Impact evaluation of social assistance policy for the elderly case study in giao an commune giao thuy district nam dinh province

Therefore, this study assesses the impact of social assistance policy for the elderly in term of two sub-polices: social monthly allowance and health care policy, by conducting a survey

VIETNAM NATIONAL UNIVERSITY, HANOI

VIETNAM JAPAN UNIVERSITY

BUI THI HOA

IMPACT EVALUATION OF SOCIAL

ASSISTANCE POLICY FOR THE ELDERLY: CASE STUDY IN GIAO AN COMMUNE, GIAO THUY DISTRICT, NAM DINH PROVINCE

MASTER’S THESIS

Hanoi, 2018

VIETNAM NATIONAL UNIVERSITY, HANOI

VIETNAM JAPAN UNIVERSITY

BUI THI HOA

IMPACT EVALUATION OF SOCIAL

ASSISTANCE POLICY FOR THE ELDERLY: CASE STUDY IN GIAO AN COMMUNE, GIAO THUY DISTRICT, NAM DINH PROVINCE

MAJOR: PUBLIC POLICY

SUPERVISORS:

Prof KATSURA RYOTARO Prof BUI THE CUONG

Hanoi, 2018

ACKNOWLEDGEMENT

First and foremost, I would like to express my heartfelt gratitude to my advisor, Professor Ryotaro Katsura, Professor Bui The Cuong I was privileged and fortunate to be under his supervision I appreciate all his continuous support, great contributions of time, ideas, and marvelous guidance with the immense knowledge and thorough understanding

I would like to extend my gratitude to all the professors from the program of Public Policy: Professor Okamoto Naoshi, Professor Hiroichi Kawashima, Doctor Nguyen Thuy Anh, Doctor Vu Hoang Linh for their useful orientations and their willing advices during doing this research amidst their busy schedules This thesis cannot

be fulfilled without their valuable comments and great advices Importantly, I honestly appreciate to all the supports from Vietnam Japan University.I also want give a thousand thanks to all the VJU friends for the happy time, companionship and encouragement

Last but not least, I would give my thankfulness to my parents andmy husband for their support and beloved attention

Student

Bui Thi Hoa

ABSTRACT

There is increasing recognition among the government and donor organization that evaluation of public intervention or national program should feature in the social policy decisionmaking process In Vietnam, the terminology of impact evaluation is quite not popular, and the policy makers often focus on assessing the input of policy/program Therefore, this study assesses the impact of social assistance policy for the elderly in term of two sub-polices: social monthly allowance and health care policy, by conducting a survey (110 respondents) in Giao An commune, Giao Thuy district, Nam Dinh province The result from this survey shows that, although the social assistance policy helps the recipient to improve their life, the level of improvement is still low For instance, this policy just has impact on enhancing the nutrition condition, but not significant impacts on guaranteeing the minimum living standard or decreasing the expenditure on health care Based on the evidences from the survey, policy implication is also suggested

