IMPACTS OF PROVINCIAL PORTABILITY POLICY ON HEALTHCARE UTILIZATION AND OUT-OF-POCKET EXPENDITURES IN VIETNAM...
Author(s)
Anh Thi Ngoc Toan, MPH1, Phuong The Nguyen, MD, DrPH2.
1Mahidol University Health Technology Assessment program, Mahidol University, Bangkok, Thailand, 2Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study (HIAS), Hitotsubashi University, Tokyo, Japan.
1Mahidol University Health Technology Assessment program, Mahidol University, Bangkok, Thailand, 2Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study (HIAS), Hitotsubashi University, Tokyo, Japan.
OBJECTIVES: As of January 1, 2021, Vietnam's provincial portability policy enables insured individuals to access inpatient treatment at any provincial hospital, receiving the same benefit package as if they had followed the referral process. This study is the first to assess the impact of this policy on healthcare utilization and out-of-pocket (OOP) expenditures in Vietnam.
METHODS: A quasi-experimental, longitudinal observational study was conducted using nationally representative data from the 2020 and 2022 Vietnam Household Living Standards Survey (VHLSS). The methodologies of propensity score matching (PSM) and difference-in-differences (DiD) were employed. Outcome variables included the frequency of hospital visits (outpatient visits and inpatient admissions) and OOP expenditures across healthcare sectors.
RESULTS: A total of 22,342 observations were analyzed, including 12,693 from the 2020 VHLSS and 9,649 from the 2022 VHLSS. There was a significant increase in total inpatient admissions (β = 2.38, p < 0.01), particularly in provincial, district, public, and private hospitals (p < 0.01). Total OOP expenditure for inpatient admissions significantly increased (β = 2.38, p < 0.01), but OOP expenditure per admission declined (β = -1.97, p < 0.01). Unemployed and married individuals showed higher utilization and greater OOP expenditures. Those in higher income quintiles had fewer admissions but higher OOP costs per admission than the poorest group. Regional differences in utilization and OOP expenditures were evident, particularly between the Mekong Delta, South Central Coasts and Highlands, Southeast, and the Red River Delta.
CONCLUSIONS: The provincial portability policy has increased inpatient healthcare utilization across public, district and provincial hospitals. Nevertheless, significant OOP expenses and the persistent equity gaps across income levels, employment statuses, and regions highlight the need for targeted reforms. These should revise the benefit package and provide financial protection for the most vulnerable groups.
METHODS: A quasi-experimental, longitudinal observational study was conducted using nationally representative data from the 2020 and 2022 Vietnam Household Living Standards Survey (VHLSS). The methodologies of propensity score matching (PSM) and difference-in-differences (DiD) were employed. Outcome variables included the frequency of hospital visits (outpatient visits and inpatient admissions) and OOP expenditures across healthcare sectors.
RESULTS: A total of 22,342 observations were analyzed, including 12,693 from the 2020 VHLSS and 9,649 from the 2022 VHLSS. There was a significant increase in total inpatient admissions (β = 2.38, p < 0.01), particularly in provincial, district, public, and private hospitals (p < 0.01). Total OOP expenditure for inpatient admissions significantly increased (β = 2.38, p < 0.01), but OOP expenditure per admission declined (β = -1.97, p < 0.01). Unemployed and married individuals showed higher utilization and greater OOP expenditures. Those in higher income quintiles had fewer admissions but higher OOP costs per admission than the poorest group. Regional differences in utilization and OOP expenditures were evident, particularly between the Mekong Delta, South Central Coasts and Highlands, Southeast, and the Red River Delta.
CONCLUSIONS: The provincial portability policy has increased inpatient healthcare utilization across public, district and provincial hospitals. Nevertheless, significant OOP expenses and the persistent equity gaps across income levels, employment statuses, and regions highlight the need for targeted reforms. These should revise the benefit package and provide financial protection for the most vulnerable groups.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
HPR36
Topic
Health Policy & Regulatory
Topic Subcategory
Insurance Systems & National Health Care, Public Spending & National Health Expenditures
Disease
No Additional Disease & Conditions/Specialized Treatment Areas