Factors Impact on Revenues of the Health Insurance Fund in Vietnam

1

INTRODUCTION

2

revenues also increased rapidly, thus the burden on the state budget reduces

1. Rationale of the Study

significantly. In particular, the poor, those who are living in remote and isolated areas

Social insurance and health insurance are great social policies of our Party and

have opportunities to get health care through health insurance with the great help from

Government. These kinds of insurance are always main factors in the social security

the Government ... However, the deployment process of health insurance policies in

system of each country, especially today when the Earth's climate is changing rapidly

our country has always faced difficulties and challenges. Among these difficulties,

in a negative direction and aging speed of population is happening rapidly. In our

fiscal health insurance, health insurance revenues and expenditures to ensure the

country, after the economy has transfered to the market economy, the Party and State

health insurance fund balances to emerging issues is always the toughest issue. This is

have had clear views and policies relating to medical field under the spirit of the

because, collecting money cannot cover costs, which leads to imbalance in the health

Party's Sixth Congress: "State and citizens are working together "[31]. From this point

insurance fund. Meanwhile, health insurance is the main and important financial

of view, health insurance policies were launched and gradually were developed until

source for each country to cover the costs of medical care for people when they are

today. At the VIII Congress of the Party, opinion relating to developing health

sick, which makes social security sustainable.

insurance was included in the Resolution orientation for the first time. Accordingly,

So how can we balance the income - cost health insurance fund in Vietnam? This

"investment for the State is increased, and other funding sources such as health

is a tough, the difficult problem, because it is a broad "economics - society" matter.

insurance are created more for health insurance to develop" [32 ]. After that, the

Only one left-hand sided issue of this equation (revenue MI) also has a lot of issues

Congress IX stated that: "Implementing social justice in health care, and try to

needed to be resolved, such as; health insurance revenues, organizing the collection,

universalize health insurance in the future" [33]. In the Congress X and XI, the

managing and collecting health insurance ...

opinion of the Party and the State about developing universal health insurance has

From this reality, the author does not have the ambition to find an absolute

shown more clearly under the spirit: "Building a diversity social security system,

solution for this precise big problem, but the author expected to find a part of the

strongly develop social insurance system, health insurance and try to develop universal

solution and decided to choose the research title: "The factors impact to the revenues

health insurance for the whole citizens "[34,35] ... Realizing these views and

of the health insurance fund in Vietnam" for this dissertation in economics.

orientations, we have institutionalized health insurance policies with a series of legal

2. Purpose of the Study

documents and started with the Decree 299 / HĐBT in 1992, the Decree 58/1998 /

- To systematize the basic theoretical issues relating to revenue, revenue

ND-CP of 1998, the Decree 63/2005 / ND-CP in 2005 and the most important was the
Health insurance Policies adopted by the National Assembly on 14.11.2008 and was
come into effect from the date 01/7/2009.
Since health insurance was applied in our country so far, its impact on life society economy has been great. Specifically, thanks to the policy, the number of
insured people increased rapidly over the years, there have been nearly 70% of the
population benefited from health insurance. Accordingly, health insurance fund

development and factors that impact the health insurance fund revenues.
- Analysis of the current situation and the factors impacting to health insurance
revenue in Vietnam. Thereby, the dissertation clarifies the factors that mainly impact
revenues of the health insurance fund.
- Recommend perspectives, orientation, solutions to develop the health insurance
fund revenue in Vietnam.


3

4

3. Objects and Scope of the Study

provinces and cities nationwide and staff collecting insurance and the Vietnamese

- Research Objects: Factors affecting to health insurance fund revenues.

social Insurance board of examination; The author randomly chooses 60 employers

- Scope of the study:

selected from enterprises in Hanoi; Intentionally selects 200 employees who were

+ Space: Revenues and factors affecting to the health insurance fund revenue in

insured in Da Nang; 110 people in Hanoi who are not insured are purposely choosen.

Vietnam (including compulsory health insurance and voluntary health insurance).

The total surveys collected for primary information are 770 questionnaires.

