Be rich or don’t be sick: Estimating Vietnamese patients’ risk of falling into destitution

This paper represents the first research attempt to estimate the probabilities for Vietnamese patients to fall into destitution facing financial burdens occurring during their curative stay in hospital. The study models the risk against such factors as level of insurance coverage, location of patient, costliness of treatment, among others. The results show that very high probabilities of destitution, approximately 70%, apply to a large group of patients, who are nonresident, poor and ineligible for significant insurance coverage. There is also a probability of 58% that low-income patients who are seriously ill and face higher health care costs would quit their treatment. These facts will put Vietnamese government’s ambitious plan of increasing both universal coverage (UC) to 100% of expenditure and rate of UC beneficiaries to 100% at a serious test. The study also raises issues of asymmetric information and alternative financing options for the poor, who are most exposed to risk of destitution, following market-based health care reforms.

Democratic Peace and Electoral Accountability

One of the few stylized facts in international relations is that democracies, unlike autoc- racies, very rarely fight each other. We examine the sustainability of international peace between democracies and autocracies, where the crucial difference between these two po- litical regimes is whether or not policymakers are subject to periodic elections. We show that the fear of losing office can deter democratic leaders from engaging in military con- flicts. Crucially, this discipline effect can only be at work if incumbent leaders can be re-elected, implying that democracies in which the executives are subject to term limits should be more conflict prone. To assess the validity of our predictions, we construct a large dataset on countries with executive term limits. Our analysis of inter-state conflicts for the 1816-2001 period suggests that electoral incentives are indeed behind the democratic peace phenomenon: while democratic dyads are in general less likely to be involved in conflicts than any other dyads, this result does not hold for democracies in which the executive faces binding term limits; moreover, the dispute patterns of democracies with term limits depend on whether the executive is in the last or penultimate mandate.