Background Health insurance is an important social protection mechanism to insure vulnerable populations against health shocks caused by injury. This study aims to examine disparities in the availability of health insurance by socioeconomic status, and the association between health insurance and long-term injury-related disability in Vietnam.

Methods We conducted a prospective cohort study of moderate to severely injury patients recruited from a public hospital in Ninh Binh, Vietnam. We administered a baseline and four follow-up surveys (at 1, 2, 4, 12 months after discharge) to participants. The surveys sought to understand injury characteristics, economic status, costs incurred for treatment, availability of health insurance or other form of social protection and self-assessed disability. Propensity score matching methods with mixed-effects models were used to examine the association between insurance status and average disability score over time.

Results A total of 1094 patients were enrolled in the study. 611 (44%) had health insurance and 483 (56%) did not. Patients that belong to households in the second, middle, and fourth quintiles of income distribution were more likely to be uninsured when compared with the highest income quintile. Insured patients had significantly higher WHODAS global average score, 1.86 (SD: 4.8), on a scale of 0–48 (0 for no functional limitation and 48 for extreme limitation) than the uninsured patients (0.49, SD: 2.1) (p<0.001). Road traffic and falls were the top two causes of injury for the insured (59% and 27% respectively) and uninsured (71% and 14%, respectively).

Conclusions Health insurance may be associated with healthcare access prior to injury, and may influence the medical care and rehabilitation services throughout the functional recovery. Households in the second and middle-income quintiles have the highest uninsured proportions, suggesting that public policy should be enacted to increase financial protection and avoid catastrophic and improvising out-of-pocket expenditures for these households.