+ About Time: The dissertation focuses on studying real situation of income and

The survey results are: the author collected 394 questionnaires from revenue

the factors affecting to health insurance fund revenue in Vietnam. Especially since the

managers, social workers who check social insurance from the entire 63 provinces

health insurance policies went into implementation from 2010 to 2014 with

and cities across the country, 52 questionnaire from enterprises, 196

comparative analysis with the operation period of health insurance activities since its

questionnaires from insured people and 103 questionnaires from people without

founding in 1992 up to now. Thereby, the dissertation proposes solutions to develop

valid health insurance coverage.

the health insurance fund revenues, contributing to balance the health insurance fund.

From the information in the questionnaires, the primary data are processed

4. Research Method

through SPSS software to analyze, synthetic and clarify the factors affecting to health

Descriptive cross-sectional research method is employed with combination of

insurance fund revenues. Integrated approaches to analysis mainly used are

qualitative and quantitative methods. The dissertation uses some common techniques

disaggregated statistics and indicators in combination with the comparative method,

such as collecting information, statistics and synthesize to analyse revenues and
factors that impact health insurance fund revenues.
The dissertation uses the methodology of dialectical materialism and historical
materialism to further clarify and systematize the basic theoretical issues about health
insurance, health insurance fund revenues.
Method to collect information:
Information is gathered from secondary data including statistical yearbook of the
General Statistics Office of Vietnam (GSO), the survey data about Vietnam Household
Living Standard (VHLSS in 2010 and 2012) of the GSO with technical assistance from
World Bank. From the annual report on the collection of social insurance Vietnam, the
data collected from the related ministries and agencies such as the Ministry of Labour,
Invalids and Social Affairs, Ministry of Health, Ministry of Finance.
Information sources gathered from the primary data are the direct survey and
interview from insured subjects through the questionnaire including: Intentional

survey collected from 400 managers, inspectors of the Social Insurance from all 63

with reference to clarify the contents to be analyzed.
Methods to analysis and synthesis: On the basis of accumulated knowledge about
health insurance, health insurance financing combined with consulting materials both
inside and abroad in this field, the author analyzes, synthesizes and systematizes indepth the basic theoretical issues about health insurance, collected money and
revenues of the health insurance fund as well as the factors affecting the revenue.
Statistical Methods: The dissertation uses synthetic statistics methods such as
statistical disaggregation method, indices, reference on the collection situation, the
factors affecting the health insurance fund revenues. Then it proposes suitable
solutions for the development of the health insurance fund revenue in Vietnam to
operate safely, sustainably health insurance fund.
5. Research Overview about

revenues and the factors affecting to the

revenues of the health insurance fund
5.1. Studies in the world.
1. Diamond;P, 1992, Organizing the Health Insurance Market, Econometrica, 60
(6), 1233 - 1254 [77]


5

2. Joint NGO Briefing Paper, May 2008: "Health Insurance in low - income
countries" [68].

6

6 Phạm Thị Thu Hường (2013) " Voluntary health insurance in the province of

Vinh Phuc - problems and solutions ", Economic Dissertation [47].

3. Research of the American Medical Association (2005) "Expanding US health

7. Dr. Đỗ Văn Sinh (2011) “Scientific evaluation schemes to evaluate operation

insurance: AMA proposal for reform", "Mở rộng bảo hiểm y tế Mỹ - dự án cải cách của

of social security funds, health insurance, forecast balance calculations social security

AMA" [66].

funds, health insurance until 2020 and vision to 2030” [34].

4. Carrin G (2002) "Social health insurance in developing countries: A
continuing challenge" [74].
5. Dey, M.S. and Flinn, C.J., 2005, An Equilibrium Model of Health Insurance
Provision and Wage Determination, Econometrica, 73 (2), 571 - 627 [76]..
6. Borrell, C., Fernandez, E., Schiaffino, A., B enach, J., Rajmil, L., Villalbi, J.R.

