The Vietnam Health Insurance Law of 2008 promulgated universal mandatory participation in health
insurance by 2014. Obtaining full compliance, and achieving universal health insurance coverage in the
coming years represents a challenging task. In 2009, 58.4% of the total population had health insurance,
meaning that 35.7 million people were not covered. The expansion of the subsidized programmes and
the use of institutional networks to launch information and enforcement campaigns should help
significantly expand coverage. However, workers in the informal sector, who have in the past been
particularly reluctant to buy health insurance, might remain difficult to reach. Therefore, understanding
the obstacles that explain the low participation of these workers and eliminating them is also part of the
strategy to expand health insurance coverage. This study looks at these two particular issues.
After a review of the legal framework and the socio-economic context in which voluntary participation
in health insurance has developed since 2003, this study uses the GSO households surveys of 2006 and
2008 to identify statistical evidence which reveal the motivations and the deterrents of those persons of
the informal sector to participate in health insurance. The group under study includes the workers and
the inactive that do not (and probably will not) receive any direct (subsidies) or indirect (as dependents
of formal employees) financial support to participate in health insurance. It is composed of persons who
are not students, not poor or near poor and who do not have direct relatives employed in the
enterprise sector. In 2008, about 23 million people could be classified in this category, of those, only
11.1% had health insurance.