2009年-世界发展银行全球_Health_Insurance___Use_of_Health_Care_Services_by_the_Poor_-_Efficiency_and_Equity_Issues_in_the_Province_of_Kon_Tum_38页_1mb

Summary of the Poverty Assessment: Health Insurance and Use of Health Care Services in Kon Tum Province

Core Content

This background paper examines the use of health care services by the poor and subsidized populations in Kon Tum province, Vietnam, under the context of the government's strategy to provide free health insurance cards to these groups. The study uses data from the Provincial Social Security (PSS) and analyzes how these groups access and utilize health care services compared to the general population.

Main Findings

• Health Insurance Coverage and Spending: The government's strategy to provide free health insurance to the poor, ethnic minorities, and remote populations has not translated into equitable use of health care services. Despite these groups representing 41% of the insured population, they accounted for only 12.4% of total health expenditures reimbursed by the health insurance system in 2006.

• Service Utilization: The subsidized populations visited health care units 3 times less frequently and were hospitalized 2 times less often than the rest of the population. This indicates a disparity in access and use of services.

• Cost Differences: The average cost of hospitalization for the poor was significantly lower (419 thousand VND) than for the general population (878 thousand VND). Similarly, the average cost of outpatient visits was 28 thousand VND for the poor and 48 thousand VND for the general population.

• Benefits Received: In 2008, the average benefit received by the poor was 122,608 VND, while the average for all insured was 258,146 VND. This highlights a gap in the financial support provided to the poor.

• Data Sources and Limitations: The study uses two databases: one on patient visits and another on insurance cards. The patient visit database covers most inpatient visits and expenditures (81.7% and 84.9%, respectively) but has lower coverage for outpatient services (45.8% and 35.4%, respectively). The insurance card database includes more individuals than the PSS tables, with a 6% increase, and overestimates the number of voluntary insured, students, and pensioners.

• Insurance Status Distribution: The insured population in Kon Tum is categorized into four groups: non-poor, poor recipients of social aid, ethnic minorities, and informal sector workers and their families. The poor make up 74% of the insured population, while the non-poor account for 25.4%.

• Age and Gender Analysis: Health expenditures increase with age, with the highest per capita costs for the elderly. Women tend to have higher health expenditures during their reproductive years, while men show higher use in later years. The poor have lower health expenditures compared to the non-poor across all age groups, with the elderly poor showing the most significant gap.

• Equity and Efficiency Issues: The study suggests that the poor may not be receiving the same quality of care as the non-poor. The lower cost of services for the poor could indicate either lower quality care or different treatment patterns. The analysis of similar diseases by age and gender shows that the poor may not be accessing the same services as the non-poor, which could affect the overall quality and cost of care they receive.

Key Information

• Government Strategy: Free health insurance cards were introduced in 2005 to cover the poor, ethnic minorities, and remote populations.
• State Budget Transfer: In 2008, about 23.2% of the VSS health insurance income was allocated to these subsidized groups.
• Health Expenditure Disparities: Subsidized groups have lower health expenditures and fewer visits to health care units, suggesting possible inefficiencies or inequities in service access.
• Data Coverage: The patient visit database has incomplete records, particularly for outpatient services and some health units.
• Insurance Card Database: This database includes more individuals and provides more detailed information on health conditions and service types, which is not fully captured in the patient visit data.
• Econometric Analysis: The study uses an econometric approach to analyze the impact of poverty, age, and gender on health care utilization and costs.

Conclusion

The findings indicate that while the government has allocated significant resources to subsidize health insurance for the poor and marginalized groups, the actual use and benefits of these services remain disproportionately low. This suggests that the strategy may not be effectively improving access or quality of care for the subsidized populations, and that further analysis is needed to understand the underlying reasons for these disparities.