Factors affecting the enrollment in voluntary health insurance of people in informal sector in Bavi District, Hanoi, 2012

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  [2] การประช มวชาการบัณฑตศกษาระดับชาต ครั งท  4 โครงการศลปศาสตรมหาบัณฑต สาขารั ฐศาสตร (ภาคพเศษ) มหาวทยาลัยเกษตรศาสตร   รวมกับ คณะบรหารธรกจ มหาวทยาลัยเทคโนโลย มหานคร และศนยศกษาวจัยและพัฒนากระบวนการยตธรรมไทย   วันศกรท   23 พฤษภาคม พ.ศ.  2557 ณ โรงแรมรชมอนด จังหวัดนนทบร   Factors affecting the enrollment in voluntary health insurance of people in informal sector in Bavi District, Hanoi, 2012 Le My Lan *   and   Dr.Kannika Damrongplasit **    Abstract  The purposes of this cross-sectional study were to analyze the factors affecting the participation in voluntary health insurance among people of different socio-economic groups in informal sector in Bavi district in Hanoi, Vietnam in 2012. This study analyzed the secondary data of 22,721 individuals with their demographic and socio-economic together with enrollment status in 2012. Descriptive analysis and binary logistic regression were used to describe the trend and discover the determinants of the decision on purchasing voluntary health insurance of people. The results from estimating a binary model reveal that gender and age, educational level, economic status, health status and occupation have significantly impact on the enrollment in voluntary scheme. Key Word:  enrollment, voluntary health insurance, determinants, farmer Introduction Health financing in Vietnam is mainly being occupied by out-of-pocket payment. In 2009, OOP payments made up more than 50% when Social health insurance and Public health spending only accounted for 18% and 22% respectively (Hoang Van Minh et al, 2012). This situation is found in many developing countries and a lot of studies prove that direct payments for health care have negative consequences for the population, particularly the poor and vulnerable   (Russell, 2005; Russell & Abdella, 2002; Town Arhin-Tenkorang,2000) and Vietnam has been facing the challenge of reducing OOP payments ‘proportion in total health expenditures for years. Realizing the situation, Vietnam policy makers decided to follow the step of other countries in implementing universal health insurance coverage in order to *  MSc. students in Health Economics and Health Care Management, Chulalongkorn University; Email: **  Lecturer at Faculty of Economics, Chulalongkorn University; Email:  การประช มวชาการบัณฑตศกษาระดับชาต ครั งท  4 วันศกรท   23  พฤษภาคม พ.ศ.  2557   ณ โรงแรมรชมอนด จังหวัดนนทบร  [3] offering affordable health care to the whole population with the purpose of reducing catastrophic costs and impoverishment due to direct payments. Within the last decades (from 1992 –  2012), Vietnam has been succeeded in providing financial protection to over 50% of their population: from 17.4% in 2002 to approximately 60% in 2010 (JAHR 2010). However, the road to its goal –  universal health insurance coverage is still very long and it requires government has to attach special importance on this issue in order to expand further coverage, especially population in informal sector and subject of voluntary health insurance; because the majority of insured people in 2010 was majority people of compulsory health insurance and other subsidized schemes which accounted for 98%. Only 8% of insured people in 2010 were voluntary health insurance holder. From experiences of other countries, it is extremely difficult to increase the coverage of health insurance within each target group rather than increasing the coverage from one group to another group; especially among groups that have to pay 100% premium or get partial subsidies from government such as near-poor, farmers and dependents of employee. Thus, in order to fulfil the target of achieving above 75% of population having health insurance in 2014, Ministry of Health needs to work hard with national and international experts in order to find way to attain this goal in time. Being aware of the necessity of updated information about factors and barriers affecting their participation in voluntary health insurance in community level, this study is a cross-sectional one that collects data about the enrollment in health insurance as well as the socio-economic factors of people in Bavi district, Hanoi in 2012 to analyze the determinants of enrollment and barriers with the purposes of providing information for policy makers to improve the current policy, to develop the benefit package and to offer better quality of health care to the population.   Purposes of the study  The purpose of this study was t o analyze the factors affecting the participation in voluntary health Insurance among people of different socio-economic groups Methods Population, Sample, and Sampling : This study is carried out under the framework of the project Indepth Universal Health Insurance which implemented in Bavi District, Hanoi, Vietnam in 2012. Bavi is a district in the North of Vietnam which is 60 km west from the center of Hanoi with the total population of about 240,000 people. The sample size under the project is 52,287 (11,089 households), about 21% of the district population. The study focuses only on people who are eligible for voluntary health insurance scheme, thus only the data of 22,728 individuals among the sample size were analyzed.  การประช มวชาการบัณฑตศกษาระดับชาต ครั งท  4 วันศกรท   23  พฤษภาคม พ.