Health, Nutrition and Population, Human Development Network, The World Bank, Washington, DC, USA.
Int J Health Plann Manage. 2013 Jan-Mar;28(1):3-15. doi: 10.1002/hpm.2114. Epub 2012 Jun 20.
Over the last few years, there have been an increasing number of impact evaluations of health insurance and other demand-side financing programs in developing countries. Yet the literature on insurance impact among small children is limited. This paper evaluates the effects of a Vietnamese government's policy in 2005, which granted free access to health services in public facilities to all children younger than 6 years. In particular, we focus on children among households who are not eligible for a program for the poor, which has been administered concurrently in the country. Using two waves of the Vietnam Household Living Standard Surveys conducted right before and after the policy started and a difference-in-differences method, we found a major increase in both inpatient and outpatient care in the secondary public hospitals. At the same time, there is evidence indicating a reduction in the use of tertiary hospitals. Compared with the policy's non-beneficiaries, beneficiaries in the age group 4-5 years also experienced fewer sick days, incurred less out-of-pocket spending on healthcare, and were less likely to encounter catastrophic expenditure. Evidence thus suggests that insurance provided by the policy has served the function as a safety net and helped improving efficiency of the health system by reducing the use of costly tertiary care.
在过去的几年中，发展中国家越来越多的健康保险和其他需求方融资计划的影响评估。然而，关于保险对幼儿影响的文献有限。本文评估了 2005 年越南政府政策的效果，该政策为所有 6 岁以下儿童提供了免费进入公共设施接受医疗服务的机会。特别是，我们关注的是那些不符合该国同时实施的贫困计划的家庭的儿童。我们利用在政策实施前后进行的两轮越南家庭生活水平调查，并采用双重差分法，发现二级公立医院的住院和门诊服务均有大幅增加。同时，有证据表明，三级医院的使用有所减少。与政策的非受益者相比，4-5 岁年龄组的受益者的病假天数减少，医疗保健自付费用减少，遭遇灾难性支出的可能性也降低。因此，有证据表明，该政策提供的保险起到了安全网的作用，并通过减少对昂贵的三级护理的使用，提高了卫生系统的效率。
