Implementation Status of Health Insurance in the Informal Economic Sector in Hanoi

The informal sector always has enough working hours during the year, 60.4% only occasionally has enough working hours [17, p.30].

The income of workers in the informal sector depends entirely on their working hours. That is also the reason why, although they have income, their income is very unstable and their working conditions are not guaranteed. In particular, workers in the informal sector do not know how to equip themselves with social insurance or voluntary health insurance. As a result, when they are sick, they cannot work to earn an income and also have to spend a lot of money during the treatment process. Thus, workers in the informal sector really need health insurance in their unstable lives. In the long run, workers in the informal sector will find it difficult to ensure social security without supportive health insurance policies and mechanisms.

On the other hand, there is a huge contradiction that there is still a huge gap between the need and the ability to participate. The need to participate in voluntary insurance of workers in this area is very large, they also want to pay high to enjoy high levels but the ability to contribute is very limited due to low income, or if they participate, they can only contribute according to the low plan, and thus, the level of satisfaction is also low.

In many cases, workers in the informal sector have to receive long-term treatment in the hospital due to serious illness or accidents but do not participate in health insurance. For those who do not have much economic conditions, treatment is very difficult. They do not have money to pay hospital fees, they try every way to earn money. However, when the money they earn is not much, they do not know where to rely on, their lives are prolonged by money borrowed, borrowed or supported by the community. Without health insurance, the majority of workers in the informal sector have to

suffer and face health risks, hindering sustainable socio-economic development.

A common characteristic of workers in the informal economy is low and unstable income, often without an employer. This is an obstacle to implementing insurance for this group. It is difficult for insurance agencies to determine income as a basis for insurance contributions and to ensure compliance with participation in the insurance program. Workers in the informal economy are often not regulated by law, and they have little access to any type of social insurance. Ensuring health insurance benefits for this group is increasingly becoming an urgent requirement for sustainable economic development and maintaining social stability.

2.2 Implementation status of health insurance in the informal economic sector in Hanoi

2.2.1 Overview of the informal economic sector in Hanoi

Hanoi is the destination of many migrant workers, they can participate in all the normal activities in daily life. They can be motorbike taxi drivers, street vendors, small retail businesses or small groups of people working together on a temporary job to earn income. Hanoi expands with a population of more than 6.4 million people, of which the number of people in working age is more than 3.2 million . This is an important resource, creating the position and strength for the economy and society of the capital to continue to grow.

Cultivated land is increasingly narrowing, especially in the delta provinces surrounding Hanoi. Agriculture and rural areas in our country are not yet able to create enough jobs for the large labor force in rural areas. Migration of agricultural workers to Hanoi is an increasing trend. That is the origin and core of the development of the informal economic sector in Hanoi. Currently, the surplus of labor in rural areas is exposed again.

more intense and widespread, creating social tension. The migration of labor to Hanoi is increasing. In Hanoi, many labor markets have been formed (at Cau Vuot Pham Van Dong, Nga Tu So, Giang Vo, Buoi, Truong Dinh, Giap Bat, ...). The informal sector is an area that absorbs most of these immigrants. Of course, their immigration supplements Hanoi's labor force, but it also puts a lot of burden on Hanoi, such as jobs, housing, and other social services such as education and health care.

In Hanoi, the informal sector is still a large source of employment, providing about 1/3 of the total number of jobs, and is increasingly expanding. People working in the informal sector are freelancers, including: hairdressers, home tailors, street vendors, freelance construction workers, motorbike taxi drivers, domestic helpers, etc. and those who voluntarily work for others without a labor contract. Low income, unstable, easy to change jobs, unstable life. Workers in the informal sector are often those who do not have a permanent residence in Hanoi. Due to these characteristics, it is difficult to control and affect the participation in health insurance of workers in this sector. These activities in Hanoi currently attract many workers. It also fills the gap in employment and income for a large part of the population.

The informal sector has a prominent scale, leading in providing jobs in Hanoi. According to the Labor and Employment Survey in Hanoi in 2009, there were 3,326,000 jobs, of which the informal sector accounted for 32% of the total number of jobs . Furthermore, if considering new jobs in 2009, the informal sector still leads with 30% of new jobs, equal to the contribution of the state-owned enterprise sector. The number of production and business units (SXKD) increased. In 2009, Hanoi had 725,000 informal production and business establishments.

formal sector, increasing by 23% in two consecutive years [7, p. 4] . The increase demonstrates the adaptability and dynamism of the informal sector during the period of economic contraction, just past the 2008 crisis. During the economic crisis, it promoted the expansion of the informal sector.

