Nguyen Lan Hoang, Hoang Anh Thuan Duc
Institute for Community Health Research, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
Front Public Health. 2017 Apr 25;5:89. doi: 10.3389/fpubh.2017.00089. eCollection 2017.
A social health insurance (SHI) program was implemented in Vietnam in 1992. Participation is compulsory for some groups, such as formal-sector workers and voluntary for other groups. In 2013, 68% of the total population was covered by SHI, with most enrollees from compulsory groups. Enrollment has remained low among persons whose enrollment is voluntary. As a result, households face financial risk due to high out-of-pocket payments for health care. The goal of this study is to identify willingness to pay (WTP) for the SHI scheme among persons whose enrollment is voluntary and to examine factors that influence their choice.
Three hundred thirty-one uninsured persons from three districts and one city of Thua Thien Hue province were interviewed face to face using a structured questionnaire. Contingent valuation technique was used to assess the WTP among the study participants. Each individual was asked to choose the maximum premium they were willing to pay for a health insurance card per year with three copayment levels of 0, 10, and 20%. Seven premium levels were offered ranging from 0 to 900,000 Vietnamese Dong (VND) (42.12 USD). The mean WTP of respondents for each scenario was estimated. Multiple linear regression analysis was used to identify factors influencing WTP for SHI.
The survey found that 73.1, 72.2, and 71.6%, respectively, for each copayment level, of the respondents would agree to participate in the SHI scheme and are willing to pay an annual premium of 578,926 VND (27.1 USD); 473,222 VND (22.1 USD); and 401,266 VND (18.8 USD) at the copayment levels of 0, 10, and 20%, respectively. The WTP for SHI is influenced by knowledge of SHI at all copayment levels ( value < 0.05). The more knowledge about SHI individuals have, the higher the WTP amount. Chronic disease was related to WTP only at a copayment level of 20% ( = 0.049).
Enhanced awareness of the benefits of SHI among the population should contribute to expanding SHI coverage in Vietnam.
越南于1992年实施了社会医疗保险（SHI）计划。某些群体，如正规部门的工人，参保是强制性的，而其他群体则是自愿参保。2013年，68%的总人口参加了社会医疗保险，大多数参保者来自强制参保群体。自愿参保人群的参保率一直较低。因此，家庭因高额的医疗自付费用而面临财务风险。本研究的目的是确定自愿参保人群对社会医疗保险计划的支付意愿（WTP），并研究影响其选择的因素。
使用结构化问卷对来自承天顺化省三个区和一个市的331名未参保人员进行了面对面访谈。采用条件估值技术评估研究参与者的支付意愿。要求每个个体选择他们每年愿意为一张医疗保险卡支付的最高保费，共付比例分别为0%、10%和20%。提供了七个保费水平，从0到900,000越南盾（VND）（42.12美元）。估计了每个情景下受访者的平均支付意愿。采用多元线性回归分析来确定影响社会医疗保险支付意愿的因素。
调查发现，在共付比例分别为0%、10%和20%时，分别有73.1%、72.2%和71.6%的受访者同意参加社会医疗保险计划，并愿意分别支付每年578,926越南盾（27.1美元）、473,222越南盾（22.1美元）和401,266越南盾（18.8美元）的保费。在所有共付比例水平下，社会医疗保险的支付意愿都受到对社会医疗保险了解程度的影响（P值<0.05）。个人对社会医疗保险的了解越多，支付意愿金额越高。慢性病仅在共付比例为20%时与支付意愿相关（P = 0.049）。
提高民众对社会医疗保险益处的认识应有助于扩大越南的社会医疗保险覆盖范围。
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