Abstract
In literature, there is limited direct evidence regarding the effect of health insurance coverage on firm performance and worker productivity. We study the impacts of health insurance on medium- and large-scale domestic private firms’ performance and productivity in Vietnam, using a large firm level census dataset. We find statistically, but suggestive, positive health insurance effects on both aggregate profit and profit per worker for both complying and non-complying firms when using the full sample. We further restrict the sample to specific industries. The positive health insurance effects could exist for both complying and non-complying firms in the heavy manufacturing and construction sector, while such positive effects could be only significant for complying firms in the wholesale/retail sectors. We could not find any evidence of positive health insurance effects in the light manufacturing sector. These results imply that the impacts of health insurance could be industry specific.
Acknowledgements
We would like to thank Yasuharu Shimamura, Koji Yamazaki, and the participants of the 2017 Asian Meeting of Econometric Society in the Chinese University of Hong Kong, Hong Kong, China for their helpful comments. This research was supported by the Japan Society for the Promotion of Science [Grant-in-Aid for Young Scientists 25780163] and Keio Gijuku Academic Development Funds.
Appendix
A Balancing test of propensity score estimations
| ATT | ATU | |||||
|---|---|---|---|---|---|---|
| Nearest 5 | Radius of 0.001 | Kernel | Nearest 5 | Radius of 0.001 | Kernel | |
| Full sample | ||||||
| Balancing test | ||||||
| t-value on the difference in means | ||||||
| ln (capital, million VND) | −1.60 | −1.58 | −0.11 | 0.25 | 0.34 | 1.18 |
| Share of long-term assets | 0.09 | 0.23 | 0.44 | −0.17 | 0.33 | −1.38 |
| ln (the number of employees) | 0.32 | 0.31 | 1.32 | −0.68 | −0.34 | −0.16 |
| ln (average wage per worker, million VND) | 0.01 | −0.13 | 0.20 | −0.17 | −0.25 | 0.41 |
| Debt-asset ratio | −0.51 | −0.51 | −0.71 | 1.11 | 0.99 | 1.36 |
| Firm's years of operation (years) | 1.03 | 1.08 | 0.93 | 0.19 | −0.04 | −0.73 |
| Owner/director's age (years) | 0.09 | 0.15 | 0.40 | 0.32 | 0.11 | −0.41 |
| Owner/director's age (years) squared | −0.30 | −0.21 | 0.09 | 0.38 | 0.16 | −0.26 |
| Owner/director's gender (=1 if male and =0 if female) | 0.06 | −0.04 | 0.94 | −0.18 | −0.39 | 0.23 |
| Light manufacturing sector | ||||||
| Balancing test | ||||||
| t-value on the difference in means | ||||||
| ln (capital, million VND) | 0.94 | 0.97 | 0.57 | −0.42 | −0.36 | −1.42 |
| Share of long-term assets | −0.32 | −0.31 | 0.48 | −1.05 | −1.08 | 0.26 |
| ln (the number of employees) | 0.31 | 0.30 | 0.12 | 1.22 | 1.21 | −0.74 |
| ln (average wage per worker, million VND) | −0.87 | −0.86 | −1.62 | 1.54 | 1.49 | −0.05 |
| Debt-asset ratio | 0.57 | 0.58 | −0.16 | 0.10 | 0.06 | −1.12 |
