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International Journal for Equity in Health

, 11:10

First Online: 29 February 2012Received: 28 September 2011Accepted: 29 February 2012DOI: 10.1186-1475-9276-11-10

Cite this article as: Liu, X., Tang, S., Yu, B. et al. Int J Equity Health 2012 11: 10. doi:10.1186-1475-9276-11-10


IntroductionHealth care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries.

MethodsHousehold survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care.

ResultsIn China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance.

ConclusionsChina has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance.

KeywordsHealth insurance Rural area Equity Health services utilization China Vietnam  Download fulltext PDF

Autor: Xiaoyun Liu - Shenglan Tang - Baorong Yu - Nguyen Khanh Phuong - Fei Yan - Duong Duc Thien - Rachel Tolhurst


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