Vietnam Health Insurance : Use of Health Care Services by the Poor Efficiency and Equity Issues in the Province of Kon Tum

One of the important political goal in the coming years in Vietnam is the achievement of universal coverage of health insurance. For that purpose the government is pursuing the strategy to provide free health insurance cards to all the poor, the ethnic minority populations and the persons living in remote or mountainous areas. These transfers aim at equalizing opportunity of access and receipts of health care services. Aggregate indicators on health insurance expenditures suggest that the system is still far from achieving these two goals, however. The use of health care units and the amount spent by the subsidized populations is much lower than by the rest of the population. Health insurance is expected to narrow the difference in health expenditures due to prices. Differences in access and treatment depend also on preference, education and other barriers. It is often cited that cultural background or underestimations about the seriousness of illness explain the lower use of health care facilities by people of ethnic minorities. This study investigated these issues through the analysis of individual’s health insurance data of the Provincial Social Security (PSS) Heath Insurance of KonTum in 2008. The main findings are that members of ethnic minorities and workers of the informal sector (not in social insurance) receive less expensive treatments and undergo less number of surgery acts than non- poor patients with the same disease, the same age and same gender. Ethnic appartenance or distance from the commune of residence and hospitals do not explain the differences in treatment, the number of visits, and the referral between the different groups of the poor and between the poor and the non poor. The result suggest that financial barriers (patient’s ability to pay out-of-pocket amounts) more than cultural barriers or distance explain the existing gap in health services use between the poor and the non-poor in Vietnam