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FINANCING UNIVERSAL HEALTH COVERAGE

IN VIETNAM

Dr Ha Van Thuy – Deputy Director


Ms Vu Nu Anh – State Official
Department of Health Insurance, MoH of Vietnam

- May, 2018 -
Disclaimer: The views expressed in this document are the views of the author(s) & do not necessarily reflect the views or policies
of the Asian Development Bank (ADB), or its Board of Directors or the governments they represent. ADB does not guarantee
the source, originality, accuracy, completeness or reliability of any statement, information, data, finding, interpretation, advice,
opinion, or view presented, nor does it make any representation concerning the same.
OUTLINE
I. Contry profile:
1.1 Social-economic-health indicators
1.2 Structure of health system & SHI
II. UHC status
2.1 Population coverage
2.2 Health service
2.3 Health financial protection
III. Moving forward
I. COUNTRY PROFILE
1.1 Social economic conditions Health indicators
Pop: 94.5 millions Life expectance: 75.2 years
Land area: 330,957 Km2 Fertility rate: 1.78
GDP per capita: 2,170 US$ Maternal mortality rate:
GDP growth rate: 6.2% 67/100,000 (live births)
Poverty rate: 9.8% IMR (<1): 15.5/1,000
Total health expenditure: 7.1% CMR (<5): 24/1,000
of GDP Weight malnutrition children
SHI Fund: 25% THE (3 bil USD) < 5y: 18%
OPP: 41%
1.2 Structure of health system
• Ministry of Health
• Central General and Specialised Hosp(s)
• Prov Preventive Hlth Center(s)
Nation • Medical and Phar Universities

• Aver pop: 1-2 mil


• Prov Dept of Health (DOH)
63 Provinces • Prov General and Spec Hospital(s)
• Prov Preventive Hlth Center(s)
• Prov Secondary Med School
• Aver pop: 120,000
698 Districts • District Health Office
• District Hospital
• District (Preventive) Hlth Center

• Aver pop: 10,000


11,121 Communes • Com Hlth Center
• 4-5 CHWs/com, icld MD
• Total hospitals: • 98,000 VHWs
• Public hospitals: 1.060 (84%)
• Private hospitals: 202 (16%)
II. UNIVERSIAL HEALTH COVERAGE
Measuring UHC

Health
Health service: financial
- Complihensive protection
benefit package;
level: 59%
-Acess to service

SHI coverage rate:


86%
2.1 Population coverage
Expanding SHI groups Revised
HI Law

Compulsory
participation

2015

4% 23% 46% 60% 65% 66% 70% 75%


2.1 Population coverage
Expanding SHI coverage
100
90 86
78
80 75
68.9 70
67
70 63.9
60
60 56.6

50 46.1
42 41
40
30
20
10
0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
SHI coverage

7
2.2 Health services
Comprehensive benefit package:
• Public health programmes and essential preventive
services for whole population: funded by State
budget.
• Hospital and curative care: medical examination and
treatment services for insured inpatients & outpatients
covered by Social Health Insurance.
But unequal acess:
• Most of the poor are living in under-developed health
system regions while health insurance spending in
concentrated in hospitals in big cities
2.3 Health financial protection
The government plays central roles in protecting population health: Commit to
increase budget for health

THE as % of GDP increase continuosly at 7.1% in 2014, higher than many


other countries in region
2.3 Health financial protection
Trends in health financing –
Expanding Public financing
Reducing OOP over the years but still high >40%
100.0%

90.0%

80.0%

70.0% Central gov

60.0% Local gov


50.0%
Social insurance
40.0%
Out-of-Pocket
30.0%

20.0% Other

10.0%

0.0%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
III. Moving forward –
Increase coverage & financial protection
We need to:
 Expand health insurance coverage to all population, focusing on informal
sector: About 15 mill people = 14% populationare still out of the system
 Developing more favour policy for informal sector to encourage them to
participate in SHI scheme.
 Mobilizing government budget for subsidy, especially increasing local
government subsidy for househole.
 Increase financial protection by reducing OPP rate:
 Looking for financing measures to cover co-payment for less affordable
members.
 Prevent extra billing.
III. Moving forward –
Quality, Equity and Efficiency
We need to:
 Improve health service Quality:
 Address public demand for access to quality and safe services
 Improve health infrastructure
 Better train health workers.
 Enhance Equity in health service access:
 Upgrade service delivery system in remote areas
 Re-channel spending to primary care, NCDs and ageing management.
 Enhance system Efficiency:
 Better Strategic purchasing
 Improve performance/responsiveness of SHI system focusing on benefit
package; provider payment mechanism.