Essays in economics of Public Health insurance in developing countries: evidence from Thailand and Vietnam.

Abstract

The three essays in this dissertation provide some evidence on the impact and the utilization of public health insurance programs in two developing countries: Thailand and Vietnam. The first essay examines the impact of Thailand's Universal Health Coverage Scheme (UCS) on households' precautionary savings. Results show that, in the short run, the UCS has no impact on households' savings or non-medical consumption expenditures, but it generates increases in both savings and non-medical consumption expenditures in the long run. These findings suggest that the UCS implementation does not produce a reduction in precautionary savings, but creates only an income effect in the long run. The second essay investigates why a large group of the UCS beneficiaries do not use health care services provided by the program. This study finds that beneficiaries from richer households are more likely to forgo low-cost health care at UC facilities and pay out-of-pocket for health care at non-UC facilities, suggesting that quality of health care at UC facilities remains a problem. Nonetheless, health care services at UC facilities tend to be a "back-up" option for non-poor households. The last essay re-examines the problem of non-utilization of public health insurance program in the context of the Vietnam's Health Care Fund for the Poor (HCFP) program. Here, distance is an important barrier to obtain access to health care for households in rural areas, but this negative impact is weaker for wealthier households. Moreover, the insured who have higher education and whose illness is more severe tend to bypass their designated health facilities in favor of higher level public facilities or private health facilities. This study also reveals an evidence of "moonlighting" among government health workers, particularly doctors. In sum, while the first essay shows that a public health insurance program can result in a welfare gain for a particular group of population, the second and third essays suggest that indirect costs of obtaining health care strongly determine health care choices, particularly when health care services are largely subsidized by the governments.