Compare the Universal Health Coverage in China and Vietnam
Background. Since the late 2000s, universal health coverage (UHC) has been identified as an important goal, which is to ensure people’s access to needed health services without suffering from financial hardships. Many countries have adopted health insurance reform as an important approach to meet the goal of UHC. China and Vietnam are two countries that have made great progress through this approach. China covered more than 97% of entire population in 2011, while Vietnam just reached 80% in 2017. Compared with the universal service package in Vietnam, the health insurance in China has been criticized for its limited benefit package and failure to protect patients from financial risks. To compare the development of health insurance and its influence on the attainment of UHC, a mix-method study was conducted in China and Vietnam.
Methods. A policy review was included to compare the important health insurance policies in these two countries. Guided by the WHO UHC model, national-level data on health financing, population coverage, health service use and financial protection were quantitatively analyzed. The quantitative result was present with qualitative data extracted from 16 interviews with UHC scholars, policymakers, and local government agency officers to provide a comprehensive comparison of the health insurance development in China and Vietnam.
Result. Along with the great political efforts to develop the health insurance, a large amount of financial resource for health and health insurance has also been devoted to health insurance. A trend toward health financing through social security fund has been observed in both countries. Regarding the health insurance policy development, China has prioritized the population coverage rate at an early stage. Through extensive subsidies for enrollees of the New Rural Medical Insurance Scheme (NCMS) and Urban Resident Medical Insurance Scheme (URBMI), 97% of China’s total population has been covered since 2011. However, the insurance benefit design is very shallow and has a clear focus on inpatient services. As a result, although an increased use of inpatient services was observed, the real financial burden actually rose. The government has started to increase the benefits package since 2009. A greatly increased government budget and improved benefit package have been observed with a decrease of the financial burden. Meanwhile, there are still gaps between the policy and real implementation, the disparities between benefit packages, health services use and, financial risks still exist among different schemes.
The development of health insurance in Vietnam depends on the expansion of the compulsory scheme. Since 2003, the Vietnamese government has started to increase the number of compulsory groups and gradually introduce a government subsidy for the vulnerable people, including the poor, children, the old and the near poor. A high population coverage rate has been achieved among all the subsidized groups. The service coverage is wide in scope and the reimbursement rate has a pro-poor design. Compared with China, there is no obvious trend on service use. The health insurance in Vietnam also provides better financial protection and has achieved a better equity with protecting the vulnerable groups than in China.
Several important lessons were learned from this comparison between China and Vietnam. The government political and financial input are essential drivers for health insurance development. Government subsidy for premium is a common approach to financing the health insurance and encourage enrollment, which is also proved to be effective in both two countries. The service package design has a strong influence on the health service use pattern and the financial burden. The design of the insurance needs to focus more on equity. The vulnerable groups, especially the poor are still disproportionately suffering from the financial risk caused by using health services and this is still a common challenge facing both China and Vietnam.
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