted. The cost inflation was more pronounced for care sought at higher level government hospitals and private hospitals than at other health facilities. ConclusionThe cost of accessing outpatient care rose sharply between 2006 and 2018, particularly for visits involving higher level government hospitals and private hospitals. These findings suggest that beside expanding the coverage over the transition path to universal coverage, efforts should be directed at reforming Vietnam's hospital-centric and fragmented delivery system as a way of containing costs and ensuring financial sustainability of social health insurance system.

Impoverishing effect of tobacco use in Vietnam

BackgroundTobacco consumption places a significant economic burden on households, which is particularly severe in developing countries like Vietnam. In a country where the social insurance system is weak and healthcare...

Childcare and maternal employment: Evidence from Vietnam

Little literature currently exists on the effects of childcare use on maternal labor market outcomes in a developing country context, and the few recent studies offer mixed results. We attempt to fill these gaps by analyzing several latest rounds of the Vietnam Household Living Standards Survey spanning the early to mid-2010s. Addressing endogeneity issues with an instrumental variable/ regression discontinuity design estimator based on children’s birth months, we find sizable and positive effects of childcare on women’s own labor market outcomes and their household income and poverty status. The effects of childcare differ by women’s characteristics and are stronger for women in the ethnic majority group or women with daughters. These effects are also somewhat larger for areas with higher income levels. Furthermore, we also find that some positive effects last after two years.

Exploring the association between agricultural production systems and household diets in Viet Nam

The government of Viet Nam promotes an integrated and diversified production system that focuses on the symbiotic relationship of livestock, aquaculture, and fruits and vegetables (F&V), locally known as Vuon Ao Chuong (VAC). The expectation is that this system can prevent soil degradation, while improving dietary quality and income. This study examines the correlation between VAC production systems and diets using cross-sectional data from the 2016 round of the Viet Nam Household Living Standards Survey (VHLSS). Using ordinary least squares, we model four continuous outcome variables related to quantity consumed of fruits and vegetables, fiber, animal protein, and dietary energy; while using logistical regression, we model three indicator variables related to whether diets are balanced in terms of intake of dietary energy derived from carbohydrates, proteins, and fats. While individual components of VAC, such as aquaculture or F&V production, show a positive correlation with one or more dietary indicators, adoption of the full VAC system is found to be positively correlated only with dietary fiber consumption, making it challenging to establish a causal link between system adoption and improved dietary quality. However, we find that several socioeconomic variables, such as access to markets, household wealth, education of the household members, and household size are positively associated with one or more dietary indicators. Further research is needed to establish strong and causal relationships, or lack thereof, between VAC system and diets by exploiting the panel structure of VHLSS to examine the role of VAC in improving nutritional outcomes in Viet Nam.

Trends in out-of-pocket expenditure on facility-based delivery and financial protection of health insurance: findings from Vietnam's Household Living Standard Survey 2006-2018.

Much of the existing empirical literature on the association between health insurance and out-of-pocket (OOP) expenditures on facility-based delivery in low- and middle-income countries is cross sectional in nature. Comparatively little is known about the dynamic shifts in OOP expenditures and the health insurance nexus. Using seven biennial waves of Vietnam's Household Living Standard Survey covering the period 2006-2018 and a generalized linear model this study examines trends in OOP expenditures on facility-based delivery and financial protection afforded by Vietnam's social health insurance system. Over the period under consideration, the pattern of health facility utilization among the insured shifted steadily from commune health centers towards higher-level government hospitals. Real OOP for delivery was 52.7% higher in 2018 than in 2006-2008 and insurance reduced OOP expenditures by 28.5%. Compared to district hospitals, giving birth at higher-level government hospitals increased OOP expenditures by 72.3% while giving birth at commune health centers reduced OOP expenditures by 55.7%. Additional analysis involving interactions between insurance status, types of public health facility and year dummies suggested a drop in financial protection of insurance, from 48% to 26.9% among women delivering at district hospitals and from 31.2 to 18.7% among those delivering at higher-level government hospitals. The modest financial protection of health insurance and its declining trend calls for policy measures that would strengthen the quality of maternal care at primary care institutions, strengthen financial protection and curb the provision of two-tiered clinical services and charges.

How Do the Individual-level Factors Impact Labour Migration: A Case of Vietnam’s Migration

This paper focuses on the effects of individual-level factors on labour migration in Viet Nam. In this study, the author use the descriptive statistics and quantitative methods using the Vietnam Household Living Standards Survey 2018 data. The research illustrates that the migratory probability of female is lower than male; the higher levels of education lead to increase the migratory probability of people; the married group seem to decrease in migration, while the migration of divorced group grew. Furthermore, the housing area increases higher lead to decrease in migration.

Impact of internal remittance on households' use of bank services: evidence from Vietnam

PurposeThis study estimates impact of remittances from internal migration on households' use of bank services in Vietnam.Design/methodology/approachThis study uses data from the Vietnam Household Living Standards Survey and the two-stage least squares method (2SLS).FindingsThe results show that receiving internal remittance increases households' probability of having bank accounts and using card services. However, these impacts are different between rural and urban areas.Research limitations/implicationsThe results of this study reveal the useful role of internal remittance in increasing the probability of households using bank services, thereby enhancing financial inclusion in Vietnam.Originality/valueDifferent from the previous studies, the purpose of this paper is to analyse the impact of internal remittance on the use of bank services in Vietnam at the household level. This paper targets internal migration because it is the main type of migration in Vietnam. Besides, to the best of the authors’ knowledge, this research is the first one that compares the role of internal remittance on households' use of bank services in rural and urban areas in Vietnam.

Why is Ethnic Minority Poverty Severe? The Case of Rural Vietnam

In Vietnam, poverty is prevalent and extremely severe among rural ethnic minorities (REM). Despite a number of studies on characteristics of poverty, very few studies comprehensively examine the determinants of poverty intensity. This study employs binary and fractional logit models to investigate the determinants of poverty and the poverty intensity of the REM. Data are obtained by combining the 2012, 2014, and 2016 Vietnam Household Living Standards Surveys. The results show that education, wage-paying employment, housing conditions, and domestic remittances reduce poverty and its intensity. Poverty incidence reduction also hinges on development programmes on credit and scholarships. The likelihood and shortfall of poverty declined for households residing in the Red River and Mekong Deltas, and in southeast Vietnam. However, language barriers, farm size and overseas remittances influenced the poverty intensity but not the likelihood of poverty. Our results suggest that previous studies using only logit models have neglected several influences of poverty intensity, which the current research overcomes.

Elderly Poverty in Vietnam: Trends and Determinants

Adopting data from the 2010 and 2016 Vietnam Household Living Standard Surveys, this paper identifies factors of elderly poverty incidences and depth in Vietnam. Our analysis shows that overall, elderly poverty is lower than the overall poverty headcount in Vietnam. Yet, some elderly groups are more vulnerable to poverty than others. In particular, the elderly living in rural areas are more susceptible to poverty than those living in urban areas. The ethnic minority elderly are likewise more vulnerable to poverty than those who belong to the Kinh-Hoa ethnic majority. We found several determining factors for elderly poverty in urban and rural areas, including region, ethnicity, education, and household age composition. Remittances and social assistance are also crucial in reducing elderly poverty in rural areas. With these findings, this study proposes several policy implications, including improving the social assistance support for the elderly, reducing regional and ethnic disparities, and supporting the employment of older people.