TABLE OF CONTENT

ACKNOWLEDGEMENT i

ABSTRACT ii

LIST OF TABLES v

LIST OF FIGURES vi

CHAPTER 1: INTRODUCTION 1

1.1 Research background and problem statement 1

1.2 Purpose of study 3

1.3 Research question 4

1.4 Scope of the research 4

1.5 Structure of the thesis 4

CHAPTER 2: LITERATURE REVIEW 5

2.1 Social assistance 5

2.1.1 Definition of social assistance 5

2.1.2 Approach to social assistance 6

2.1.3 Category of social assistance 7

2.1.4 Role of social assistance 7

2.2 Social assistance policy 7

2.2.1 Definition of social assistance policy 7

2.2.2 Purpose of social assistance policy 7

2.2.3 Content of social assistance policy 8

2.2.4 Factor influencing to social assistance policy 11

2.3 Literature review on social assistance policy for the elderly 11

2.3.1 Study on the overview of social assistance policy 11

2.3.2 Study on impact of monthly social allowance for the elderly 13

2.3.3 Study on impact of health care for the elderly 14

CHAPTER 3: METHODOLOGY 16

3.1 Rationales for using a quantitative and qualitative approach 16

3.1.1 Qualitative method 16

3.1.2 Quantitative method 16

3.2 Sampling design 17

3.3 Questionnaire design 18

3.4 Survey process 18

3.5 Data analysis 19

3.6 Study site 19

CHAPTER 4: FINDINGS FROM SURVEY 21

4.1 Situation of implementing social assistance policy for the elderly at Giao An commune 21

4.2 Finding and discussion 22

4.2.1 General information of survey sample 22

4.2.2 Impact of social monthly allowance on the elderly 27

4.2.3 Impact of health care policy on the elderly 31

4.2.4 Aspiration of the elderly 40

CHAPTER 5: CONCLUSION AND IMPLICATION 42

5.1 Conclusion 42

5.2 Implication 42

5.3 Limitation and further study 43

REFERENCES 44

Appendix: 48

LIST OF TABLES

Table 3.1: Selecting the respondents 18

Table 4.1: Characteristic of the respondent 23

Table 4.2: Education level of older people in treatment group 25

Table 4.3: Marital status of the elderly in control and treatment group 25

Table 4.4: Sex Ratio of the Old-Age Population in Giao An commune 26

Table 4.5: The proportion of participating in economic activity 27

Table 4.6: Source of income of treatment group 28

Table 4.7: Evaluating the impact of social assistance policy 30

Table 4.8: Assessing the life before and after receiving the social monthly allowance 31

Table 4.9: Health status of control and treatment group 33

Table 4.10: Expenditure for health care 36

Table 4.11: Evaluating the impact of health care policy 38

Table 4.12: Evaluate of the elderly about their health status after receiving the health care policy 39

LIST OF FIGURES

Figure 3.1: The poverty rate of population and the elderly 20

Figure 4.1: The number of people receiving social assistance policy from 2014 to 2017 in Giao An commune 21

Figure 4.2: The expenditure for social monthly allowance from 2014 to 2017 in Giao An commune 22

Figure 4.3: Spending of social allowance 29

Figure 4.4: Trends in self-reported health by gender and groups 32

Figure 4.5: The frequency of going to the health facility 34

Figure 4.6: The type of health facility that the people in treatment group often visit 35

Figure 4.7: Situation of receiving the health care measures 37

Figure 4.8: Impact of health care policy on some aspects 38

Figure 4.9: Aspiration of the elderly 41

CHAPTER 1: INTRODUCTION

1.1 Research background and problem statement

In order to improve the living standard, the Vietnam’s government has implemented

a large number of support programs (income redistribution programs) such as cash transfers and food supply The social assistance policy for the social protection subjects was established since 1945, with the aim to support for the people who were affected by war, natural disasters, the orphan children and the people with disabilities Along with the development of socio-economic, the social assistance policy was amended to meet the requirement of people as well as to cover more vulnerable people To date, this policy is a crucial part of social protection policy Social assistance, or in other words, non-contributory social protection (Katja Bender et al, 2013) is benefits in-cash or in-kind of financed by the state (from general taxes, not contributory) to secure the minimum living standards for people According to the Resolution No 15/NQ-TW of the Communist Party, the social assistance policy includes 2 main components: (i) regular social support in community, and (ii) unplanned social support The regular social support in community embraces monthly social allowance, health care and support for education and vocational training, focuses on people who particularly vulnerable, such as those over-80 years, people with severe disabilities, people with HIV/AIDs, and children in single-parent families

The national social assistance system itself has evolved as a lifecycle system, addressing risks related to old age, disability, childhood and unemployment Investment in social assistance has been relatively limited In 2015, the investment for regular social assistance was only 0.31% of GDP (Khondker, 2015), in which the largest schemes were transfers for people aged 80 and over and for people with disabilities (Long, G.T and Cuong, N.V, 2014) While Viet Nam’s over-80s social allowance is the largest scheme, its overall expenditure just covers for 0.09% of

GDP, lower than many other developing countries, many of which invest more than 1% of GDP (Castel and Anh P.H, 2014) The coverage of the population by regular social assistance transfers is also low (Long, G.T and Cuong, N.V, 2014) There are approximate 2.7 million individuals receive one of the social assistance allowances, among that, the recipient is elderly accounting for nearly 60 percent According to the Decree No 136/ND-CP about the social support policies for social protection subjects in Vietnam, the standard of social assistance is 270.000 VND (~$12) per month The value of the over-80s allowance is one of the lowest social pensions in developing countries, at 6.7% of GDP per capita, with many countries paying at above 15% of GDP per capita

Vietnam is facing with the trend of aging population In 2013, the elderly (the older person who is over 60 years old) in Vietnam reached 10.2 percent of total population (GSO, 2013), and Vietnam has already entered the “ageing phase” The increasing in the number of the older people represents the great achievement of the government in improving the physical and spiritual life, preventing diseases and health care However, rapid population aging has a profound impact on economic,

as well as on the infrastructure and social conditions (UNFPA, 2011) in the context

of a lower-middle-income country as Vietnam The older people is also a subject of social protection system, hence, the retirement, pensions, especially the social benefits tend to extend longer due to there are more people live longer It requires the Vietnam government to consider about how to remain the social security system

as well as the social assistance system effectively (Bravo, 2011) On the other hand, increasing in life expectancy might also result in increasing the treatment costs and raising the demands for health care systems, because the elderly are typically more vulnerable to chronic diseases

