This article is originally published in BMC Public Health, aiming to examine the impacts of compulsory public health insurance made through the law amendment on the enrollment, healthcare utilization, and out-of-pocket expenditures of middle- and low-income households during the transition period in Vietnam.
Vietnam has gradually expanded social health protection through public health insurance (PHI) since the 1990s. However, the enrollment of public health insurance can be compulsory or voluntary, depending on employment status. The compulsory scheme covers only those with formal employment. At the same time, the full premium subsidies by the government are provided to the poor and vulnerable population. While a voluntary scheme is applied for informal employment, including their dependents. Thus, 30 % of the remaining uninsured people were in the informal sector in 2014.
The important change was made through amendment of the Law of Health Insurance in 2014. Following the amendment, the PHI is compulsory for all Vietnamese population, starting from January 2015. Importantly, increases in premium subsidies and medical coverage are adopted to incentivize enrollment, while employers are mandated to pay for employee’s premiums. During a tolerance period, there is no personal penalty for those who are not enrolled in the PHI.
Findings showed that the expansion of mandatory health insurance coverage through increase in premium subsidies and medical coverage led to significantly increase of PHI enrollment and healthcare utilization among the middle-and low-income groups. However, it did not significantly decrease out-of-pocket payment among these groups. Thus, improving enrollment of PHI and financial risk protection remain challenges for PHI in Vietnam. Read more