Understanding family-based health insurance enrolment among informal sector workers in a rural district of Vietnam: Adverse selection and key determinants
Understanding family-based health insurance enrolment among informal sector workers in a rural district of Vietnam: Adverse selection and key determinants
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DOI：
10.1080/17441692.2020.1864434
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发表时间：
2020-12-22
影响因子：
3.3
通讯作者：
Do, Uyen Thi
中科院分区：
文献类型：
--
作者：
Hien Thi Ho;Santin, Olinda;Do, Uyen Thi
背景：以家庭为基础的健康保险（FHI）的实施仍然面临挑战，这是越南实现全民健康覆盖的关键战略。目标：探讨越南农村地区非正规部门工人 (ISW) 参加 FHI 的经验和影响因素。方法：2016 年 1 月至 6 月在北宁省农村地区 Tien Du 进行了一项横断面研究。从省级社会保险数据库中提取二手数据，以确定该地区 ISW 中 FHI 的比率。从 55 名参与者收集了定性数据：20 次半结构化深度访谈 (IDI) 和 6 次焦点小组讨论 (FGD)。数据逐字转录。进行了主题分析。结果：只有 25.1% 的 ISW 有 FHI。那些患有 FHI 的人往往年龄较大或已经出现健康问题或从事“危险”工作。不同层面逆向选择的关键决定因素包括：个人、家庭和卫生系统。结论：健康保险普及率低仍然是 ISW 的一个问题。政策制定者应考虑提高FHI意识并提高初级卫生服务质量，简化ISW的登记和索赔程序。需要额外的政府保费补贴来增加 ISW 中的 FHI 入学人数。
Background: Challenges remain in the implementation of family-based health insurance (FHI) - the key strategy for achieving universal health coverage in Vietnam. Objectives: To explore the experiences of and factors influencing enrolment in FHI among informal sector workers (ISW) in a rural district in Vietnam. Methods: A cross-sectional study was conducted from January to June 2016 in Tien Du, a rural district in Bac Ninh province. Secondary data were extracted from provincial social insurance databases to identify the rate of FHI among ISW in the district. Qualitative data were collected from 55 participants: 20 semi-structured in-depth interviews (IDI) and 6 focus group discussions (FGD). Data were transcribed verbatim. Thematic analysis was conducted. Results: Only 25.1% of ISW had FHI. Those individuals with FHI tended to be older or already experiencing health problems or have 'risky' jobs. The key determinants of adverse selection from different levels included: individual, family and health system. Conclusions: Low health insurance uptake remains an issue for ISW. Policy makers should consider raising awareness of FHI and improve the quality of primary health services, simplify the procedures of enrolment and claim for ISW. Additional government premium subsidy is required to increase FHI enrolment among ISW.