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Does rural health insurance bring equity of access to and utilization of health services? A comparison between China and Viet Nam

Date: Poster sessions
Source: Forum 11
Authors: Liu Xiaoyun, Lecturer, Health Services Research, International Health Group, Liverpool School of Tropical Medicine, United Kingdom
with Rachel Tolhurst, Baorong Yu, Nguyen Khanh Phuong, Joanna Raven and Shenglan Tang

Abstract

Health-care financing reforms in both China and Viet Nam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to explore and compare equity issues in rural health insurance in the two countries.

A qualitative study and household survey were conducted in six counties of China and four districts of Viet Nam. Equity was analysed according to geographic and economic factors.

In China, health insurance arrangements greatly vary among counties, in terms of government subsidy, premium level, ceiling, co-payment, and management procedure. Viet Nam is implementing fragmented national health insurance programmes; compulsory health insurance covers employees in formal sectors and from 2005 covers the poor. Different voluntary programmes co-exist. The near-poor are the least supported by any insurance scheme.

In China, poor households (26.4%) were less likely to seek treatment when feeling sick than rich households (21.2%). Among those who had been recommended for hospitalization, 12.9% of people from poor families refused, while only 5.4% from rich households did so. Most (69.7%) of the refusals were due to economic difficulties. In Viet Nam, the poorest households used the most outpatient services, while the near- poor used the least. But 15­27% of health insurance card holders did not use their health insurance cards when using services provided by government health facilities, mainly because of the poor quality of services to health insurance card holders.

The different arrangements of rural health insurance in China and Viet Nam bring different equity considerations. The decentralized context of the New Cooperative Medical Scheme in China may lead to considerable geographical inequity among different counties. Poor people still face serious financial difficulties in accessing health services. The poor in Viet Nam were successfully covered by compulsory health insurance, but still experienced difficulties in accessing high quality health services. The near-poor were least supported by any health insurance programme. Central and local governments' roles in health insurance in both countries need to be studied and promoted.