5.3. Issues needed for further study
Theoretical Gaps: the concepts of the health insurance fund revenues,
distinguishing revenue collection activities with health insurance, evaluation indicator
system assessing the growth of the revenue, the factors affecting the revenues of the
health insurance fund.

and Segura, A., 2001, Social class inequalities in the use of and access to health

Gaps in research methodology: Since most of the factors affecting the health

services in Catalonia, Spain: what is the influence of supplemental private health

insurance fund's revenues are qualitative factors, and there are only few quantitative

insurance?, International Journal for quality in Healthcare, 13 (2), 117 – 125 [72].

indicators are: The number of objects and structure of object insured health insurance

7. Euson T, San PB. Health clarges and exemptions in Vietnam. Bamako Initiontive
Operations Research Programme Paper No 1, 1996, UNICEF New York [81].
8. Hiroi Yoshinnosi (professor, Univercity ChiPa). “Social security, medical
insurance in Japan and suggestions to apply in Vietnam” [35].
5.2. Studies in Vietnam
1. Lê Minh Phiêu (2010): " Reorganization of Vietnamese health insurance
system " – Montesquieu University - France [41].

premiums. Therefore, the dissertation uses survey methods using questionnaires with
respondents are: health insurance managers, different stakeholders ... to collect the
primary data. Then the author uses the method to synthesize, analysize data sources to
assess the impact of each factor to the health insurance fund revenues.
Gaps in practice: The dissertation conductes a comprehensive, detailed and objective
analysis factors affecting the revenues of the health insurance fund in Vietnam.
Analysis of factors affecting to health insurance fund revenues in Vietnam to be

2. Ass.Prof. Dr. Phạm Tất Dong và Dr. Đàm Viết Cương (9/2002). "User fees,

studied from the perspective of management and policy makers as well as policy

health insurance and the use of health services" in the health cooperation program

implementation. Therefore, solutions and recommendations of the dissertation are to

Vietnam - Sweden [46].

purify the policy and it is expected that these policies will quickly come to real life.

3. Dr. Trần Văn Tiến (2002) in the book " User fees, health insurance and the

6. New Contributions of the Study

use of health services, also has a journal titled "The draft of the roadmap towards

- New academic, theoretical contributions:

universal health insurance " [65].

+ The dissertation studies and puts forward the concepts of the health insurance

4. Phạm Lương Sơn (2012): "Study drug bidding situation for the base health
insurance and treatment in Vietnam " – Economic Dissertation [44].
5. Dr. Lê Duy Đồng và Dr. Bùi Sỹ Lợi (2001) published the book " Orientations policy
on social development and social development management period 2011 - 2020" [38].

fund revenues, distinguishing revenue to processing, health insurance collecting
mechanism.
+ Identifies factors that affect to the income of the health insurance fund,
explains and clarifies contents of each factor.


7

8

CHAPTER 1

+ Proposes indicators to assess the development of the health insurance fund
revenues.

RATIONALE AND PRACTICES OF FACTORS IMPACTING TO
REVENUES OF THE HEALTH INSURANCE FUND

- New findings drawn from the research findings:
+ Analysis and clarify the status of revenue collection and the health insurance
fund in Vietnam (2010-2014).

1.1. Background of health insurance
1.1.1. The concept and characteristics of health insurance

+ Clearly identifies factors affecting to the health insurance fund revenue in

1.2.1.1. Concepts

Vietnam, including policies and laws on health insurance; objects and structure of

Health insurance is a policy of the State Social security, with community, risk-

participants; the rate and method of collecting health insurance; Working mechanisms

sharing characteristics, based on the contributions of those who participated in the

and organization of the collection; the propagation and dissemination of policies and

fund, with the support and patronage of the State for the purpose of paying the cost of

legislation; the monitoring and inspection of the implementation of health insurance

medical care for members in the community when they are sick, get diseases. It runs

and the coordination between the authorities involved in health insurance.

with non profit.

+ Proposes some solutions to develope the health insurance fund revenues;
including measuring policies and implementing health insurance policies in Vietnam.
7. Conclusion
Besides the introduction, conclusion, list of references, appendices. The thesis is
structured into three chapters:
Chapter 1: Rationale and practice on the factors affecting the revenues of the
health insurance fund.
Chapter 2: Analysis of the factors affecting the revenues of the health insurance
fund in Vietnam.
Chapter 3: The views, orientation and development solutions revenues of the
health insurance fund in Vietnam.

1.1.1.2. Characteristics of health insurance
Health insurance is an objective, diversified and complex need of a society;
Health insurance is a social policy lying in a system of social security policies of
each country.
Sharing financial calculation, risk sharing important contents are always the
nature of health insurance.