| Firm's years of operation (years) | 0.45 | 0.46 | 0.97 | 0.12 | 0.10 | 0.75 |
| Owner/director's age (years) | 0.95 | 0.93 | 1.21 | −0.48 | −0.48 | −0.21 |
| Owner/director's age (years) squared | 1.01 | 0.99 | 1.04 | −0.39 | −0.37 | −0.11 |
| Owner/director's gender (=1 if male and =0 if female) | 1.03 | 1.04 | 1.58 | −0.91 | −0.90 | −0.77 |
| Heavy manufacturing sector | ||||||
| Balancing test | ||||||
| t-value on the difference in means | ||||||
| ln (capital, million VND) | 0.50 | 0.46 | 0.41 | −0.24 | −0.14 | −0.37 |
| Share of long-term assets | −0.56 | −0.50 | −0.29 | 0.35 | 0.28 | −0.15 |
| ln (the number of employees) | 0.29 | 0.28 | 0.60 | 0.31 | 0.28 | 0.77 |
| ln (average wage per worker, million VND) | −1.25 | −1.28 | −0.93 | −0.89 | −0.81 | −0.21 |
| Debt-asset ratio | 0.44 | 0.50 | 0.13 | −0.61 | −0.52 | −0.74 |
| Firm's years of operation (years) | 1.52 | 1.53 | 1.31 | 0.83 | 0.69 | 0.89 |
| Owner/director's age (years) | −0.80 | −0.74 | −0.94 | 0.14 | 0.01 | 0.74 |
| Owner/director's age (years) squared | −1.04 | −0.99 | −1.15 | 0.35 | 0.22 | 0.98 |
| Owner/director's gender (=1 if male and =0 if female) | 1.11 | 1.14 | 1.12 | −0.08 | −0.12 | −0.72 |
| Construction sector | ||||||
| Balancing test | ||||||
| t-value on the difference in means | ||||||
| ln (capital, million VND) | −0.85 | −0.79 | −0.74 | −0.05 | 0.08 | 0.94 |
| Share of long-term assets | −0.11 | −0.07 | −0.01 | −0.69 | −0.61 | 0.32 |
| ln (the number of employees) | 0.09 | 0.08 | 0.66 | −1.26 | −1.29 | −0.85 |
| ln (average wage per worker, million VND) | 0.33 | 0.36 | 0.56 | 0.66 | 0.55 | −0.24 |
| Debt-asset ratio | 0.01 | 0.14 | 0.93 | −1.61 | −1.58 | 0.37 |
| Firm's years of operation (years) | −1.06 | −1.07 | 1.47 | −0.09 | −0.18 | 0.31 |
| Owner/director's age (years) | −0.06 | −0.20 | 0.68 | 0.60 | 0.47 | 0.18 |
| Owner/director's age (years) squared | −0.14 | −0.27 | 0.64 | 0.72 | 0.60 | 0.21 |
| Owner/director's gender (=1 if male and =0 if female) | −0.18 | −0.10 | 0.32 | −0.49 | −0.61 | −0.02 |
| Wholesale/retail sector | ||||||
| Balancing test | ||||||
| t-value on the difference in means | ||||||
| ln (capital, million VND) | 0.77 | 0.75 | −0.17 | 1.37 | 0.66 | 0.68 |
| Share of long-term assets | −0.27 | −0.25 | −0.31 | −0.22 | 1.47 | −0.10 |
| ln (the number of employees) | 0.33 | 0.29 | 0.27 | −0.22 | −0.33 | 0.99 |
| ln (average wage per worker, million VND) | −0.36 | −0.34 | 1.32 | −0.53 | −0.72 | −0.44 |
| Debt-asset ratio | 0.57 | 0.60 | −0.16 | 0.84 | −0.25 | 0.70 |
| Firm's years of operation (years) | −0.73 | −0.73 | −1.21 | 0.36 | 0.64 | 0.60 |
| Owner/director's age (years) | −0.25 | −0.17 | −0.15 | 0.26 | 0.29 | −0.19 |
| Owner/director's age (years) squared | −0.25 | −0.18 | −0.18 | 0.26 | 0.31 | −0.17 |
| Owner/director's gender (=1 if male and =0 if female) | −0.20 | −0.19 | −0.78 | 0.45 | 0.45 | −0.12 |
Note: 27 industry and 63 province dummies are omitted.
