Health Care Statistics
World Health Statistics
Country Profile
Health care in Vietnam is financed through various sources, including individual out-of-pocket payments, central and provincial government tax revenues, supply-side subsidies, and to a smaller extent, private insurance and external aid. To curb the high incidence of catastrophic household spending, Vietnam has introduced various reforms, culminating in the 2003 introduction of the Health Care Fund for the Poor.
Health care in Vietnam is financed through various sources, including individual out-of-pocket payments, central and provincial government tax revenues, supply-side subsidies, and to a smaller extent, private insurance and external aid. To curb the high incidence of catastrophic household spending, Vietnam has introduced various reforms, culminating in the 2003 introduction of the Health Care Fund for the Poor.
Over the years, Vietnam experimented with a number of programs designed to reduce catastrophic health spending by households. For example, in the early 1990s, the government introduced fee waivers. Unfortunately, these were only loosely targeted at the poor and largely unsuccessful at curbing out-of-pocket expenditure since they did not cover spending on drugs, the main source of OOP spending at the time.
The initial health insurance program introduced in 1992 was primarily targeted at formal sector workers and did not include viable coverage options for the poorest segments of the population. Lack of coverage often led to impoverishing OOP expenditure, especially among lower-income households. Prior to the creation of the Health Care Fund for the Poor (HFCP), the government initiated a program known as Free Health Care Cards for the Poor, in which 1.5 million people (out of a target of 4 million) were enrolled in Vietnam’s compulsory scheme. However, the plan had many flaws. Local governments were reliant on their own funds to finance the scheme, which posed a considerable challenge in many provinces, especially those where poverty rates were high. Care was often rationed according to funds available, providing minimal coverage of treatment costs. There was also reluctance on the part of providers to treat patients in the scheme. Care was often available at only one provider, usually the local district hospital, which could be prohibitively far from many of the people it intended to serve. Beyond that, inclusion required a complex application process.
In 2003, the Health Care Fund for the Poor (HFCP) replaced this program through the passing of Decision 139. Learning from the failings of its predecessor, HCFP has strong financial support from the central government, clear eligibility criteria, wider options for where care can be obtained, and strict guidelines for implementation.
In 2006, at the health system level, the Vietnamese Health Insurance Agency (VSS) still accounted for only 13% of total health spending in Vietnam. The remainder of health spending is comprised of supply-side subsidies, which account for 20% of health expenditures in Vietnam, and out-of-pocket (OOP) payments, which account for 67% of total health spending.
Vietnam
Historical Context
Health care in Vietnam is financed through various sources, including individual out-of-pocket payments, central and provincial government tax revenues, supply-side subsidies, and to a smaller extent, private insurance and external aid. To curb the high incidence of catastrophic household spending, Vietnam has introduced various reforms, culminating in the 2003 introduction of the Health Care Fund for the Poor.
Over the years, Vietnam experimented with a number of programs designed to reduce catastrophic health spending by households. For example, in the early 1990s, the government introduced fee waivers. Unfortunately, these were only loosely targeted at the poor and largely unsuccessful at curbing out-of-pocket expenditure since they did not cover spending on drugs, the main source of OOP spending at the time.
The initial health insurance program introduced in 1992 was primarily targeted at formal sector workers and did not include viable coverage options for the poorest segments of the population. Lack of coverage often led to impoverishing OOP expenditure, especially among lower-income households. Prior to the creation of the Health Care Fund for the Poor (HFCP), the government initiated a program known as Free Health Care Cards for the Poor, in which 1.5 million people (out of a target of 4 million) were enrolled in Vietnam’s compulsory scheme. However, the plan had many flaws. Local governments were reliant on their own funds to finance the scheme, which posed a considerable challenge in many provinces, especially those where poverty rates were high. Care was often rationed according to funds available, providing minimal coverage of treatment costs. There was also reluctance on the part of providers to treat patients in the scheme. Care was often available at only one provider, usually the local district hospital, which could be prohibitively far from many of the people it intended to serve. Beyond that, inclusion required a complex application process.
In 2003, the Health Care Fund for the Poor (HFCP) replaced this program through the passing of Decision 139. Learning from the failings of its predecessor, HCFP has strong financial support from the central government, clear eligibility criteria, wider options for where care can be obtained, and strict guidelines for implementation.