Health insurance involves a lot of parties, depending on the types of health
insurance ...
1.1.1.3. Features of health insurance
Firstly, health insurance is a social policy with broad, diversed object with great
coverage; therefore, it should be legalized.
Secondly, health insurance operates with non profit.
Thirdly, health insurance always reflects economical, social, humanitarian and
noble humanity.
Fourthly, the financial resources meeting the needs in health insurance policies
always encounter complex difficulties because eligible subjects for health insurance
are extensive .
Fifthly, the development of policies and institutions implementing of health
insurance policies in different countries are different.


9

1.1.2. The role of health insurance
1.1.2.1. Protecting financial situation for participants

10

1.2.2.3. Assessment indicators for the development of the health insurance
fund revenues.

1.2.2.2. Covering health care for the entire population

1. The number of insured employees relating working

(1)

1.1.2.3. Reducing budget burden for the State

2. Number of agencies taking part in insurance as a must

(2)

1.1.2.4. Ensuring main responsibilities in the system of social security policies

3. Amount of receivable insurance

(3)

1.1.3. Main activities of health insurance

4. The number of insured employees relating working(L)

(4)

1.1.3.1. Disseminating policy relating health insurance legislation

5. The number of agencies taking part in insurance (D)

(5)

1.1.3.2. Allocating health insurance cards

6. Real amount of money collected from insurance (T)

(6)

1.1.3.3. Operating income - expenditure and investment of the health insurance fund

7. The growth rate of insured employees relating to working ( t L )

1.1.3.4. Coorperating in organizing health insurance

8. The growth rate of agencies taking part in insurance ( t D )

1.2. The health insurance fund and health insurance fund revenues

9. The growth rate of revenues from health insurance ( t T )

1.2.1. The health insurance fund

10. The average of health insurance contribution per employee relating to

The health insurance fund is an independent financial fund, working outside the
state budget. The formation, existence and development of the health insurance fund
always has its own purpose and subject:
1.2.2. The revenues of the health insurance fund
1.2.2.1. Concept
The revenues of the health insurance fund are the contributions of the
stakeholders, revenues from operating activities and other sources to mainly cover

working ( M )
11. The growth rate of health insurance contributions for workers relating to
working ( t M )
12. Number of insured employees without labour relation ( C N ) (12)
13. Revenue from the health insurance from employees without labor relations ( TN ) (13)

14. The growth rate of the insured employees without labour relation ( TCN )

health care costs for participants when they get sick or have diseases as prescribed

15. The growth rate of revenues from employees without labour relation ( t TN )

legally and carried out by the health insurance agency.

16. Mức đóng góp BHYT bình quân một người chưa có quan hệ lao động trong

1.2.2.2. The need of developing health insurance fund revenues
Developing revenues for the health insurance fund also means to increase the
number of participants and potential contribution of subjects and object groups. This

năm ( M N )
17. The average contribution level of health insurance from those who do not
have health insurance. ( TMN )

most critical issue not only relates to health insurance agency but also relates to all

18. Number of people participating health insurance ( D Y )

levels and sectors.

19. Proportion of population with health insurance ( TD )
20. Annual total income in health insurance ( TY )
21. The growth rate of insured people in general ( t D )


11

12

22. The growth rate of insurance revenue in general ( t TY )

1.4.1.3. In Korea

23. The annual health insurance contribution rate per 1 insured person ( M D ):

1.4.1.4. In Thai land

24. The general growth rate of insurance contributions ( t MY ):

1.4.1.5. In Taiwan

25. Interest received from investing activities of idle health insurance fund ( LY ) (25)

1.4.2. Health insurance fund sources in Vietnam

1.4.2.1. Appearance and development

26. Profitability rate from investment activities ( Te )
In addition, in view of the fund management, the development of the health
insurance fund revenue must also put in balance relationship between income and
expenses. It also needs considering:
Total expenditure

Total annual
revenue from health
insurance

=

KCB
for the insured

a/ 1992 – 2008 period
b/ 2009 - 2014 period
1.4.2.2. Organization Management of Vietnam Health Insurance