ศ.  2557   ณ โรงแรมรชมอนด จังหวัดนนทบร  [4] Data used for analysis: 1. Individual information: age, sex, education level, occupation, marital status, self-reported health status   2. Household information: Socio-economic conditions of the households divided into 5 quintile groups of wealth index 3. Information about health insurance participation: enrolling or not enrolling Data Analysis:  Descriptive analysis and four binary logistic regressions were used to analyze the data. Marginal effect was calculated to find out the different impact of each significant factors in the probability of purchasing voluntary health insurance of people in Bavi district. Results Table 1  Estimated coefficients and marginal effects from binary logistic regression for enrollment of people in Bavi district Whole sample Farmer Employed Dependents Variables Coef ME Coef ME Coef ME Coef ME Male -0.6042455 -0.0423268*** -0.4926986 -0.0323888*** -0.7106333 -0.0525362*** -0.3708519 -0.0424487 Married -0.0443522 -0.0032162 -0.0512712 -0.0034914 -0.1466319 -0.0116062 0.2193639 0.0241385 age2360 0.0076253 0.0005219 -0.1604495 -0.0111496 0.1806915 0.0123348 -0.161379 -0.0194494 age61 0.6956407 0.0624964*** 0.6075043 0.0570615**** 1.172024 0.1173175*** -0.0793124 -0.0098254 quintile1 -1.294856 -0.089057*** -1.210086 -0.0802807*** -1.466275 -0.1037798*** -1.113854 -0.1147849*** quintile2 -0.8451308 -0.0681212*** -0.8327272 -0.0632535**** -0.8788976 -0.0759894*** -0.5908605 -0.072589** quintile3 -0.6730597 -0.0577097*** -0.6664359 -0.0537899*** -0.7083703 -0.0649767*** -0.3937496 -0.0516395 quintile4 -0.3729787 -0.0356353*** -0.3936111 -0.0351203*** -0.3748902 -0.0386013*** -0.1320272 -0.0188435 lessprimary -1.535249 -0.107849*** -1.125073 -0.1336363*** -2.158068 -0.1386056*** -0.89346 -0.101711** Primary -1.059691 -0.087165*** -0.8526853 -0.1100495*** -1.442202 -0.1153735*** -0.4596879 -0.0602173 secondary -0.7204597 -0.066466*** -0.6237248 -0.0862082*** -0.7284688 -0.0731986*** -0.414856 -0.0551229 highschool -0.5271034 -0.051919*** -0.4802669 -0.0692257**** -0.5153938 -0.0554242*** -0.4442577 -0.0584821 Bad 1.072399 0.1146639*** 1.114259 0.1832192*** 1.198084 0.1379522*** 0.6796726 0.0998771* Average -0.041708 -0.0028948 -0.0943881 -0.0107921 -0.0187793 -0.0013784 -0.0678101 -0.0077967 Farmer -0.3416085 -0.0259409** employed -0.1648143 -0.0133757 _cons -0.7938988 -1.074578 -0.9603659 -0.9323778 *Significant at less than 10% ; **Significant at less than 5%; ***Significant at less than 1% In the first regression, the data was the whole sample of 22,728 individuals. The results shown in  Table 1 indicate that gender; economic status, educational level, health status and occupation are significant related to the participation in the voluntary health insurance scheme of people in the informal sector in Bavi district at p-value 5% and 95% CI. The result discovers that gender, education, economic condition and occupation have negative impact on the enrollment in voluntary health insurance while age and health status are positive significant to the decision of holding health insurance. The results from  การประช มวชาการบัณฑตศกษาระดับชาต ครั งท  4 วันศกรท   23  พฤษภาคม พ.ศ.  2557   ณ โรงแรมรชมอนด จังหวัดนนทบร  [5] the 2 nd  to the 4 th  regressions demonstrate that farmer and employed people share the same factors, sign and trends with the whole sample while dependents only had some dummy variables of economic status and educational level as significant determinants of decision on purchasing health insurance.  The marginal effects of each significant variables of employed & self-employed group, excepting health status rank the largest among those of other occupation groups. In term of health status variable, marginal effect from farmer group is the highest. Discussion & Suggestion * Factors negatively affecting the enrollment of people in Bavi and of each occupation groups: - Gender : With negative marginal effect, it means that if a person is a male, he will less likely to buy health insurance. It can be explained that voluntary health insurance scheme provides several benefit packages for women such as antenatal care for pregnant women, deliver services which appeal more to female than male. Then, in order to obtain the equal proportion of insured people between male and female in voluntary health insurance scheme, specific benefit package for male should be considered. - Economic status : All dummy variables of five quintile groups in the 1 st , 2 nd  and 3 rd  regression are negative significant in comparison with 5 th  quintile (the richest group –  omitted) with the increasing marginal effect when the economic status increases while only 2 dummy variables of 1 st  and 2 nd  quintile in the 4 th  regression are negative significant and share the same trend. It means that the richer the people are, the higher likelihood of purchasing voluntary health insurance is. It implies that when the economic status becomes better, people have tendency to care about their health which makes them want to enroll in health insurance scheme. It is easily seen that when poor people are in the struggle for living, they don’t h ave both capacity and strength to take care of their health even they want to. Health insurance’s objective is reducing the catastrophic risk of the poor due to medical expenses but it would make no good to them if they can’t even afford for health insuran ce premium and become insured. Hence, subsidy for people who are in difficult condition should be taken into account. Currently, the poor and the single elderly people are subjects of subsidized health insurance premium but other groups like the near-poor, the poor who have just escaped from poverty also need attention from government and society. Besides, government should attach importance on economic development policies such as microfinance, subsidies for farmers, professional education for dependents in order to improve their economic conditions. - Educational level : From the 1 st  to the 3 rd  regression, all dummy variables from less than primary to high school level are negative significant in comparison with higher education variables (omitted) with the increasing marginal effect along with the increase in educational level. The result indicates that the more educated the people are, the higher likelihood of purchasing voluntary health insurance of people is. The impact of education on the enrollment of health insurance already proved in several papers ( Khan and
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