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Survey for evaluating the impact of introducing free access to health services at district and commune level


Free access mechanism was designed to be introduced under the revamped Act of Health Insurance in 2014 and came into effect in January 2016 at district level. Before the introduction, Social Health Insurance (SHI) subscribers had needed to see doctors in a designated medical institutions as their first entry point and then to be referred to hospitals at a higher level, otherwise they had needed to pay a higher co-payment rate for seeing doctors in a non-designated hospitals without references and ended up with an increase in co-payment rate. On the one side, the free access mechanism brought more choices of hospitals at district level for the SHI subscribers District hospitals and commune health stations which had operated in a geographically separated market before might face a harsher competition within provinces. On another side, the expansion of choices for patients might congest hospitals at a higher level.

Since the government is now contemplating to scale up the free access mechanism to the provincial level in 2021, despite of its magnitude of the policy, what impacts were generated has not been rigorously analyzed yet. Upon the request from the Ministry of Health (MoH), the SHIP
Project in collaboration with ISMS conducted “the data collection survey for evaluating the impact of free access to health services at district level. Through the Survey, both positive and negative impacts of the policy are statistically reviewed and reported as evidence to examine whether the policy should be scaled up to the provincial level in the coming time.


The objective of the Survey is to identify potential benefits and practical obstacles of scaling up the free access mechanism to the provincial level by evaluating impacts of the policy implementation at district level in 2016.
The specific objectives of the Survey are to evaluate to impact of free access to:
1) using health services of patients with HI;
2/providing health service at district and commune level;
3/ managing of HI fund;
and thereby 4/ giving evidence-based recommendation to scale up to the provincial level.

Study design

The survey was combined quantitative and qualitative method. Qualitative data was collected through in-depth interview with patients, health officers and SHI officers. Quantitative data was secondary data on human resource, facility and health care services of selected provinces.

Study site and time

The survey was implemented in 6 provinces: Nam Dinh, Phu Tho, Kien Giang, Ho Chi Minh, Lam Dong, Binh Thuan from January to March 2020.


The Survey was carried out with financial and technical support of SHIP project – JICA.

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