The Multiple Effects of Child Health Insurance in Vietnam

Dang, Thang (2017): The Multiple Effects of Child Health Insurance in Vietnam.

Abstract

This paper estimates multiple effects of tremendous expansion in health insurance coverage for children on medical services utilizations for both children and parents by focusing on Free Care for Children Under Six, a child health insurance program that provides free access to health care practices for children under 6 in Vietnam. Using a regression discontinuity design, the paper finds that child health insurance has considerable positive effects on children’s health care uses whereas it reduces parental health care utilization for some outcomes. In particular, child health health insurance increases the probabilities of public inpatient visit and private outpatient visit by 22.3% and 33% respectively while it rises the frequencies of public inpatient visits and private outpatient visits by 0.32 times and 2.24 times respectively. In contrast, child health insurance reduces a mother’s probabilities of public inpatient visit and public outpatient visit by 32.6% and 27% respectively, number of public inpatient visits by 0.41 times. Also, paternal impacts of child health insurance consists of a 23.2% reduction in the probability of private outpatient visit and a 1.01 time decrease in the frequency of private outpatient visits. The paper significantly provides a more insightful understanding of various impacts of a health policy on health care utilization from developing countries.

• Item Type: MPRA Paper
• Language: English
• Keywords: Child health insurance; health care utilization; regression discontinuity; Vietnam
• Subjects: I - Health, Education, and Welfare > I1 - Health > I12 - Health Behavior; I - Health, Education, and Welfare > I1 - Health > I13 - Health Insurance, Public and Private; I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health

References

Athey, S., Imbens, G.: The State of Applied Econometrics: Causality and Policy Evaluation, Stanford, mimeo (2016)

Bailey, S.R., Marino, M., Hoopes, M., Heintzman, J., Gold, R., Angier, H., O’Malley, J.P., DeVoe, J.E.: Healthcare Utilization After a Children’s Health Insurance Program Expansion in Oregon. Maternal and Child Health Journal 20, 946–954 (2016)

Becker, G.S.: Treatise on the Family. Harvard University Press, Cambridge (1981)

Behrman, J.R.: Intrahousehold Distribution and the Family. In: Rosenzweig, M.R., Stark, O. (eds.) Handbook of Population and Family Economics Vol. 1A, pp. 125-187. North-Holland Publishing Company, Amsterdam (1997)

Bergstrom, T.C.: A Survey of Theories of the Family. In: Rosenzweig, M.R., Stark, O. (eds.) Handbook of Population and Family Economics Vol. 1A, pp. 21-79. North-Holland Publishing Company, Amsterdam (1997)

Bisgaier, J., Rhodes, K.V.: Auditing access to specialty care for children with public insurance. New England Journal of Medicine. 364, 2324-2333 (2011)

Bonfrer, I., Breebaart, L., van de Poel, E.: The Effects of Ghana’s National Health Insurance Scheme on Maternal and Infant Health Care Utilization. PLoS ONE. 11, 11 (2016)

Chen, Y., Jin, G.Z.: Does Health Insurance Coverage Lead to Better Health and Educational Outcomes? Evidence from Rural China. Journal of Health Economics. 31, 1–14 (2012)

Committee on Child Health Financing: Children’s Health Insurance Program (CHIP): accomplishments, challenges, and policy recommendations. Pediatrics. 133, 784-793 (2014)

Cortez, R., Romero, D., Camporeale, V., Perez, L.: Results-based financing for health in Argentina: The Plan Nacer program. Health, Nutrition, and Population Family of the World Bank’s Human Development Network, Washington, DC (2012)

Currie, J.: Policy Interventions to Address Child Health Disparities: Moving Beyond Health Insurance. Pediatrics. 124, 3 (2009)

Dang, T.: Does the More Educated Utilize More Health Care Services? Evidence from Vietnam Using a Regression Discontinuity Design, MPRA Paper 77641, University Library of Munich, Germany (2017)

Dang, T.: Intergenerational mobility of earnings and income among sons and daughters in Vietnam, MPRA Paper 75357, University Library of Munich, Germany (2015)

Dao, H.T., Waters, H., Le, Q.V.: User fees and health service utilization in Vietnam: How to protect the poor?. Public Health. 122, 1068-1078 (2008)

Dubay, L., Kenney, G.: The Impact of CHIP on Children's Insurance Coverage: An Analysis Using the National Survey of America's Families. Health Services Research. 44, 2040–2059 (2009)

Gajate-Garrido, G., Ahiadeke, C.: The effect of insurance enrollment on maternal and child health care utilization: The case of Ghana, IFPRI Discussion Paper 01495. International Food Policy Research Institute (IFPRI), Washington, DC (2015)

Goland, E., Hoa, D.T.P., Målqvist, M.: Inequity in maternal health care utilization in Vietnam. International Journal for Equity in Health. 11, 24 (2012)

Hahn, J., Todd, P., Klaauw, W.V.D.: Identification and estimation of treatment effects with a regression discontinuity design. Econometrica. 69, 201-209 (2001)

