Temporal Trends in Patient Choice of Outpatient Care Provider Among Vietnam's Insured Rural Residents, 2006-2020.

Much of the existing empirical literature on patient choice of medical care provider in low- and middle-income countries is cross sectional in nature. Comparatively little is known about the dynamic shifts in patient choice of provider, particular under transitions to universal health coverage. Using eight biennial waves of Vietnam's Household Living Standard Survey covering the period 2006-2020 and a multilevel multinomial logit model, this study examined temporal trends in patient choice of provider among the insured rural residents. Patient choice of provider shifted steadily from commune health centres (CHCs) towards public hospitals and private health facilities over the study period. Patients were 3.9 and 8.3 times, respectively, as likely to use higher-level government hospitals and private hospitals over CHCs in 2018-2020 than in 2006-2008, and 2.8-3 times as likely to use district hospitals or private clinics. The shifts were more pronounced for economically better-off patients than the less better-off patients. Relative to 2006-2008, patients in the top three expenditure quintiles were 5.4 times as likely to use higher-level government hospitals over CHCs for a medical treatment in 2018-2020 than patients in the bottom two expenditure quintiles, and by as much as 11.5 times as likely to use private hospitals. These findings call for systemic policy measures that would relocate the entry point to the health system from hospital outpatient departments to grassroots primary care services and to improve public and private hospital accountability as a way of ensuring equitable access to high-quality essential health care for all.