B Mean difference in outcome variables and regressors in the first stage probit
| With health insurance | Without health insurance | Difference | |
|---|---|---|---|
| (1) Light manufacturing sector | |||
| Outcome variables | |||
| Aggregate profit after tax deduction | 613.453 | 188.259 | 425.195 |
| (million VND) | (2,337.923) | (905.891) | (80,126)*** |
| Profit after tax deduction per employee | 3.508 | 1.800 | 1.708 |
| (million VND) | (15.155) | (10.030) | (0.564)*** |
| Regressors in the first stage probit | |||
| ln (capital, million VND) | 9.600 | 8.528 | 1.073 |
| (1.431) | (1.390) | (0.060)*** | |
| Share of long-term assets | 0.398 | 0.349 | 0.049 |
| (0.245) | (0.280) | (0.011) | |
| ln (the number of employees) | 4.682 | 4.182 | 0.500 |
| (0.888) | (0.749) | (0.035)*** | |
| ln (average wage per worker, million VND) | 3.095 | 2.903 | 0.192 |
| (0.447) | (0.517) | (0.020)*** | |
| Debt-asset ratio | 0.555 | 0.472 | 0.082 |
| (0.274) | (0.307) | (0.012)*** | |
| Firm's years of operation (years) | 7.150 | 4.923 | 2.226 |
| (5.998) | (4.129) | (0.225)*** | |
| Owner/director's age (years) | 45.787 | 44.003 | 1.784 |
| (9.113) | (9.085) | (0.386)*** | |
| Owner/director's gender (=1 if male and =0 if female) | 0.690 | 0.699 | −0.009 |
| (0.462) | (0.458) | (0.019) | |
| Sample size | 1,357 | 940 | |
| (2) Heavy manufacturing sector | |||
| Outcome variables | |||
| Aggregate profit after tax deduction | 1,076.016 | 194.194 | 881.822 |
| (million VND) | (2,846.251) | (987.843) | (79.164)*** |
| Profit after tax deduction per employee | 7.207 | 2.131 | 5.076 |
| (million VND) | (20.448) | (10.509) | (0.592)*** |
| Regressors in the first stage probit | |||
| ln (capital, million VND) | 9.887 | 8.852 | 1.035 |
| (1.213) | (1.188) | (0.041)*** | |
| Share of long-term assets | 0.386 | 0.363 | 0.023 |
| (0.219) | (0.237) | (0.007) | |
| ln (the number of employees) | 4.416 | 3.902 | 0.514 |
| (0.767) | (0.644) | (0.024)*** | |
| ln (average wage per worker, million VND) | 3.222 | 3.030 | 0.192 |
| (0.448) | (0.487) | (0.015)*** | |
| Debt-asset ratio | 0.570 | 0.489 | 0.081 |
| (0.248) | (0.277) | (0.008)*** | |
| Firm's years of operation (years) | 7.064 | 5.063 | 2.001 |
| (6.509) | (3.994) | (0194)*** | |
| Owner/director's age (years) | 46.269 | 44.278 | 1.992 |
| (9.099) | (9.117) | (0.312)*** | |
| Owner/director's gender (=1 if male and =0 if female) | 0.805 | 0.823 | −0.019 |
| (0.396) | (0.381) | (0.013)* | |
| Sample size | 2,164 | 1,393 | |
| (3) Construction sector | |||
| Outcome variables | |||
| Aggregate profit after tax deduction | 442.787 | 150.348 | 292.439 |
| (million VND) | (1,367.499) | (513.028) | (28.280)*** |
| Profit after tax deduction per employee | 4.359 | 2.510 | 1.849 |
| (million VND) | (13.003) | (8.394) | (0.301)*** |
| Regressors in the first stage probit | |||
| ln (capital, million VND) | 9.722 | 8.837 | 0.885 |
| (1.199) | (1.087) | (0.031)*** | |
| Share of long-term assets | 0.243 | 0.234 | 0.009 |
| (0.203) | (0.219) | (0.005)* | |
| ln (the number of employees) | 4.409 | 4.002 | 0.408 |
| (0.777) | (0.660) | (0.020)*** | |
| ln (average wage per worker, million VND) | 3.340 | 3.143 | 0.197 |
| (0.527) | (0.528) | (0.014)*** | |
| Debt-asset ratio | 0.602 | 0.483 | 0.119 |
| (0.246) | (0.277) | (0.007)*** | |
| Firm's years of operation (years) | 6.728 | 5.088 | 1.641 |