Hoai, N.T., Dang, T.: The determinants of self-medication: Evidence from urban Vietnam. Social Work in Health Care. 56, 260-282 (2017)

Imbens, G.W., Lemieux, T.: Regression discontinuity designs: A guide to practice. Journal of Econometrics. 142, 615–635 (2008)

Ladinsky, J.L., Nguyen, H.T., Volk, N.D.: Changes in the Health Care System of Vietnam in Response to the Emerging Market Economy. Journal of Public Health Policy. 21, 82–98 (2000)

Lee, D.S., Lemieux, T.: Regression discontinuity designs in economics. Journal of Economic Literature. 48, 281-355 (2010)

Li, M., Baughman, R.: Coverage, Utilization, and Health Outcomes of the State Children's Health Insurance Program. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. 47, 296-314 (2010)

Maeda, A., Cashin, C., Harris, J., Ikegami, N., Reich, M.R.: Universal health coverage for inclusive and sustainable development : a synthesis of 11 country case studies. World Bank Group, Washington, DC (2014)

Målqvist, M., Lincetto, O., Ng Du, N.H., Burgess, C., Hoa, D.T.P.: Maternal health care utilization in Viet Nam: increasing ethnic inequity. Bulletin of the World Health Organization. 91, 254–261 (2013)

Memirie, S.T., Verguet, S., Norheim, O.F., Levin, C., Johansson, K.A.: Inequalities in utilization of maternal and child health services in Ethiopia: the role of primary health care. BMC Health Services Research. 16, 51 (2016)

Nguyen, C.: The impact of health insurance programs for children: evidence from Vietnam. Health Economics Review. 6, 34 (2016)

Nguyen, C.: The impact of voluntary health insurance on health care utilization and out-of-pocket payments: new evidence for Vietnam. Health Economics. 21, 946-966 (2012)

Nguyen, H., Knowles, J.: Demand for voluntary health insurance in developing countries: The case of Vietnam’s school-age children and adolescent student health insurance program. Social Science & Medicine. 71, 2074-2082 (2010)

Nguyen, H., Wang, W.: The effects of free government health insurance among small children-evidence from the free care for children under six policy in Vietnam. International Journal Health Planning and Management. 28, 3–15 (2013)

Palmer, M., Mitra, S., Mont, D., Groce, N.: The impact of health insurance for children under age 6 in Vietnam: A regression discontinuity approach. Social Science & Medicine. 145, 217-226 (2015)

Palmer, M.G.: Inequalities in Universal Health Coverage: Evidence from Vietnam. World Development. 64, 384–394 (2014)

Peng, X., Conley, D.: The implication of health insurance for child development and maternal nutrition: evidence from China. European Journal of Health Economics. 17, 521–534 (2016)

Russ, S., Garro, N., Halfon, N.: Meeting children's basic health needs: From patchwork to tapestry. Children and Youth Services Review. 32, 1149–1164 (2010)

Sauerborn, R., Nougtara, A., Latimer, E.: The elasticity of demand for health care in Burkina Faso: differences across age and income groups. Health Policy Plan, 9, 185–192 (1994)

Somanathan, A., Dao, H.L., Tien, T.V.: Integrating the Poor into Universal Health Coverage in Vietnam, Universal Health Coverage Studies Series (UNICO) Studies Series No. 24. World Bank Group, Washington, DC (2013)

Somanathan, A., Tandon, A., Dao, H.L., Hurt, K.L., Fuenzalida-Puelma, H.L.: Moving toward Universal Coverage of Social Health Insurance in Vietnam: Assessment and Options. Directions in Development. World Bank Group, Washington DC (2014)

Somanathan, A.: The Impact of Price Subsidies on Child Health Care Use: Evaluation of the Indonesian Healthcard, Policy Research Working Paper No.4622. World Bank Group, Washington, DC (2008)

Tien, T.V., Phuong, H.T., Mathauer, I., Phuong, N.T.K.: A Health Financing Review of Vietnam with a Focus on Social Health Insurance: Bottlenecks in Institutional Design and Organizational Practice of Health Financing and Options to Accelerate Progress Towards Universal Coverage. World Health Organization, Geneva (2011)

Varian, H.R.: Causal inference in economics and marketing. PNAS. 113, 7310–7315 (2016)

Wehby, G.L.: Child health insurance and early preventive care in three South American countries. Health Policy and Planning. 28, 328–338 (2013)

World Health Organization and World Bank: Monitoring progress towards universal health coverage at country and global levels: Framework, measures and targets. World Bank Group, Washington, DC (2014)

World Health Organization: Tracking universal health coverage: first global monitoring report. World Bank Group, Washington, DC (2015)

Yip, W., Berman, P.: Targeted health insurance in a low income country and its impact on access and equity in access: Egypt's school health insurance. Health Econ. 10, 207-220 (2001)

Zimmer, D.M.: The Effects of the State Children’s Health Insurance Program on Insurance Status and Health Care Utilization of Children. Journal of Family and Economic. 32, 373–383 (2011)