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Health Financing and Delivery in Vietnam
Figure 3.8: Utilization Rates over Time for VSS Members and Vietnam’s Population as a Whole 2.0
25%
1.6
20%
1.4 1.2
15%
1.0 0.8
10%
0.6 0.4
5%
average growth rate per annum
contacts per person per annum
1.8
0.2 0.0
0% population
VSS
population
inpatient care 2003
2004
VSS
outpatient care 2005
2006
average growth per annum
Source: Authors’ calculations from VSS data and MOH Health Statistics Yearbook (various years). The population data reflect inpatient admissions and numbers of outpatients in all facilities including commune health centers.
VSS enrollees than among the population at large, but the cost has risen more quickly. Two explanations suggest themselves, both of which are likely to be at least partly true. Determining which is “truer” is impossible with existing data. The first is that adverse selection is becoming more serious for VSS. According to this view, worse risks are increasingly likely to join the voluntary schemes, and local governments increasingly likely to enroll the worse risks among the under-six children and Decision 139 target population, issuing the healthy a health card instead. The latter is good from the point of view of targeting government resources on those most in need, but adverse selection worsens VSS’s risk profile; if this is not taken into account when premiums and contributions are set, the result will be that VSS will inevitably run a deficit. Adverse selection can lead to the eventual collapse of a health insurance scheme, sometimes termed the health insurance “death spiral.” Insurers soon enough realize that their enrollees are not average risks, and that their revenues are insufficient to cover their