In 2006, at the health system level, the Vietnamese Health Insurance Agency (VSS) still accounted for only 13% of total health spending in Vietnam. The remainder of health spending is comprised of supply-side subsidies, which account for 20% of health expenditures in Vietnam, and out-of-pocket (OOP) payments, which account for 67% of total health spending.
The Health Care Fund for the Poor (HCFP) was created in 2003 to provide care for the poor, ethnic minorities, and the disadvantaged. Initially implemented as a separate social program, HCFP was rolled into the national compulsory health insurance (CHI) scheme in July of 2009 as a result of a new National Health Insurance Law. Through the Health Care Fund for the Poor, as well as the existing voluntary and compulsory health insurance schemes, Vietnam has expanded coverage to 36.5 million people, or 42% of the population of Vietnam.
The Health Care Fund for the Poor (HCFP) was created in 2003 to provide care for the poor, ethnic minorities, and the disadvantaged. Initially implemented as a separate social program, HCFP was rolled into the national compulsory health insurance (CHI) scheme in July of 2009 as a result of a new National Health Insurance Law. Through the Health Care Fund for the Poor, as well as the existing voluntary and compulsory health insurance schemes, Vietnam has expanded coverage to 36.5 million people, or 42% of the population of Vietnam.
The current national health insurance system consists of two parts a, compulsory health insurance scheme (CHI) and a voluntary health insurance scheme (VHI). The CHI formally consists of two sub-schemes:
- A contributory scheme for the formally employed, pensioners, full-time students
- A non-contributory scheme for the poor, children under the age of 6 and some socially protected population groups.
The VHI targets family members of those in the compulsory health insurance scheme, and others who enrolled through certain organizations, including communes.
The Health Care Fund for the Poor (HCFP), now a part of the CHI, extended coverage to three distinct groups:
- Households defined as poor according to official government poverty standards
- All households, regardless of income, living in communes considered “disadvantaged” through a separate decision in 1998
- Ethnic minorities living in the central highland provinces and the six mountainous provinces. The main objectives of the HCFP are to increase access to health care and reduce the financial burden of health expenditure faced by the poor and ethnic minorities.
The HCFP is financed through general government revenues, and is entirely free to its beneficiaries. The central government finances the bulk of the cost, but provincial governments are responsible for co-financing a percentage of the program. The HCFP provides a comprehensive benefits package, including inpatient and outpatient care as well as maternal and preventive health services. The Vietnam Health Insurance Agency (VSS) is the agency responsible for implementing the HCFP, along with Vietnam’s other health insurance schemes.
In 2007, it was estimated that about 36.5 million people were covered by public health insurance in Vietnam, accounting for about 42% of the population. The poor account for over 41% of the insured and voluntary health insurance members account for a further 25.7%. The number of people with health insurance coverage increased sharply from 2005, mostly as a result of government policy promoting the purchase of health insurance cards for the poor.
Vietnam
Summary of Reforms
The Health Care Fund for the Poor (HCFP) was created in 2003 to provide care for the poor, ethnic minorities, and the disadvantaged. Initially implemented as a separate social program, HCFP was rolled into the national compulsory health insurance (CHI) scheme in July of 2009 as a result of a new National Health Insurance Law. Through the Health Care Fund for the Poor, as well as the existing voluntary and compulsory health insurance schemes, Vietnam has expanded coverage to 36.5 million people, or 42% of the population of Vietnam.
The current national health insurance system consists of two parts a, compulsory health insurance scheme (CHI) and a voluntary health insurance scheme (VHI). The CHI formally consists of two sub-schemes:
- A contributory scheme for the formally employed, pensioners, full-time students
- A non-contributory scheme for the poor, children under the age of 6 and some socially protected population groups.
The VHI targets family members of those in the compulsory health insurance scheme, and others who enrolled through certain organizations, including communes.
The Health Care Fund for the Poor (HCFP), now a part of the CHI, extended coverage to three distinct groups:
- Households defined as poor according to official government poverty standards
- All households, regardless of income, living in communes considered “disadvantaged” through a separate decision in 1998
- Ethnic minorities living in the central highland provinces and the six mountainous provinces. The main objectives of the HCFP are to increase access to health care and reduce the financial burden of health expenditure faced by the poor and ethnic minorities.