| (5.273) | (3.527) | (0.123)*** | |
| Owner/director's age (years) | 45.285 | 44.390 | 0.895 |
| (8.693) | (8.623) | (0.240)*** | |
| Owner/director's gender (=1 if male and =0 if female) | 0.908 | 0.902 | 0.006 |
| (0.289) | (0.297) | (0.008) | |
| Sample size | 2,479 | 2,696 | |
| (4) Wholesale/retail sector | |||
| Outcome variables | |||
| Aggregate profit after tax deduction | 645.592 | 258.293 | 387.300 |
| (million VND) | (2,095.714) | (1,353.808) | (71.030)*** |
| Profit after tax deduction per employee | 8.172 | 4.296 | 3.876 |
| (million VND) | (29.322) | (20.474) | (1.009)*** |
| Regressors in the first stage probit | |||
| ln (capital, million VND) | 10.052 | 9.491 | 0.561 |
| (1.163) | (1.127) | (0.043)*** | |
| Share of long-term assets | 0.231 | 0.241 | −0.011 |
| (0.210) | (0.221) | (0.008)* | |
| ln (the number of employees) | 4.019 | 3.795 | 0.223 |
| (0.605) | (0.542) | (0.022)*** | |
| ln (average wage per worker, million VND) | 3.452 | 3.330 | 0.122 |
| (0.500) | (0.505) | (0.019)*** | |
| Debt-asset ratio | 0.669 | 0.619 | 0.050 |
| (0.229) | (0.265) | (0.009)*** | |
| Firm's years of operation (years) | 6.966 | 5.478 | 1.489 |
| (4.369) | (3.870) | (0.160)*** | |
| Owner/director's age (years) | 44.516 | 43.703 | 0.813 |
| (8.906) | (9.036) | (0.341)*** | |
| Owner/director's gender (=1 if male and =0 if female) | 0.729 | 0.724 | 0.005 |
| (0.444) | (0.447) | (0.016) | |
| Sample size | 1,903 | 1,076 |
Notes:
Standard deviations are in parentheses for means and standard errors are in parentheses for the difference in mean.
***p < 0.01, **p < 0.05, *p < 0.10.
27 industry and 63 province dummies are omitted.
References
Aizawa, Naoki, and Hanming Fang. 2013. “Equilibrium Labor Market Search and Health Insurance Reform.” No. w18698. National Bureau of Economic Research.10.3386/w18698Search in Google Scholar
Baker, David W., Joseph J. Sudano, Jeffrey M. Albert, Elaine A. Borawski, and Avi Dor. 2001. “Lack of health insurance and decline in overall health in late middle age.” New England Journal of Medicine 345 (15): 1106–12.10.1056/NEJMsa002887Search in Google Scholar
Caliendo, Marco, and Sabine Kopeinig. 2008. “Some Practical Guidance for the Implementation of Propensity Score Matching.” Journal of Economic Surveys 22 (1): 31–72.10.1111/j.1467-6419.2007.00527.xSearch in Google Scholar
Cotlear, Daniel, Somil Nagpal, Owen Smith, Ajay Tandon, and Rafael Cortez. 2015. Going Universal: How 24 Developing Countries are Implementing Universal Health Coverage from the Bottom Up. World Bank Publications. http://documents.worldbank.org/curated/en/2015/09/25018544/going-universal-24-developing-countries-implementing-universal-health-coverage-reforms-bottom-up. Accessed 10 December 2015.10.1596/978-1-4648-0610-0Search in Google Scholar
Currie, Janet, and Brigitte C. Madrian. 1999. “Health, Health Insurance and the Labor Market.” Handbook of Labor Economics 3: 3309–416.10.1016/S1573-4463(99)30041-9Search in Google Scholar
Franks, Peter, Carolyn M. Clancy, and Marthe R. Gold. 1993. “Health Insurance and Mortality.” Journal of the American Medical Association 270 (6): 737–41.10.1001/jama.1993.03510060083037Search in Google Scholar
Gibson, Teresa B., A. Mark Fendrick, and Michael E. Chernew. 2012. “Cost-Sharing and Productivity. No. W18402.” National Bureau of Economic Research.10.3386/w18402Search in Google Scholar