Administration
+

expenses in

during the year

+

Annual
Preventive

the year

1.3. Factors impact on revenues of the health insurance fund
1.3.1. Legal policies on health insurance
1.3.2. Social and economic conditions
1.3.3. The awareness of the people about popular propaganda policy on health
insurance policies
1.3.4. Quality health care for those participating health insurance

1.3.5. Organizatiing to collect health insurance
1.3.6. Inspection, testing and monitoring
1.3.7. Participants and organization of the insured people
1.3.8. Health insurance premiums
1.4. Revenues and development of the health insurance fund revenues in
some countries in the world and lessons for Vietnam

BHXH Huyện
Chi trả cho đại lý

1.4.1. Revenues and developing health insurance fund revenues in some countries
in the world
1.4.1.1. In the Federal Republic of Germany
1.4.1.2. In Japan

Hình 1.1: The organization system of Vietnam Social Insurance


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14

1.4.2.3. The coverage rate of health insurance in Vietnam
CHAPTER 2

The government set a target of 2020, the coverage rate is minimum 80%.

ANALYSIS ON FACTORS AFFECTING TO THE REVENUES

Table 1.1: Number of participants by health insurance type

Number of health
Year

insurance participants

Health insurance
compulsary

voluntary participation

participation

OF HEALTH INSURANCE FUND IN VIETNAM

Health insurance

2.1. Current status of the revenues and collected revenues of Vietnam health
insurance

People

Growth

People

Growth

People

Growth

2.1.1 Sources of health insurance revenues and results

(million)

rate (%)

(million)

rate (%)

(million)

rate (%)

Sources of health insurance fund include:

2010

50.184

-

46.024

-

4.159

-

2011

52.094

1,038

47.110

1,024

4.987

1,199

2. Profits from investment activities of the health insurance fund.

2012

58.977

1,132

53.494

1,136

5.483

1,099

3. Sponsorship, donation from domestic and oversea organizations and

2013

63.018

1,069

55.950

1,046

7.068

1,289

2014

64.608

1,025

57.039

1,019

7.568

1,071

1. Fund collected under the Health Insurance Law;

individuals.
4. Other legal sources. "(Act 33 - Law of Health Insurance)

Source: Vietnam Health Insurance [4]

Table 2.1: The results of health insurance (2010-2014)

1.4.2.4. Lessons for Vietnam

Total income of

compulsory collected

Voluntary collected

Firstly, health insurance policy needs to be organized appropriately according to

health insurance

health insurance

health insurance

each economic - social development period of the country.

Year

Secondly, voluntary health insurance is a coming step to progress to universal
health insurance.
Thirdly, the State should always support the health insurance fund.

2010

Fourthly, the determination of health insurance premiums should have specific
regulations for each type of health insurance.

2011

Fifthly, the State management issues for health insurance should be determined.
Sixthly, social health insurance is necessarily sponsored by the State.

2012

amount

Growth

amount

growth

amount

growth

(billion

Rate ( %)

(billion

rate (%)

(billion

rate (%)

VND)

VND)

23.305,2

21.759,3

VND)

1.545,9

31.829,4

136,6

29.724,2

136,6

2.105,1

136,2

40.176,9

126,2

37.758,3

127,0

2.417,6

114,8

48.433,8

120,6

44.685,1

118,3

3.748,7

155,1

55.026,0

113,6

51.027,3

114,2

3.998,7

106,7

Sevenly, the State needs to accelerate the complete health care market.
2013

2014

Source: Vietnam Social Insurance [4]


15

16

2.2. Analysis of factors affecting the income of the health insurance fund in

Rate of health insurance

Vietnam

Health insurance rate is regulated in Act 13 of the Law on Health Insurance.

Year

Table 2.2: The average fee of health insurance (2010-2014)

2.2.1. Health insurance policy

General insurance

2.2.2. Social and Economic conditions

Compulsory health

Voluntary health

insurance

insurance

Table 3.4: The relationship between economic growth - income and health

Average

Growth

Average

Growth

Average

Growth

rate per

rate (%)

rate per

rate (%)

rate per

rate (%)

person

person

person

(VND)

(VND)

(VND)

-

473.029

-

insurance rate (2010-2014)
Indicator

Unit

466.105

2011

571.621

131,3

612.104

120,8

526.290

136,2

2012

692.689

113,2

712.422

124,6

483.524

91,9

2013

768.790

111,0

812.456

114,0

535.530

110,8

rate/person

2014

859.781

111,8

895.215

110,2

571.244

106,7

386.488

-

5.

