Health insurance for the poor in Hanoi

HANOI NATIONAL UNIVERSITY UNIVERSITY OF ECONOMICS

-------------------------------

NGUYEN THANH BINH

HEALTH INSURANCE

FOR THE POOR IN HANOI

Major : Political Economy Code : 60 31 01

MASTER'S THESIS IN POLITICAL ECONOMY

SCIENTIFIC INSTRUCTOR: ASSOCIATE PROFESSOR, DR. MAI THI THANH XUAN

Hanoi - 2010

INDEX

Page

Table of abbreviations. i

List of tables. ii

List of charts. ii

List of diagrams. ii

Introduction. 1

Chapter 1 : Theoretical and practical basis of health insurance for the poor 7

1.1. Concept, characteristics and nature of health insurance 7

1.1.1. Some basic concepts related to health insurance 7

1.1.2. Main characteristics of health insurance activities 10

1.1.3. Nature of health insurance 13

1.2. The necessity of health insurance and the mechanism for forming the health insurance fund 17

1.2.1. The necessity of health insurance 17

1.2.2. Mechanism for formation and use of health insurance fund 20

1.3. Health insurance for the poor 27

1.3.1. The poor and their health care needs 27

1.3.2. State policy on health insurance for the poor 34

1.3.3. Establishing, managing and using the health insurance fund for the poor 35

1.3.4. Organizing the issuance of cards and health care for the poor 38

1.3.5. Experience in developing health insurance for the poor in some localities

direction

Chapter 2 : Current status of health insurance activities for the poor in Hanoi 45

and the issues raised

2.1. Overview of Hanoi and Hanoi City Health Insurance 45

2.1.1.

Some main features of Hanoi's socio-economy	45
2.1.2.	Overview of Hanoi City Health Insurance	47
2.2.	The reality of health insurance for the poor in Hanoi	51
2.2.1.	Hanoi City's policy on health insurance for the poor	51
2.2.2.	The implementation of health insurance for the poor in Hanoi since 2005	53
2.3.	2005 to present Evaluation of health insurance activities for the poor in Hanoi	68
2.3.1.	Basic achievements	68
2.3.2.	Limitations and causes	70
2.3.3.	Some issues raised for health insurance for the poor in Hanoi at present	77
Chapter 3:	now Orientation and solutions for developing health insurance for people	82
3.1.	poor in Hanoi in the coming time Orientation of health insurance development for the poor	82
3.1.1.	Vietnam's orientation	82
3.1.2.	Orientation of Hanoi City	86
3.2.	Some key solutions to promote health insurance activities for	89
	poor people in Hanoi
3.2.1.	Strengthening the propaganda of policies and guidelines of the Party and State on health care for the poor and near-poor	89
3.2.2.	Strengthening the health system, first of all the grassroots health network	91
3.2.3.	Tightly organize the process of selecting the poor and distributing	95
	health insurance card for the poor
3.2.4.	Innovation in health financial management policies and mechanisms for health care facilities	97

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3.2.5. Strengthening state management of health insurance activities 98

health insurance for the poor in general

CONCLUSION 101

LIST OF REFERENCES 103

LIST OF ABBREVIATIONS

Status

Acronym	Vietnamese Meaning
1	Social insurance	Social insurance
2	Health insurance	Health insurance
3	BN	Patient
4	BV	Hospital
5	Social health insurance	Social health insurance
6	Health Insurance	Private health insurance
7	BYT	Ministry of Health
8	Management Board	Management Board
9	CSSK	Health care
10	CP	Government
11	GDP	Gross domestic product
12	HCSN	Administrative career
13	ILO	International Labor Organization
14	KCB	Medical examination and treatment
15	Health insurance	Medical examination and treatment Health insurance
16	Labor, Invalids and Social Affairs	Labor - Invalids and Social Affairs
17	MDG	Millennium Development Goals
18	ND	Decree
19	State budget	State budget
20	Ho Chi Minh City	Ho Chi Minh City
21	Medical Center	Medical Center
22	TYT	Medical station