The HCFP is financed through general government revenues, and is entirely free to its beneficiaries. The central government finances the bulk of the cost, but provincial governments are responsible for co-financing a percentage of the program. The HCFP provides a comprehensive benefits package, including inpatient and outpatient care as well as maternal and preventive health services. The Vietnam Health Insurance Agency (VSS) is the agency responsible for implementing the HCFP, along with Vietnam’s other health insurance schemes.
In 2007, it was estimated that about 36.5 million people were covered by public health insurance in Vietnam, accounting for about 42% of the population. The poor account for over 41% of the insured and voluntary health insurance members account for a further 25.7%. The number of people with health insurance coverage increased sharply from 2005, mostly as a result of government policy promoting the purchase of health insurance cards for the poor.
With about half of its population still without health insurance, Vietnam is seeking to continue expanding coverage in a sustainable manner. To achieve universal health coverage by 2014 as stipulated in the Health Insurance Law, the VSS is working to build creative solutions to cover informal workers and other hard to reach populations.
With about half of its population still without health insurance, Vietnam is seeking to continue expanding coverage in a sustainable manner. To achieve universal health coverage by 2014 as stipulated in the Health Insurance Law, the VSS is working to build creative solutions to cover informal workers and other hard to reach populations. The government is also striving to expand the management capacity of those working within the health insurance system.
Despite the success of Vietnam’s national insurance schemes to date, there are several specific challenges that have been identified as priority areas of focus in the years ahead:
- Continuing to expand health insurance coverage in a sustainable manner: A lack of health-related social security programs for those without health insurance coverage continues to be a problem. About 50% of the population are without health insurance and end up paying health care costs out of their own pockets. The chances that they may fall into the poverty trap when encountering catastrophic medical expenditures are enormous. To fulfill the universal coverage plan stipulated by the Health Insurance Law by the year 2014, the VSS is working on building creative solutions to expand coverage to the informal populations.
- Resolving the health insurance fund imbalance: Fee-for-service reimbursement mechanisms, which are widely used in a context of allowing greater financial autonomy, are one of the main causes for high levels of overspending in the health insurance fund in recent years. Some new payment mechanisms have been introduced since 2009, however greater work needs to be done in this area
- Upgrading the capacity of the health insurance system: The limited specialized health insurance management skills in the VSS has been an ongoing challenge. The management of insured patients and health care costs is not always strict enough. The health insurance fund, pension fund and some other social security funds are managed under one umbrella (VSS) and this stifles professional specialization, administrative capacity and operations management necessary to manage this very special fund.
Vietnam
The Way Forward
With about half of its population still without health insurance, Vietnam is seeking to continue expanding coverage in a sustainable manner. To achieve universal health coverage by 2014 as stipulated in the Health Insurance Law, the VSS is working to build creative solutions to cover informal workers and other hard to reach populations. The government is also striving to expand the management capacity of those working within the health insurance system.
Despite the success of Vietnam’s national insurance schemes to date, there are several specific challenges that have been identified as priority areas of focus in the years ahead:
- Continuing to expand health insurance coverage in a sustainable manner: A lack of health-related social security programs for those without health insurance coverage continues to be a problem. About 50% of the population are without health insurance and end up paying health care costs out of their own pockets. The chances that they may fall into the poverty trap when encountering catastrophic medical expenditures are enormous. To fulfill the universal coverage plan stipulated by the Health Insurance Law by the year 2014, the VSS is working on building creative solutions to expand coverage to the informal populations.
- Resolving the health insurance fund imbalance: Fee-for-service reimbursement mechanisms, which are widely used in a context of allowing greater financial autonomy, are one of the main causes for high levels of overspending in the health insurance fund in recent years. Some new payment mechanisms have been introduced since 2009, however greater work needs to be done in this area
- Upgrading the capacity of the health insurance system: The limited specialized health insurance management skills in the VSS has been an ongoing challenge. The management of insured patients and health care costs is not always strict enough. The health insurance fund, pension fund and some other social security funds are managed under one umbrella (VSS) and this stifles professional specialization, administrative capacity and operations management necessary to manage this very special fund.