Despite a vast number of state budgets spent on social assistance for the older person in Vietnam, there is still very little known about the actual impact of this intervention on the target group More commonly, the policy makers focus on assessing the input and immediate output of a policy, for instance: How much

money is spent? How many health insurance cards are distributed - rather than assessing whether these polices have achieved the intended goals (Paul J Gertler et

al, 2016) In order to enhance the effectiveness of the social assistance programs for the elderly, it’s important to evaluate the impact of these programs Impact evaluation can increase the effectiveness of the policy by providing helpful information for decisions as to whether the program should be terminated of expanded (Cuong, 2014)

According to the research of World Bank (2008), the social protection program in Vietnam still has the gap in term of limited coverage, weak outreach to marginalized and vulnerable people, and a high leakage rate A number of previous studies posit that Vietnam has not been capable of dealing with these gaps, which in turn may have negative impacts on effectiveness and efficiency of these programs and policies Unless these gaps are closed, they may even exacerbate social inequality and disparities between different groups of the population

Therefore I decide to choose the topic: “Impact evaluation of social assistance policy for the elderly: Case study at Giao An commune, Giao Thuy district, Nam Dinh province” as my master dissertation

1.2 Purpose of study

The main objective of evaluating the impact of a policy is to assess the extent to which the policy has changed outcomes of the policy beneficiaries Therefore, my study aims to elucidate the impact of social assistance policy on the senior people

by conducting a survey at Giao An commune, in order to improve the efficiency of spending public resources as well as to find out the alternative measures to implement this policy This study measures the impact of social assistance policy on the elderly based on some key indicators such as poverty, income, access to health care service and expenditure for health

1.3 Research question

The research seeks to answer the main question: Do the social assistance policy (including two programs: monthly social allowance and health care) cause better living condition and health in elderly

1.4 Scope of the research

The research focuses on investigating the impact of social assistance policy for the elderly at Giao An commune, Giao Thuy district, Nam Dinh province The data was collected from 2014 to 2017

1.5 Structure of the thesis

The thesis includes 5 chapters:

Chapter 1: Introduction

Chapter 2: Literature review

Chapter 3: Methodology

Chapter 4: Findings from survey

Chapter 5: Conclusion and implication

CHAPTER 2: LITERATURE REVIEW

2.1 Social assistance

2.1.1 Definition of social assistance

Social assistance is known based on some aspects: feature, role, approach and so on Although most of the updated documents have not yet provided the whole definition

of social assistance, there were some documents explained the terminology closed

to social assistance

According to the Ministry of Labor Invalids and Social Affair, Social protection is

the policies, activities of the government and communities in order to help the vulnerable subjects/groups to ensure the minimum living condition as well as to help them to integrate to community and contribute to the development of society

In the definition of UNICEF (2006), Social work is the motivation for changing in

society, motivation for tackling the problems and motivation for empowerment The principle of human right and social equality are the core value of social work

Another organization define that social welfare is a component of GDP, which is

used to meet the demand of citizens in term of physical and spirit Social welfare includes of expenditure for pension, social insurance, scholarship and subsidy for education, health care services and so on

In the research of Nguyen Hai Huu (2007), Social security is a system of schemes,

policies, measures of the government and community in order to help all of the citizens to respond to the risks and shocks in economic, which lead them to the accident, decrease in income or fall into poverty

Dinh Nguyen Van (2008) said that, Social relief is the support in kind of financial

from government and community for the people who face with the difficulties, risks

such as: natural disaster, disabilities, older … His opinion on social assistance was

that “it is a support from community by cash or other appropriate measures in order

to help the recipients integrate to society”

From the above definition, it can be said that, social assistance is not only the responsibility of government, but also of society, not only for a certain group, but also for other vulnerable groups And, more important, social assistance is a pillar/ component of social security system Hence, social assistance can be defined as

“Social assistance policy is the measures and solutions of the government in order

to help the social protection subjects to overcome difficulties in the immediate and

in long term This guarantee of government is implemented through providing the monthly financial support, health care services, education and other social assistance services”

2.1.2 Approach to social assistance

Human right approach

This approach considers the human as the center of policy; hence the government should have the measure to help the people who cannot implement their rights and

to help them to ensure the basic condition for their life The responsibility of government is to guarantee the safe for all of the member in society when they have

to face with some challenges such as: decrease in income, get the shocks in economic … Base on this approach, the social assistance was planned to ensure the food, clean water, safe house, access to health care services, access to education, communication …

Risk management approach

According to this approach every people in society has to face with risks The risks lead the people to decrease in income, loose the caregiver or affect to the livelihood Social assistance is the measure to manage and prevent the risk

Universal approach

According to the viewpoint of this approach, all members in society have the demand on ensuring the social security Therefore, providing the social assistance for all subjects, no need any requirement as well as the priority criteria The good point of this approach is that the criteria to select the subject is simple, therefore the

management cost is low However, the disadvantage of this approach is the low level of support, and this leads to not ensure the minimum living standard This approach just consider about the coverage rate, not focus on the quality of the support

2.1.3 Category of social assistance

Regarding to the way of implementation, there are two kinds of social assistance, including regular social assistance and un-planned social assistance

Regarding to the subjects of social assistance, it consists of the elderly, the people with disability, the orphan children, and other vulnerable subjects

Regarding to the place of subject, including support in community and support in the welfare-house

2.1.4 Role of social assistance

Social assistance is a management instrument of government; therefore, it has some role such as: ensuring the social security for society, redistributing the income in society and preventing and addressing the risks

2.2 Social assistance policy

2.2.1 Definition of social assistance policy

Social assistance policy is a component of Vietnam’s overall social security and poverty reduction system Social assistance policy is the measures and solutions of the government in order to help the social protection subjects to overcome difficulties in the immediate and in long term This guarantee of government is implemented through providing the monthly financial support, health care services, education and other social assistance services

2.2.2 Purpose of social assistance policy

The general purpose of social assistance policy is to address the problem of equality, stability and sustainable development in politics and socio-economy The detail goal of this policy is to help the social protection subjects to have a stable and

safe living condition, to integrate into society and to contribute to the development

of society

2.2.3 Content of social assistance policy

Assistance forms are also diversified, include the monthly allowance (by cash), nurturing fees in the social protection centres; supporting healthcare and medical cost, education, accommodation, and clean water

Vietnam provides non-contributory social assistance cash transfers to different categories of the population Social assistance cash transfers are available under Decree No.136/2013/ND-CP to orphans, children and adolescents deprived of parental care, elderly living alone, people above the age of 80 without a pension, severely disabled unable to work, mentally disabled and poor single parents (see Box 1)

According to the Decree No.136/ND-CP, the standard of social support is 270.000 VND per month, and the following six groups are entitled to monthly social

assistance benefits:

Box 1: The social subject of social assistance policy

1 Children under 16 years old having no nurture source subject to one of the cases prescribed as follows:

a) Being abandoned and not yet adopted;

e) Both mother and father are missing as stipulated by law;

g) Both mother and father are receiving the care and nurture benefits at the social protection establishments or social houses,

h) Both mother and father are serving the prison term in jail or is exercising the decision on handling of administrative violation at the reform schools, compulsory educational establishments and compulsory detoxification establishments;

i) Mother or father is missing as stipulated by law and the remaining parent is receiving the care and nurture benefits at the social protection establishments or social houses,

k) Mother or father is missing as stipulated by law and the remaining parent is serving prison term

in jail or is exercising the decision on handling of administrative violation at the reform schools, compulsory educational establishments and compulsory detoxification establishments;

l) Mother or father is receiving the care and nurture benefits at the social protection establishments

or social houses and the remaining is serving prison term in jail or is exercising the decision on handling of administrative violation at the reform schools, compulsory educational establishments and compulsory detoxification establishments;

2 Persons between 16 and 22 years subject to one of the cases specified in Clause 1 of this Article are in high school, vocational school, professional school, college and university of first degree

3 Children infected with HIV of poor households and persons infected with HIV of poor

households without monthly pension, social insurance allowance, monthly preferential allowance for revolutionary contributors and other monthly allowances

4 People of poor households who are not married; are married but the wife or husband has died or

is missing as stipulated by law and is raising children under 16 years or child from 16 to 22 years old and these children is in high school, vocational school, professional school, college and

university of first degree (hereafter referred to as poor people who are raising children)

5 The elderly people subject to one of the following cases:

a) The elderly people of poor households do not have any person with obligations and rights to serve them or have person with obligations and rights to serve them but this person is receiving the monthly social allowance

b) The elderly people from 80 years or older not subject to the provisions under Point a of this Paragraph have no monthly pension, social insurance allowance or social allowance;

c) The elderly people of poor households do not have any person with obligations and rights to serve them; have no condition to live in community, meet the conditions to be admitted to the

social protection establishments or social houses but there are other people who wish to take care of them in community

6 Disabled children and disabled people eligible for social allowance as stipulated by law on disabled people”

The content of social assistance policy including three sub-policies: (i) the social monthly allowance, (ii) the health care policy and (iii) the education and vocational support policy This study will examine the impact of the social monthly allowance policy and health care policy for the elderly.In 2015, more than 2.643.000 people in the targeted group have received the monthly cash transfer and the supporting (subsidy) for health insurance card, in which, the elderly accounts for 56 percent

Social monthly allowance policy

Social allowance is the amount of money that the government allocates monthly to the policy beneficiary to buy food and other necessary expenses for their life The level of social allowance is calculated based on the minimum expenditure to maintain the daily life of the subject This allowance also includes the cost for the caregiver in case of the beneficiary cannot self-care.The different beneficiary groups will have the different in the level of allowance The level of allowance is adjusted by the development of socio-economic and the available of state budget This program was implemented in 2004 to provide a minimummonthly benefit of VND 65,000 (about $US 4) to all elderly people aged 90 and overwho did not have

a contributory pension and not eligible for other special socialallowances In April

2007 (under Decree No.67/2007/ND-CP), the minimum eligible agewas reduced to

85, and the minimum monthly benefit was increased to VND 120,000(about $US 7) In 2010 (under Decree No.13/2010/ND-CP), the minimum eligible age wasreduced to 80, and the minimum monthly benefit was increased to VND 180,000 (about$US 9) In 2013, the social assistance policy was amended by the Decree No 136/2013/ND-CP, and the minimum monthly benefit was increased to VND 270,000 (about $US 12)

Health care policy

The policy of caring for the elderly health is implemented through: (i) issuing freely the health insurance card for the people over 80 years old; (ii) prioritizing medical examination and treatment for the old people; (iii) disseminating the common knowledge in term of disease prevention and self-healthcare; and (iv) coordinating with the higher level of health facility in periodical health checkup

The health insurance policies are concerned about how to mitigate households’ lost of welfare in case of unexpected health expenditure or lost of labor income because of a member’s sickness, maternity leave, unemployment, disability, old-age or death

2.2.4 Factor influencing to social assistance policy

Analyzing the factor which has impact on social assistance policy is necessary in order to find out the causes and lessons learn from the success or failure to improve the policy The number of beneficiary is an important factor that affecting to social assistance policy If the coverage of this policy is not too much, the policy will be designed to increase the level of support However, if the policy covers all the members in society while the budget is limited, the level of support will be designed to reduce This factor has significant impact on the effectiveness and efficiency of policy The demand of beneficiary is one of the factors influencing to the implementation

of policy A success policy focus on the demand of the recipient, it means that the policy will provide toward the need of the beneficiary

Another factor is capacity of the people who will get the support from government The capacity includes (i) the capacity to ensure the individual demand by themselves, (ii) and the capacity to access to the policy

Besides, the politic, legal documents and culture also have the impact on social assistance policy on some aspects

2.3 Literature review on social assistance policy for the elderly

2.3.1 Study on the overview of social assistance policy

Social assistance policy is an important pillar of social security system in Vietnam Focusing on the regular social support program – a component of social assistance

policy, the study of Toan (2010) and Cuong (2013) provide an overview of the implementation of this policy In their researches, the education support program, monthly social support program and health care program for all the protection subjects were examined Both studies show that, although social assistance policy have a significant impact on the beneficiaries, it still has some shortcomings such as low coverage, low level of support and the criteria to choose the recipient is not consistent

According to the same study of Kidd Stephen et al (2016), there are some challenges that social assistance system in Vietnam is facing, such as high proportion of disability, inequality, aging society and climate change Their study also demonstrates that many older people experience poverty and poverty rates are higher among older women In other research, Giang (2012) also shows the current state and the challenges that the social protection policy (for the vulnerable groups) facing His study emphasizes on examining the delivering and accessibility of the people in vulnerable group in term of health insurance, retirement pensions and social assistance The paper finds that the transfer of services and financial support are still unequal between groups, in which the advantaged groups have better utilization of services than disadvantaged groups The strengths and weaknesses of current social assistance system are also seen in Evan’s study (2011) This study explores the issues of implementation and performance of the current program design, especially the issues of budget allocation, implementation and monitoring The evidence from the study of Evan and Harkness(2008) reports that, currently, the social protection program in Vietnam is scattered and the Vietnam government tends to improve the inequality by the state transfers However, these supports are quite not proportionate For instance, the recipient of such transfers mostly is the people in formal sector, with higher level of education achievement, often living in urban areas and getting the pension In contrast, other vulnerable groups such as the poor, the disability or the older people are rarely the beneficiaries of this government protection and examines the consequences of the current policies for a

better reform This research provides the empirical evidence of the elderly’s need on social the same purpose, in order to provide the evidence for the plan of expanding the coverage of social assistance program, the note of WorldBank (2010) indicates anevaluation of the arrangements for delivering Vietnam’s main social assistance program, and proposes options for further strengthening in the short and medium term This study uses the data collected from Ha Giang Province and Ho Chi Minh City in July 2010 The finding shows that the current delivery mechanisms for social assistance are basic, with limited human resources, no caseload management and no integrated database that would allow tracking of beneficiary numbers Therefore, the expected increase in beneficiary coverage implies that program administration will have to be systematically strengthened and professionalized to ensure effective implementation

There are some studies pay attention on the factor that affecting the social assistance policy For instance, study of Dung Nguyen Duy (2015) shows that along with the change in demographic, climate change is also a significant factor influencing to the implementation of this policy Another study (Handayani, Sri Wening at al, 2017) suggests that information and communication technology also affects to social assistance program due to the demand for more accurate and efficient service Information and communication technology provides convenience and faster service as well as better security for beneficiaries and the public

2.3.2 Study on impact of monthly social allowance for the elderly

Recently, cash transfers are increasingly considered as the most effective social protection policy instruments to help the most vulnerable group by breaking the intergenerational transmission of poverty, preventing exposure to short term shocks, contributing to human capital development and reducing the inequality Evidence from some countries indicates that such programs have had positive impacts in poverty reduction, education, health, and nutrition (UNICEF, 2009)

The research of Giang (2011) shows a prospective assessment of the potential impacts of expanded cash transfer programs for various types of elderly people on

old-age poverty reduction, by using the data from the Viet Nam Household Living Standards Survey The finding of this study indicates that a cash transfer program would influence in reducing the poverty rate among the old-age group Especially, this results shows that, given a limited resource, the elderly living in rural area would be most effective for poverty reduction, and that a program which providing lower benefits to a higher number of recipients would be better in reducing poverty incidence than a program that providing higher financial support to a lower number

of recipients The same was found in study of Sothea Oum et al (2010) Additional finding by this study also suggests that the cash transfer program would be influential in reducing poverty rate among the old-age group The result in Giang et

al (2013) study also demonstrates that cash transfer would help reduce expenditure inequality

Pham and Castel (2010) carried a research in order to assess the potential impact of cash transfer (social allowance) – a new program of social assistance designed in the Decree No 67/2007/ND-CP This study aims to estimate how many people and families could benefit from the new policy if it had enough resource to be fully implemented without any restriction The result of their research indicates that a large share of the extremely poor would remain excluded from this policy

2.3.3 Study on impact of health care for the elderly

The program Health support for the old person aims to provide them with the access

to high quality health care services It includes three main components: (i) provision

of the health care card for the elderly; (ii) exemption and education of health care fees for the elderly; and (iii) provision of medicines, health facilities, and human resources for health centers in localities However, recently, the study of Giang and Bui(2013) show that although the health insurance and health-care services have been expanded in Vietnam over the past decade, the most vulnerable groups among older persons have lower access rates and a greater financial burden In concordance with previous research, Evan (2011) found that the coverage for elderly by health

cards was weak, and this study suggests that additional efforts need to be made to reach low income households for access to healthcare

Focusing on assessing the need of daily care and their socio-economic determinants among senior people living in rural area, the study of Hoi, L.V et al (2011) founds that the offspring (including children and grandchildren) are the main caregivers for the older people Age group, sex, educational level, marital status, household membership, working status, household size, living arrangement, residential area, household wealth, poverty status, and chronic illnesses were determinants of daily care needs in old age The same was found in study of Giang Thanh Long et al (2018) This study explored the factors associated with the perceived health status

of the Vietnamese older people The study found that there were no statistically significant differences between older people in their perceived health status in terms

of age group, gender, marital status, and living area In contrast, however, the study also found that reading ability, working status, morbidity, activities in daily living, experience of domestic violence, household income, and satisfaction with housing conditions were strongly correlated with older people’s perceived health status

In the study of Kyung-Sook Bang et al (2017) about the health status and related quality of life of rural elderly Vietnamese, they found that women were more functional limitations than men, and more than half the respondents requested more healthcare information, particularly on disease management

health-The study of Teerawichitchainan (2010) describes differences in health perception and reporting among elderly men and women in Vietnam and discusses the implications of such differentials on health outcomes Two health indicators, self-rated health and hypertension, are examined Results demonstrate a complex picture

of how actual health statuses and perception about health can differ among male and female elders Evidence suggests gender is but one of several dimensions that differentiate health in later life While older women are more likely to be vulnerable because of their survival to later ages and widowhood, they do not necessarily have poorer health than men

Qualitative information such as understanding the local sociocultural and institutional context, as well as program and participant details Qualitative information can help identify mechanisms through which programs might be having

an impact; such surveys can also identify local policy makers or individuals who would be important in determining the course of how programs are implemented, thereby aiding operational evaluation But a qualitative assessment on its own cannot assess outcomes against relevant alternatives or counterfactual outcomes That is, it cannot really indicate what might happen in the absence of the program Hence, in this study, I also used the quantitative method to evaluate the impact of social assistance policy for the elderly

3.1.2 Quantitative method

Quantitative analysis is important in employing the program impacts A mixture of qualitative and quantitative methods might therefore be useful in gaining a comprehensive view of the program’s effectiveness The quantitative evaluation

setupinvolved comparisons of outcomes across matched treated and untreated pairs

of communities

There are two types of quantitative impact evaluations: ex post and ex ante An ex ante impact evaluation attempts to measure the intended impacts of future programs and policies, given a potentially targeted area’s current situation Ex post evaluations, in contrast, measure actual impacts accrued by the benefi ciaries that are attributable to program intervention One form of this type of evaluation is the treatment effects model Ex post evaluations have immediate benefits and reflect reality

3.2 Sampling design

The program impact is equal to the difference between the average outcome when the participants did participate in the program and the average outcome of the same participants when they had not participated in the program The fundamental problem in measuring the program impact is that the outcome of the participants if they had not participated cannot be observed In this case, the counterfactual is used

to estimate the impact of program A comparison group (also called control group)

is constructed so that their characteristics are similar to those of the participants in program (called the treatment group) The difference between the treatment and comparison groups is that the treatment group participated in the programs while the comparison group did not

In this study, the treatment group includes older persons who receiving the social support, and the control group consists of older persons who are not benefit from this policy Total number of the elderly in the case study is 1.454 people, in which, the figure of the elderly receiving government assistance is 177people From the list

of 177 people, 70 older people were selected for treatment group, from 80 to 84 years old For the comparison commune, there are 40 respondents were chosen

randomly from 1.277 older people (1454 minus 177) who do not participate in this policy, and are from 75-79 years old (See more in table 1) Both the people in two groups have the same characteristics in term of income, health status and access to social services

Table 3.1: Selecting the respondents

Total number

of people

from

Selected for survey

80 – 84 years old

75 – 79 years old

Treatment group (people over 80 years

old)

Comparison group (people from 60 to 79

years old and do not receive any kind of

financial support from government)

of questionnaire survey consisted of 110 respondents

For the local government, in-deep interview is conducted to gather the information

in term of the condition and criteria to select beneficiaries, factor affects the policy and how policy should be improved There were 4 communal cadres took part in the in-deep interview

3.4 Survey process

The survey was organized into two parts

Firstly, before carrying out the survey, a test of survey was conducted on 10 respondents to check and find out the mistake, the illogicality of the questionnaire After that, the questionnaire was discussed and edited to fit with the reality

In the second part, the survey was carried out This survey lasted 3 weeks, from October, 29th to November, 18th, with both in-deep interview and questionnaire survey Due to a major of respondentsneeds the support when they want to read, or write or communicate, hence, each interview took around 30 minutes to explain and fill the data For each case study of the in-deep interview, I also observed the daily life, livelihood, house status … in order to re-check/verify the information that they provided

The main source of income is from agricultural production and aquaculture with the income per capital is 37.500.000 VND The poverty rate of Giao An commune in

2017 is 4.6%, in which, the poverty rate among the people aged 60 and over is much higher, at 8.3% (see more in figure 1)

Figure 3.1: The poverty rate of population and the elderly

Source: Report on the socio-economic of Giao An commune in 2014, 2015, 2016,

2017

Giao An commune is chosen as a case study in order to evaluate the impact of social assistance policy for the elderly due to some following reasons First, the majority of the older adult lives in the rural area, hence, selecting Giao An commune – a commune located in the rural of Red river delta is quite suitable Second, the proportion of the old people at this commune is 13.2% ( according to the report on the socio-economic 2017), it means that Giao An population has already entered the “aging phase” Third, due to the poverty rate and the income per capita of Giao An commune is quite similar with the average figure of the whole country, so that this case study is representative

CHAPTER 4: FINDINGS FROM SURVEY

4.1 Situation of implementing social assistance policy for the elderly at Giao

An commune

At Giao An commune, the social assistance policy was carried out fully and timely for the vulnerable groups The total number of recipient increases from 2.868 people in 2014 to 4.080 people in 2017 In which, the number of beneficiary in old-age group also increases, from 1.848 people in 2014 to 2.124 people in 2017 It can

be said that, the proportion of recipient is elderly covers for more than fifty percent

of total beneficiaries

Figure 4.1: The number of people receiving social assistance policy from 2014

to 2017 in Giao An commune

Source: Report on the socio-economic of Giao An commune 2017

For the social monthly allowance, the total expenditure for all subjects in 2017 is 1.189.350.000 VND, in which, the spending of this kind of support for the old people accounts for 48% It means that the financial support level for the elderly is lower than other vulnerable groups Among the older people who received the monthly allowance from government, the proportion of elderly female is higher

than elderly male Particularly, in 2014, proportion of female-recipient is 76.6%, this figure in 2017 is 70%

Figure 4.2: The expenditure for social monthly allowance from 2014 to 2017 in

Giao An commune

Source: Report on the socio-economic of Giao An commune 2017

About the implementation of health care policy, in 2017, the Giao An commune health center examined for 2.902 people which covered by health insurance fund The commune authority also spent 252.000.000 VND to support for the household with average living standards and household with difficult circumstances to buy the health insurance card Up to now, the coverage of health insurance card at Giao An commune is 85.2%

4.2 Finding and discussion

4.2.1 General information of survey sample

The sample of this study consisted of 110 respondents and were divided into two groups: control group (40 respondents) and treatment group (70 respondents) These respondents were randomly recruited from 22 villages of Giao An commune

As shown in table 2, of the 110 respondents who completed the questionnaires, 37.3

% were male, while 62.7% were female Among the older people of control group,

Expenditure for social monthly allowance

Total amount of money spending for social assistance

The amount of money spending for social assistance for the elderly

more than 50% achieved the highest education level at primary school, and 20% of them graduated from secondary school The proportion of people illiteracy in comparison group (2.5%) was much lower than the treatment group (21.43%) Nearly 70% of respondent in beneficiary group has the highest level of education at primary school

Table 4.1: Characteristic of the respondent

Characteristics

Control group

Treatment group

Not graduated secondary school

Source: Compiled by author based on the data from the survey

Especially, the result from statistic of treatment group indicates that, the education level of female is lower than male Particularly, with the level of education ranks from 1 to 7, in which 1 is lowest education level (illiteracy) and 7 is the highest level of education (graduated secondary school), the mean of education level for female is 1.88 while this figure of male is 3.52 The result of education level of female elderly in comparison with male in this study is also similar with the result

of other researches For instance, in the research of (Daniele Belanger et al, 2012), the illiteracy rate among women was higher than men, and it was also true in older age groups Other studies also indicate that the older women in Vietnam were significantly disadvantaged to men with regards to their educational attainment, and education is expected to positively affect old-age health and wellbeing

Table 4.2: Education level of older people in treatment group

Summary of Education

Female 1.8888889 0.77524841 45 Total 2.4714286 1.4912443 70 Source: Compiled by author based on the data from the survey

Regarding to the marital status of the respondent, there are significant gender differences

in marital status Overall, the proportion of widowed of women is higher than men for both groups As can be seen from the table4, there is 35% of female respondent in comparison group is widowed, and this figure in treated group is 50%

Table 4.3: Marital status of the elderly in control and treatment group

Gender

Control group Treatment group

Married Widowed Married Widowed

Female 25.0% 35.0% 14.0% 50.0%

Source: Compiled by author based on the data from the survey

The data fromtable 5 also illustrates that, at Giao An commune, when the female getting older, the number of elderly female is higher than the number of elderly male due to the mortality rates of elderly males are higher than mortality rates of

elderly female (UNFPA, 2011) The older women are more likely to be vulnerable because of their survival to later ages and widowhoods (UN, 2007), therefore these facts in turn require the government to address various issues related to aging and gender due to the marital status is an important indicator of elderly living arrangement and old-age support

Table 4.4: Sex Ratio of the Old-Age Population in Giao An commune

on their own with less physical and emotional support from family members(Barbieri, 2006)

In this case study, the living arrangement of older people is similar with the previous research There is 60% of the elderly in control group is living with their wife/husband, whereas the figure of treatment group is 26% A half of the respondent in beneficiary group said that they are living with their children, and the number of comparison group is just 26% A notable point, the proportion of people

in treated group has to living alone (without their partner or children) is 24%, higher than the proportion in control group (17%)

There is difference in the caregiver of two groups For the treatment group, the people taking care the older people is “children” accounts for 75%, while the children is considered as the caregiver for the control groups just accounts for 45% More than a half of the older adult in comparison group gets the care from their counterparts This phenomenon quite contrasts to the result from the study of Hoi et