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Liu Xiaoyun; Tang Shenglan; Yu Baorong; Phuong Nguyen; Yan Fei; Thien Duong; Tolhurst Rachel (2012)
Publisher: BioMed Central
Journal: International Journal for Equity in Health
Languages: English
Types: Article
Subjects: Health services utilization, Health insurance, wa_30, Vietnam, Rural area, Equity, Research, wa_100, Health Policy, China, wa_20_5, RA1-1270, Public aspects of medicine, Public Health, Environmental and Occupational Health



Health care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries.


Household survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care.


In China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance.


China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance.

  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. Carrin G, James C: Reaching universal coverage via social health insurance: key design features in the transition period Geneva: World Health Organization; 2004.
    • 2. Carrin G, James C, Evans D: Achieving universal health coverage: developing the health financing system Geneva: World Health Organization; 2005.
    • 3. Gao J, Qian J, Tang S, Eriksson BO, Blas E: Health equity in transition from planned to market economy in China. Health Policy Plan 2002, 17(suppl 1):20-29.
    • 4. Sepehri A, Chernomas R, Akram-Lodhi H: Penalizing patients and rewarding providers: user charges and health care utilization in Vietnam. Health Policy Plan 2005, 20(2):90-99.
    • 5. Ekman BN, Liem T, Duc HA, Axelson H: Health insurance reform in Vietnam: a review of recent developments and future challenges. Health Policy Plan 2008, 23(4):252-63.
    • 6. Hu S, Tang S, Liu Y, Zhao Y, MEscobar ML, de Ferranti D: Reform of how health care is paid for in China: challenges and opportunities. Lancet 2008, 372(9652):1846-53.
    • 7. CPC Central Committee, Sate Council: Decisions on further strengthening rural health work Beijing: CPC Central Committee, Sate Council; 2002.
    • 8. Yan F, Raven J, Wang W, Tolhurst R, Zhu K, Yu BR, Collins C: Management capacity and health insurance: the case of the New Cooperative Medical Scheme in six counties in rural China. Int J Heal Plan Manag 2011, 26(4):357-378.
    • 9. Culyer AJ, Wagstaff A: Equity and equality in health and health care. J Heal Econ 1993, 12(4):431-57.
    • 10. Whitehead M: The concepts and principles of equity and health. Heal Promot Int 1991, 6(3):217-28.
    • 11. Hidayat B, Thabrany H, Dong H, Sauerborn R: The effects of mandatory health insurance on equity in access to outpatient care in Indonesia. Health Policy Plan 2004, 19(5):322-35.
    • 12. Palmer N, Mueller DH, Gilson L, Mills A, Haines A: Health financing to promote access in low income settings-how much do we know? Lancet 2004, 364(9442):1365-70.
    • 13. Wang H, Yip W, Zhang L, Wang L, Hsiao W: Community-based health insurance in poor rural China: the distribution of net benefits. Health Policy Plan 2005, 20(6):366-74.
    • 14. Whitehead M, Dahlgren G, Evans T: Equity and health sector reforms: can low-income countries escape the medical poverty trap? The Lancet 2001, 358(9284):833-36.
    • 15. Ritchie J, Lewis J: Qualitative research practice: a guide for social science students and researchers London: SAGE Publications; 2003.
    • 16. Wagstaff A, Lindelow M, Gao J, Xu L, Qian J: Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme. J Heal Econ 2009, 28:1-19.
    • 17. You X, Kobayashi Y: The new cooperative medical scheme in China. Health Policy 2009, 91:1-9.
    • 18. Wu M, Zhang Z, He M, Ruan Y, Lv C, Tao L, et al: Qualitative study on the Implementation and Determinants of the New Cooperative Medical System in Rural China. Study report from WB/MOH NCMS study Beijing: Ministry of Health; 2006.
    • 19. World Health Organization: The World Health Report 2008: Primary Health Care Now More Than Ever Geneva: World Health Organization; 2008.
    • 20. McIntyre D: Learning from Experience: Health care financing in low and middle-income countries Geneva: Global Forum for Health Research; 2007.
    • 21. China Ministry of Health: Developing New Rural Cooperative Medical Scheme Beijing: Ministry of Health; 2003.
    • 22. Bogg L, Dong H, Wand K, Cai W, Diwan V: The cost of coverage: rural health insurance in China. Health Policy Plan 1996, 11(3):238-52.
    • 23. Tang S, Meng Q, Chen L, Bekedam H, Evans T, Whitehead M: Tackling the challenges to health equity in China. Lancet 2008, 372(9648):1493-501.
    • 24. Wang H, Zhang L, Hsiao W: Ill: Health and its potential influence on household consumptions in rural China. Health Policy 2006, 78(2-3):167-77.
    • 25. Zhang L, Cheng X, Liu X, Zhu K, Tang S, Bogg L, et al: Balancing the funds in the New Cooperative Medical Scheme in rural China: determinants and influencing factors in two provinces. Int J Heal Plan Manag 2010, 25(2):96-118.
    • 26. Sun Q, Liu X, Meng Q, Tang S, Yu B, Tolhurst R: Evaluating the financial protection of patients with chronic disease by health insurance in rural China. International Journal for Equity in Health 2009, 8(1):42.
    • 27. Chaudhuri A, Roy K: Changes in out-of-pocket payments for healthcare in Vietnam and its impact on equity in payments, 1992-2002. Health Policy 2008, 88(1):38-48.
    • 28. Wagstaff A: Health Insurance for the Poor: Initial Impacts of Vietnam's Health Care Fund for the Poor Washington DC: The World Bank; 2007.
    • 29. Xu Y, Zhang X, Zhu X: Medical Financial Assistance in rural China: policy design and implementation. Studies in HSO&P 2008, 23:295-317 [http:// www.eldis.org/vfile/upload/1/document/0809/Medical%20financial% 20assistance%20in%20rural%20China%20-%20policy%20design%20and% 20implementation.pdf], .
  • No related research data.
  • No similar publications.

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