TW	Central
24	People's Committee	People's Committee

LIST OF TABLES

TT number

Table name	Page
Table 1.1	The situation of granting health insurance cards to the poor in Ho Chi Minh City Bright	40
Table 2.1‌	GDP per capita of Hanoi and the whole country 2000-2010	46
Table 2.2	The development of health insurance fund for the poor in Hanoi	54
Table 2.3	Results of implementing health insurance for the poor in Ha Noi city Internal	59
Table 2.4	Frequency of medical examination and treatment of insurance participants	62
Table 2.5	Frequency of health insurance in Hanoi after implementing the Law on Health Insurance	63
Table 2.6	Summary of medical examination frequency and medical examination cost of a person poor/year	64
Table 2.7	Health Insurance Fund Balance for the Poor 2005-2010	67

LIST OF CHARTS

TT number

Table name

Page

Chart 2.1

Number of health insurance cards issued to the poor over the years

Chart 2.2

Frequency, cost and average total cost of health care for a

poor people/year

LIST OF DIAGRAM

TT number

Table name	Page
Diagram 2.1	Number of poor patients receiving inpatient and outpatient medical care	60
Diagram 2.2	Average cost of one medical examination and treatment for inpatients and outpatients	61
Diagram 2.3	Revenue and expenditure of health insurance fund for the poor 2005-2010	68

INTRODUCTION

1. Urgency of the topic

Health is a precious asset of human beings, an important condition for the socio-economic development of the country. Taking care of human health in a fair and effective manner is a viewpoint of our Party and State, in which the consistent ideology is to build and develop Vietnamese medicine, especially since the reform process was initiated.

Economic development in more than 20 years of renovation has significantly improved the conditions of eating, dressing, living, traveling, and studying, so people's health has been increasingly enhanced. The Health Insurance (HI) policy in our country has been implemented since 1992 according to Decree No. 299/HDBT dated September 15, 1992 of the Council of Ministers (now the Government). However, during this period, the poor have not been purchased by the State for health insurance, so when going to the hospital for examination and treatment, they still have to pay hospital fees, only a few who are too poor are exempted from paying hospital fees, thus facing many difficulties in medical examination and treatment. At the 8th Congress (1996), our Party put forward the viewpoint "Economic growth must be associated with social progress and social justice", and emphasized: "In our society, all poor people must be examined, treated and have good health care".

To implement that policy, since 1992, our country has had a health insurance policy. Since then, 18 years have passed, the number of people participating in health insurance has increased, from 3.8 million people/year in 1993 (accounting for 5.4% of the population) to 23.7 million people/year in 2005 (accounting for 28% of the population), and 53 million people/month in May 2010 (accounting for 62% of the population). However, the majority of the poor, including those who have not been issued a card and those who have been issued one, have not had access to medical examination and treatment services (KCB) from the health system. This situation is due to many reasons, but basically

The main reason is that their economic capacity cannot meet their needs for medical examination and treatment. On the other hand, some of the State's support policies on free medical examination and treatment and health insurance for them have not been fully and synchronously implemented. This reality is posing a requirement for the authorities as well as researchers to find effective solutions to bring the Party and State's policies and guidelines into real life, in order to create better conditions for the poor to enjoy achievements in the medical field, first of all in health care.

Hanoi is a locality with more favorable conditions than the whole country in public health care, because it is the political, economic, educational, medical center... of the whole country. Over the past two decades, health insurance in Hanoi has gradually developed strongly, increasingly meeting the medical examination and treatment needs of all residents, including the poor, a significant part of the city's population. However, despite many efforts, there are still many poor people in the area who have not been issued health insurance cards, or have been issued cards but do not have the conditions to use them, due to many financial and administrative problems. That is posing a requirement for sectors and levels, directly the health sector, the Labor - Invalids and Social Affairs sector to promptly resolve, in order to ensure social justice for the poor in enjoying health care services.

Based on that requirement, we chose the issue of "Health insurance for the poor in Hanoi" as the research subject for our master's thesis.

2. Research situation.

Health insurance is a major social issue, so it has been studied by many people. Among the published works related to the thesis topic are: