title: Who is giving up the free lunch? The insured patients' decision to access health insurance benefits and its determinants: Evidence from a low-income country.
abstract: OBJECTIVE
  This paper examines the determinants of the insured's decision to use their health insurance card when seeking outpatient and inpatient health care in Vietnam.
  
  
  METHODS
  Uses Vietnam's latest Household Living Standard Survey data and random-intercept logistic regression to assess the influence of the observed individual, household and commune/ward factors on the insured's decision to access health insurance benefits while controlling for the unobserved commune/ward-specific factors.
  
  
  RESULTS
  Compared to the compulsory enrollees, the voluntary enrollees and the beneficiaries of the Health Care Fund for the Poor are less likely to use their card when seeking inpatient care. An individual's likelihood of accessing insurance benefits varies inversely with income and the level of education, suggesting that the outpatient care provided to the insured is of inferior quality.
  
  
  CONCLUSIONS
  Although health insurance has the potential of increasing access and reducing the financial burden of health care utilization, Vietnam's experience clearly suggests that these benefits may not be fully realized as long as the quality of care remains low and the high opportunity costs of accessing insurance benefits deter the insured from accessing benefits.
authors.affiliation: Department of Economics, University of Manitoba, Winnipeg, MB R3T 5V5, Canada. sepehri@cc.umanitoba.ca
authors.forename: Ardeshir
authors.initials: A
authors.lastname: Sepehri
authors.forename: Sisira
authors.initials: S
authors.lastname: Sarma
authors.forename: John
authors.initials: J
authors.lastname: Serieux
mesh_terms: D003657:Decision Making; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007342:Insurance Benefits / Q000191:economics*; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D016015:Logistic Models; D017059:Models, Econometric; D015999:Multivariate Analysis; D012111:Residence Characteristics; D014744:Vietnam