Community perceptions of voluntary health insurance in rural Vietnam

OBJECTIVES To explore community perceptions of voluntary health insurance (VHI) as factors influencing low enrolment in VHI. METHODS A qualitative study was conducted using focus group discussions with men and women who are members of VHI schemes and who are not members in four districts in rural Vietnam. Data was analysed using grounded theory. RESULTS Many perceived that illness and the costs of illness cannot be predicted. Knowledge and understanding about HI (health insurance) schemes was limited. There is a common perception that HI can help with the costs of health care, and this is linked to buying HI when ill. Information about HI schemes is not well disseminated: information is often insufficiently detailed and inconsistent, whilst methods do not reach many. There were several complaints about HI schemes: the premium is too high for individuals and families; delay in receiving HI cards and frequent mistakes on cards prevents people using HI; and the drug list is too narrow, so people need to buy additional drugs. Many people with insurance perceived that they received lower quality care than those who paid fees for healthcare. They reported receiving fewer and cheaper drugs and less sophisticated investigations and treatments. They also felt they had to wait longer to be seen by healthcare workers. These experiences limited willingness to enrol and use of HI cards at outpatient facilities. CONCLUSION Low enrolment in VHI is affected by low perceptions of ability to control health risks, lack of understanding of HI in general and specific schemes and perceived problems with scheme administration, benefits and quality of health services. The potential problem of adverse selection may influence the sustainability of the scheme. Recommendations to increase enrolment and benefit from the scheme include improving communication with the rural population on HI, reducing the premium level (consider additional government subsidy), adjusting the benefit package, reducing administrative problems in the schemes and addressing provider payment issues