Hadley, Jack. 2003. “Sicker and poorer – The Consequences of Being Uninsured: A Review of the Research on the Relationship between Health Insurance, Medical Care Use, Health, Work, and Income.” Medical Care Research and Review 60 (2_suppl): 3S–75S.10.1177/1077558703254101Search in Google Scholar
Heckman, James J., Hidehiko Ichimura, and Petra E. Todd. 1997. “Matching as an Econometric Evaluation Estimator: Evidence from Evaluating a Job Training Programme.” The Review of Economic Studies 64 (4): 605–54.10.2307/2971733Search in Google Scholar
Keele, Luke. 2010. “An Overview of Rbounds: An R Package for Rosenbaum Bounds Sensitivity Analysis with Matched Data.” White Paper. Columbus, OH: 1–15.Search in Google Scholar
Matsushima, Midori, and Hiroyuki Yamada. 2014. “Public Health Insurance in Vietnam Towards Universal Coverage: Identifying the Challenges, Issues, and Problems in Its Design and Organisational Practices.” Kokusai Hoken Iryo (Journal of International Health) 29 (4): 289–97.Search in Google Scholar
Ministry of Health. 2009. “BẢO HIỂM XÃ HỘI TỈNH BÌNH DƯƠNG.” Danh sách khám chữa bệnh 64 tỉnh thành. Accessed October 10, 2012. http://www.bhxhbinhduong.gov.vn/Danh-muc-co-so-KCB-ban-dau-.Search in Google Scholar
O'Brien, Ellen. 2003. “Employers' Benefits from Workers' Health Insurance.” The Milbank Quarterly 81 (1): 5–43.10.1111/1468-0009.00037Search in Google Scholar
Rosenbaum, Paul R. 2002. “Observational Studies.” In Observational Studies, 1–17. New York: Springer.10.1007/978-1-4757-3692-2Search in Google Scholar
Rosenbaum, Paul R., and Donald B. Rubin. 1983. “The Central Role of the Propensity Score in Observational Studies for Causal Effects.” Biometrika 70 (1): 41–55.10.21236/ADA114514Search in Google Scholar
Smith, Jeffrey A., and Petra E. Todd. 2005. “Does Matching Overcome LaLonde's Critique of Nonexperimental Estimators?.” Journal of Econometrics 125 (1): 305–53.10.2139/ssrn.286297Search in Google Scholar
Sorlie, Paul D., Norman J. Johnson, Eric Backlund, and Douglas D. Bradham. 1994. “Mortality in the Uninsured Compared with that in Persons with Public and Private Health Insurance.” Archives of Internal Medicine 154 (21): 2409–16.10.1001/archinte.1994.00420210037005Search in Google Scholar
Viet Nam News. 2013. Health insurance project goal: 80 % coverage by 2020. Accessed May 24, 2013. http://vietnamnews.vn/society/237645/health-insurance-for-all-project-approved.html.Search in Google Scholar
Vietnam Social Security (VSS). 2010. “Vietnam Social Security Annual Report.” Hanoi, Vietnam Social Security.Search in Google Scholar
Vietnam Social Security (VSS). 2011. “Vietnam Social Security Annual Report.” Hanoi, Vietnam Social Security.Search in Google Scholar
Vietnam Social Security (VSS). 2012. “Vietnam Social Security Annual Report.” Hanoi, Vietnam Social Security.Search in Google Scholar
World Bank. 2015. “World Development Indicators.” Accessed April 6, 2016. http://data.worldbank.org/data-catalog/world-development-indicators.Search in Google Scholar
World Health Organization. 2013. “World Health Report 2013: Research for Universal Health Coverage.” World Health Organization. Accessed November 27, 2017. http://apps.who.int/iris/bitstream/10665/85761/2/9789240690837_eng.pdf?ua=1.Search in Google Scholar
© 2018 Walter de Gruyter GmbH, Berlin/Boston