2. Average income/person/month

Source: Vietnam Social Insurance [4]

3. Income growth rate
4. The average health insurance

The growth

rate

of

health

insurance

2.1.3. Organisating the collection of health insurance

6. The average growth rate of prices

2.1.4. The revenue and expenditure balance sheet of the health insurance fund

of medical services

Table 2.3: Surplus income - cost health insurance fund (2010-2014)
Unit: billion

1

2011

2012

2013

6.78

5.96

5.25

5.42

1,000 VND

1,150

1,179

1,196 1,294 1,464

Income%

-

2.6

1,000 VND

466.1

612.1

692.6 768.7 859.7

-

31.5

13.4

10.8

11.9

-

14.7

17.6

19.6

22.4

1. Economic growth rate

2010

Year

2010

Health insurance

Total expenses

Revenues - expenses

Gross

insurance

differences

2

3

4=2–3

2010

23.305

18.895

4.410

2011

31.829

24.753

7.076

2012

40.176

33.419

6.757

2013

48.434

39.060

9.374

2014

55.026

45.550

9.476

Note: The data does not include hedge and management funds
Source: Vietnam Social Insurance [4]

Premiums
%
services%

1.8

7.2

2014
5.65
%

14.8

Source: GSO - Vietnam Social Insurance [46]
The dissertation applies the following research models:
a) Model 1: the probability of participating voluntary health insurance

Accreditation results multicollinearity provides the following results:
Variable | VIF 1 / VIF
+ ---------------------- ------------primary |0.130580 7.66
Secondary|0.170446 5.87
Highschool| 5:39 0.185368
quintiles_5 |0.271461 3.68
Quintiles_4| 3:44 0.290361


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quintiles_3 | 3:21 0.311263

(margin) of going to health care center or not to the probability of their choice in

quintiles_2 |0.361636 2.77

buying voluntary medical insurance, about 38% of people who go to health care

Reg8_8|0.608112 1.64

center compared with 32% of people do not. From the regression results in table

Reg8_7| 1:54 0.648215

and figure 1, it is implied that those who go to health care center for health

reg8_5 | 1:42 0.704634
reg8_4 | 1:38 0.726024
reg8_2 | 1:35 0.738252
reg8_6 | 1:24 0.807133
urban | 1:16 0.860509
visited | 1:15 0.872969

treatment should be encouraged and propagated to purchase voluntary health
insurance. To reinforce this claim, column 2 line 1 shows that people spending on
health insurance will spend about 24% higher in health insurance than those who do
not when other elements unchanged.
The study took the first quintile of income (or low income groups) as a standard

reg8_3 | 1:10 0.907788

for comparison. Probability of purchasing voluntary health insurance rose steadily

year_1 | 1:09 0.915149

according to income level. This means that the higher income families have, the more

business | 1:09 0.920389

they will be able to participate in voluntary medical insurance. Specifically, the high

hhsize | 1:08 0.927807

income group will have a double probability of participating health insurance than

female | 1:01 0.993172

poor groups. Thus, to facilitate and increase revenue for voluntary health insurance,

------------- + ----------------------

we should focus on the target groups at the upper and middle class.

Mean VIF | 2:41

Next, the ethnic minorities have a lower probability of voluntary insurance than

This result shows that the model has no multicollinearity phenomenon and it is

the Kinh and Hoa groups. This is largely because they are poor or vulnarable groups in

estimated that the model's variables are statistically significant at 1% (excluding a

the society, along with they are issued health insurance cards for free and they often

coefficient). That R-squared result of the Logit model is low (6%) is consistent with

live in rural and mountainous areas. The table statistics show that the number of

the characteristics of this model form. R-squared of the regression model OLS at

people participating in voluntary medical insurance in rural areas is 2/3 times higher

18.5% due to the studies using independent variables are qualitative variables while

than those in urban, but the ability to participate is lower, 0.39 compared to 0.32

the dependent variable is the dependent variable for the purpose of comparing the

respectively (Figure 3.9). In fact, the difference is negligible so we should focus on

difference of the group rather than the beat General price. Such results will provide

encouraging both rural and urban people to participate in voluntary health insurance.