Table 2.5: Structure of production and business households and employment by economic sector group

Industry Group

Official production and business households					Informal production and business households
Proportion of production and business households official (%)			Structure of non-business production households official (%)			Structure	u	job	do (%)
Hanoi	200 7	2009 Hanoi old	2009 Hanoi new	2007	2009 Hanoi old	2009 Hanoi new	2007	2009 Hanoi old		2009 Hanoi new
Labour
career and build	11, 6	7.3	6.9	18.2	18.3	24.8	27.8	24.8		37.3
build
Love trade	29, 1	21.9	19.8	37.3	30.1	40.3	32.6	26.9		33.5
Service	12, 7	11.7	15.1	44.5	51.6	34.9	39.6	48.4		29.2
Shared:	19, 5	14.3	15.4	100	100	100	100	100		100

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(Source: Joint research group of Vietnam and France)

Table 2.6: Comparison table of data on informal production and business establishments (IBPEs), number of employees and proportion of employees in the informal sector

with total labor.

Order

Nationwide	Hanoi	Ho Chi Minh City Bright
PCT Production and Business Facility	8,400,000	725,000	750,000
Number of employees (People)	11,000,000	1,065,000	1,000,000
Labor rate %	24	32	32.9

(Source: Labor market and informal economy in Vietnam during crisis and recovery 2007-2009)

The growing importance of the informal sector in terms of production output. The total turnover of the informal non-agricultural sector in Hanoi in 2009 was VND 143,000 billion (Table 2.7). Informal households in Hanoi produced a volume of products and services equivalent to VND 69,353 billion and created VND 33,962 billion in added value. Each sector (manufacturing, trade, services) created about one-third of the total added value in this sector in Hanoi. Formal households play a less important role than informal households in terms of their contribution to production value and added value in Hanoi.

Table 2.7: Total revenue, output and production value in 2009 in Hanoi

Unit: billion VND

Total annual level (billion VND)

Industry Group	Revenue	Product value export	Value added more
Industry and construction	37,004	36,873	11,684
Commerce	83,837	12,980	11,452
Service	22,173	19,501	10,825
Informal production and business households	143,014	69,353	33,962
Official production and business households	85,566	40,595	28,059
Shared	228,580	109,948	62,021

(Source: Employment, Working Conditions and Earnings in the Informal Sector; Key Public Policy Challenges)

Table 2.8: Economic efficiency of the informal sector, 2007 and 2009. Average added value per production and business household and labor productivity in Hanoi.

Industry Group

Monthly average (2009; 1,000 VND)	Growth rate 2007-2009 (% - reality)
Industry and construction build	5,997	-12.4%
Commerce	3,466	-7.0%
Service	3,746	-14.7%
Non-official production and business households awake	4,192	-8.6%
Official production and business households	19,318	73.1%

Shared

6.503

10.8%

(Source: Employment, Working Conditions and Earnings in the Informal Sector; Key Public Policy Challenges)

According to Table 2.8, we can see the income gap between the informal sector groups and the clear difference between the formal sector and the informal sector. The income gap between the largest average sector (industry and construction) and the smallest (commerce) is 173%, the sector group with the highest average income is 143% higher than the average income of the informal sector. On average, with income in 2009, the income ratio of the informal sector is only equivalent to 22% of the formal sector.

The informal economic sector has also partly supported the economy of Vietnam in general and Hanoi in particular during the recent economic downturn. While the unemployment rate in other countries has increased due to the impact of global economic fluctuations, in Vietnam it has decreased. In particular, thanks to the origin of this sector, many businesses have prospered and succeeded. The informal economic sector has created jobs for many workers in Hanoi, not only that, but informal sector jobs have also supported the development and contributed to the stable growth of Hanoi in particular and the whole country in general.

2.2.2 Implementation of Health Insurance in the informal sector in Hanoi Implementation of the responsibility of participating in health insurance of the subjects

The subjects under the Health Insurance Law have been implemented correctly. As of December 31, 2011, the total number of people participating in health insurance was 55.9 million, equivalent to 63.7% of the population [3, p.6]. However, the coverage level of health insurance policy for

The number of workers in the informal sector nationwide is very low, accounting for only 0.19% [4, p.8].

In Hanoi, the health insurance policy is better communicated to workers, so the coverage is better than the general level. In Hanoi, by the end of 2010, there were about 5,000 people, accounting for nearly 0.5% of the workforce in the informal economic sector in Hanoi. Of the 5,000 workers in the informal economic sector participating in voluntary health insurance, in addition to a few workers in small private enterprises, most of them participated by adverse selection. They are often people with chronic diseases, serious illnesses, etc. When they choose to participate in health insurance, it means that they plan to use it for their own medical treatment to reduce costs.

Health insurance participants have access to medical services at all levels. The access rate at all levels is quite stable. In 2010, in Hanoi, there were about 10 million people with health insurance cards who went to see a doctor (9.2 million outpatients and 0.8 million inpatients). The average frequency of medical examination and treatment is 2.5 times/person/year. The number of medical examinations and treatments at provincial and district levels is about 70-80% of the total number of health insurance examinations and treatments. The number of health insurance examinations and treatments in 2011 was 11.4 million. Organizing medical examinations and treatments at commune health stations has created conditions for health insurance participants to access health services from the grassroots level. The cost of medical examinations and treatments for health insurance participants at the commune level in 2011 increased by 14% compared to 2010.

Table 2.9: Health insurance examination and treatment costs at different levels in Hanoi

Unit: million VND

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