Population Coverage: 36.5 million Year Launched: 2003 Membership: Full Member

Provider payment reforms to achieve UHC.

Vietnam introduced various health financing reforms, culminating in the introduction of the Health Care Fund for the Poor in 2003.

The Context

The Health Care Fund for the Poor (HCFP) provides 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 2009 as a result of a new National Health Insurance Law. The current national health insurance system consists of two CHIs – one contributory scheme and one non-contributory scheme – and one voluntary health insurance scheme.

Key Reforms

The National Health Insurance Law fully subsidized health insurance premiums for the poor. Enrollment in the scheme became mandatory, resulting in almost complete enrollment of the poor by 2011. Vietnam has combined elements of contributory social health insurance with substantial levels of tax financing to provide coverage for the poor and informal sector.

To achieve universal health coverage by 2014, as stipulated in the Health Insurance Law, the Vietnamese Health Insurance Agency (VSS) is working to build creative solutions and revisions to implementation and design challenges. Vietnam is overcoming challenges such as fragmented funding, high out-of-pocket payments, and government subsidies not reaching the poor.

Impact: Cross-Country Knowledge Sharing

Vietnam is a founding member of the Joint Learning Network for Universal Health Coverage (JLN). Vietnam has been an active member in the JLN Technical Initiatives, particularly the Provider Payment Mechanisms Technical Initiative as the Department of Health Insurance and Ministry of Health have been working to design a new provider payment system. Vietnam has also been an active participant in the Information Technology and Primary Health Care Initiatives.

Vietnam hosted their first knowledge sharing workshop in March 2012 get ideas on how to manage rapid cost escalation of health services driven by a vicious circle of currently prevalent fee-for-service provider payment mechanism (PPM) and rapid rise of high-tech services. This meeting set in motion a process for developing new provider payment models and refining existing systems in Vietnam by exploring various PPM options presented by international experts and experiences from other JLN member countries.

As a result of these interactions, the Provider Payment Initiative launched the JLN Collaborative on Costing of Health Services for Provider Payment for countries seeking additional support around costing methodologies and their respective advantages and disadvantages.

The JLN Costing Collaborative created a Core Working Group (CWG) of JLN country costing experts, and international costing experts, to synthesize the rich experience of JLN member countries and jointly develop a costing manual that documents the main costing methodologies, shares examples of tools and templates, and uses case examples to illustrate their application in different country contexts. This manual will serve as a baseline of knowledge for countries to consult around the different options available to them, and concrete examples of how costing methodologies work in practice.