higher recommendation because the health insurance policy is a broadly covered

What is noteworthy here is that spending on health insurance in urban and rural areas

policy for the entire population rather than policies focusing on a specific target

is not statistically significant, we expected that people living in urban areas will spend

group.

more on health insurance; however, this expectation has not been demonstrated. This

The group seeking treatment at health units will have a higher probability of
buying medical insurance than those who don’t go to medical units for treatment
(first row, column 1). More specifically, Figure 3.8 shows the marginal influence

could be a negative signal to those livng in rural areas, because they have to spend for
health insurance as much as people living in urban areas.


19

20

Table 2.5: Calculation of the factors affecting health insurance revenue in Vietnam

2.2.3. The propagation of policy and legislation

under the two types of subjects: compulsory subjects and voluntary subjects

2.2.4. Quality of heath treatment under health care insurance
2.2.5. Participation procedure, charging and expenditure of health insurance
for medical expenses
2.2.6. Inspecting, checking and monitoring health insurance

Type of health

2.2.7. Participants, structure and participants and the premium of health

insurance

Health insurance

Number of

premiums average

participants in

(1,000 VND /

medical insurance

person)

(million)

(billion)
(billion)

(billion)

insurance
To see the impact of theses quantitative factors to the health insurance fund
revenues of Vietnam, the writer used composite index method in statistical and
secondary data sources of the Vietnam social insurance agency for analysis, namely:
- If the symbol of participants in 2013 and 2014 are

and

- If the symbol of health insurance premiums in 2013 and 2014 are
then a composite index system with 3 factors will be set up as follow:

1. Compulsory
health insurance
2. Voluntary health

and

insurance
General

812.4

895.2

55.9

57.0

45413.2

51026.4

46306.8

535,5

571,2

7,0

7,5

3.748,5

4.284,0

4.016,2

781,59

857,53

62,9

64,5

49.161,7

55.310,4

50.323,0

Source: The author’s investigation documents

a) the relative number:

2.3. General assessment of revenues development and other factors affecting
the income of health insurance in Vietnam
2.3.1. Achievements
Firstly, revenue is increasingly expanding and relatively stable, because subjects
( 1)
b) the absolute number:

(2)

(3)

participating health insurance is rapidly growing, especially in this kind of voluntary
health insurance.
Secondly, health insurance has the most powerful and largest to the income of
health insurance fund in both relative and absolute numbers.
Thirdly, due to economic and social conditions are stable, despite the economic
crisis, the pace of economic growth remained relatively high compared with other
countries in the region and around world.
Fourthly, all of these factors, either qualitative or quantitative, more or less
impact on the health insurance fund revenues, but their aggregate impact is important.
Fifthly, in the recent stage of implementing the Health insurance Law, annual
revenues are rising, therefore, basically balance income - cost is ensured.


21

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Difference between revenue - expenses of the previous years is always higher than
CHAPTER 3

the following years.
2.3.2.Limitation and the cause
Firstly, the views and perceptions about health insurance are not really sufficient.
Secondly, the propulgation of laws and policy documents guiding the
implementation has been slow compared to the proposed schedule.
Thirdly, statistical indicator system serves revenue management has not yet been
complemented and quotas of receivables has not been assigned.

Fourthly, quality of health treatment and health insurance is still weak, which
leads to the fact that a majority of people do not want to participate
Fifthly, in recent time, management subject participating compulsary health
insurance is not strick.
Sixthly, the procedures for registration of voluntary health insurance are
inadequate.
Seventhly, investment of idle funds from health insurance has not yet been
realized.

PERCEPTION, ORIENTATION AND SOLUTIONS FOR DEVELOPMENT
FUND REVENUES OF HEALTH INSURANCE IN VIETNAM
3.1. Perception and orientation for development of health insurance
fund in Vietnam
3.1.1. Perception
Firstly, the health insurance fund's revenues must always be the goal of growth
and development.
Secondly, all related levels and relevant departments must be responsible for
directing and guiding people to participate under the health insurance law.
Thridly, developing health insurance fund's revenues must tie to economic social conditions of the country in each period.
Fourthly, developing health insurance fund must be linked to income nourishing
source of revenue for the health insurance fund.
Fifthly, the health insurance fund revenue must be managed under law and
inspection and supervision of revenues must be strengthened.
Sixthly, policies of the Party and the State must always be advocated thoroughly
in the process of developing revenue sources.
3.1.2.

