Two Essays on Health Care in Vietnam

Health for all has been an aspiration and a target for many countries around the world. This dissertation consists of two papers investigating aspects of health care in Vietnam. The first paper evaluates the effects of the Free Health Care Card program for children under six on health care utilization, out-of-pocket spending, and self-reported health outcomes. First introduced in 2005, the program provides free health care for all children under six regardless of their families’ income and location. I exploit the timing of the program to implement a difference-in-differences research design and a regression discontinuity design to evaluate the effects of the program using cross-sectional data. I find that health insurance is associated with a 20% increase in the probability of an outpatient visit for all children and a 56% increase in the probability of an inpatient visit for children aged 0-2. Insurance is also associated with a 69% reduction in inpatient out-of-pocket spending for children age 3-5 and a 30% reduction in number of sick days. The difference-in-differences results are consistent with regression discontinuity results. These results illustrate the importance of expanding the range of benefits as well as the need to tailor public health programs to specific groups. The second paper investigates the determinants and impacts of informal payments in the health care sector in Vietnam. I employ multivariate regression and the bivariate probit method by Altonji et al., 2005. Patients who are wealthier, use public outpatient, or those who stay in central hospital are more likely to offer informal payment. Additionally, informal payment is associated with a reduction in the number of sick days and a higher probability of staying longer in the hospital.