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.

OBJECTIVES: 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.