Orientation and objectives to develop Vietnam health insurance fund revenues

3.1.3.1. Orientation

- Increasing revenue for the health insurance fund based on contributions from
the community.
- Health insurance premiums must be adjusted in accordance with the Health
insurance Law in period.
- Managing closely the health insurance fund, preventing revenue loss, and abuse
against the health insurance fund.
- Exploitating other financial resources to contribute to the development of health
insurance fund.
3.1.3.2. Goals of developing resource for insurance fund
- Overall objective: Mobilizing all resources for a full health insurance premium,


23

and legally for forming the health insurance fund. Ensuring a stable and sustainable
development for health insurance fund, and balancing the revenue - expenses.
Gradually decreasing the support from the State.
B, Specific goals:
- Collecting accuratedly and fully and timely health insurance fee.
- Closely managing the participants, especially people in regional non-state
enterprises, preventing health insurance fund losses;
- Strengthening sanctions for violations of insurance law, such as evasion,
arrears, escape fees ... . to develop revenue for sustainable health insurance fund.
3.2. Solutions to develop revenues of the health insurance fund in Vietnam
3.2.1. Further concretizing and improving the health insurance policies and
legislation system.
3.2.2. Strengthening and spreading propaganda developments policy on health
insurance legislation
3.2.3. Closely managing the insured subjects, especially those relating to
working.

24

CONCLUSION
The dissertation "The factors affecting the health insurance fund revenues in
Vietnam" has contributed as follow:
1 /. Systematizating the theoretical issues about health insurance and health
insurance fund revenues including: Concepts, classification and the role of health
insurance; Revenues of the health insurance fund, to distinguish the collection of
revenues; factors affecting the health insurance fund revenues. In particular, the
dissertation has researched and proposed a system of statistical indicators assessing the
development of health insurance fund revenues. Showing expericen in developing
health insurance fund revenues in several countries around the world, from which it
draws some lessons for Vietnam.
2 /. Analyzing and assessing the current status of health insurance revenues in the
2010 - 2014 period; factors affecting the revenue of the health insurance fund in
Vietnam in recent years. Through analysis, the dissertation clarified the obtained
results, as well as limited problems in collecting and developing health insurance fund
revenues, as well as limited reasons.
3 /. Recommending perspective system and solutions to develop health insurance

3.2.4. Raising the quality of health care treatment of health insurance
3.2.5. Renewing the collection and management of the health insurance fund revenues
3.2.6. Investing effectively reserve funds and the amount of idle money in the

fund revenue in Vietnam.
Although there are certain theoretical contributions as well as collections and
analysis of actual development of the health insurance fund revenue in Vietnam are

health insurance.

provided through secondary sources and primary with an aim to clarify the factors that

3.2.7.

affect revenue, the sample size of the survey is still not high, so the results analysis

Promoting the application of information technology and gradually

modernizing information technology in health insurance management

and evaluation is still more or less limited. As a policy of the Party and the State, a

3.2.8. Concretizing functions, tasks and issues related to health insurance agents

pillar in the social security policies system, health insurance, the revenue and the

3.2.9. Strengthening inspection, inspection and strictly handle individuals and

factors that impact the health insurance fund revenues need to be further studied. If the

organizations that commit violations of insurance law
3.3. Recommendations
3.3.1. For the Congress

income of the health insurance fund sustainably develops, the goal of universal health
insurance in our country will become a reality.
The solutions and recommendations to develop health insurance fund revenues

3.3.2. For the Government

in Vietnam as well as the content is presented in the dissertation certainly has not yet

3.3.3. For Ministry of Health

completed and there are many shortcomings; therefore, the author would like to

3.3.4. For Vietnam Social Insurance

receive additional comments, contributions from economists, of all interested people

3.3.5. For the Party committees and governments

to further complete the disseration.