title: Can rural health insurance improve equity in health care utilization? A comparison between China and Vietnam.
abstract: BACKGROUND
  Health care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries.
  
  
  METHODS
  Household survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care.
  
  
  RESULTS
  In China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance.
  
  
  CONCLUSIONS
  China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance.
authors.affiliation: China Center for Health Development Studies, Peking University, PO box 505, 38 Xue Yuan Road, Hai Dian District, Beijing 100191, PR China. xliu@bjmu.edu.cn
authors.forename: Xiaoyun
authors.initials: X
authors.lastname: Liu
authors.forename: Shenglan
authors.initials: S
authors.lastname: Tang
authors.forename: Baorong
authors.initials: B
authors.lastname: Yu
authors.forename: Nguyen Khanh
authors.initials: NK
authors.lastname: Phuong
authors.forename: Fei
authors.initials: F
authors.lastname: Yan
authors.forename: Duong Duc
authors.initials: DD
authors.lastname: Thien
authors.forename: Rachel
authors.initials: R
authors.lastname: Tolhurst
mesh_terms: D000288:Administrative Personnel / Q000523:psychology; D000328:Adult; D002681:China / Q000453:epidemiology; D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D017281:Cost of Illness; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D019458:Insurance Coverage / Q000592:standards* / Q000706:statistics & numerical data; D009111:Local Government; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D036301:Qualitative Research; D012111:Residence Characteristics; D040841:Resource Allocation / Q000592:standards*; D019035:Rural Health Services / Q000191:economics*; D012923:Social Class; D014744:Vietnam / Q000453:epidemiology