2014年-世界发展银行全球_Moving_toward_Universal_Coverage_of_Social_Health_Insurance_in_Vietnam___Assessment_and_Options_177页_4mb

Summary of "Moving toward Universal Coverage of Social Health Insurance in Vietnam: Assessment and Options"

Core Content

This report, published by the World Bank in 2014, evaluates Vietnam's progress toward achieving Universal Health Coverage (UHC) through its Social Health Insurance (SHI) system and provides recommendations for further reforms. It outlines the challenges, opportunities, and necessary steps to expand coverage, improve financial protection, and enhance equity in health financing.

Main Goals and Objectives

The report is based on the Universal Coverage Master Plan (2012), which aims to:

• Increase SHI enrollment rates from ~60% (2010) to at least 70% by 2015 and 80% by 2020.
• Reduce out-of-pocket (OOP) spending from ~57.6% (2010) to less than 40% by 2015.

These goals are central to the Vietnamese government's strategy to ensure affordable, equitable, and quality access to health services.

Key Challenges

1. Low Enrollment Rates

Despite compulsory enrollment for formal sector workers, SHI coverage remains low. The "missing middle" population, including the near-poor and informal workers, is not adequately included.

2. High OOP Payments

Even with high enrollment, OOP payments remain a significant portion of health spending, exposing households to financial risk and leading to inequitable health-seeking behavior.

3. Fragmentation in Fund Pooling

The SHI system is fragmented, with poor provinces subsidizing richer ones and the poor subsidizing the rich, limiting effective risk pooling.

4. Inefficiencies in Resource Allocation and Purchasing

There are inefficiencies in the way health services are purchased and resources are allocated, including:

• Inconsistent provider payment mechanisms.
• High costs of pharmaceuticals.
• Inappropriate utilization of health services.

5. Institutional Constraints

The SHI system faces challenges in organization, management, and governance, which hinder its effectiveness and scalability.

Key Recommendations

1. Expanding Coverage

• Increase general revenue subsidies to cover the near-poor and informal sector.
• Implement family-based enrollment to improve participation rates.
• Use information, education, and communication (IEC) to raise awareness and encourage enrollment.
• Strengthen enrollment compliance through targeted measures for mandated groups.

2. Improving Financial Protection and Equity

• Reduce OOP payments by adjusting reimbursement rates and copayment policies.
• Introduce progressive benefit packages to ensure more equitable access.
• Monitor and address catastrophic and impoverishing OOPs, especially among poor households.

3. Costing Universal Coverage

• Use revenue projections based on the Master Plan and Lieberman-Wagstaff model to estimate the financial requirements.
• The report highlights the need for accurate and realistic cost estimates to guide policy decisions.

4. Mobilizing Resources

• Reprioritize health spending within the national budget.
• Increase the share of public funding in health expenditure.
• Explore external financing and public-private partnerships (PPP) to supplement resources.

5. Reducing Fragmentation

• Consolidate fund pooling at the national level.
• Learn from global experiences such as Japan, Republic of Korea, and China to improve risk pooling.
• Implement public financing reforms to reduce disparities between regions and income groups.

6. Strengthening Resource Allocation and Purchasing

• Reform provider payment mechanisms to reduce costs and improve efficiency.
• Enhance pharmaceutical procurement to ensure cost-effective and equitable access to medicines.
• Address inefficiencies in the delivery of health services, such as unnecessary treatments and high prices.

7. Strengthening SHI Governance

• Improve the organization and management of the SHI system.
• Establish a clear governance framework to ensure accountability and transparency.
• Implement transitional supervision and final governance arrangements to support institutional reforms.

Implementation Road Map

The report provides a road map for institutional reform, including:

• Legislative and regulatory changes to support UHC.
• Health system strengthening measures.
• Addressing data and information gaps to improve decision-making.
• Coordination between different levels of government and stakeholders.

Global Lessons and Context

The report draws on global experiences to inform recommendations, including:

• The role of general revenues in subsidizing enrollment.
• The impact of voluntary enrollment on coverage expansion.
• The importance of information, education, and communication (IEC) in promoting health insurance uptake.
• The effectiveness of risk pooling in countries like Japan and Republic of Korea.

Conclusion

Vietnam has made significant progress toward UHC, but challenges in coverage expansion, financial protection, and system efficiency remain. The report emphasizes the need for comprehensive reforms in funding, service delivery, and governance to achieve the ambitious goals set out in the Master Plan. These reforms are critical to ensuring that health services are affordable, accessible, and equitable for all citizens.

Key Information

• Enrollment rates: ~60% (2010) to ~80% (2020).
• OOP share: ~57.6% (2010) to <40% (2015).
• Funding sources: General revenue, public funding, and external assistance.
• Institutional actors: Ministry of Health (MoH), Vietnam Social Security (VSS), World Bank, WHO, UNICEF, and other development partners.
• Methodology: Based on background analyses, cost simulations, and stakeholder consultations.

Appendices

The report includes several appendices for detailed reference:

• Appendix A: Overview of the Vietnamese health system.
• Appendix B: Consultation process for the health insurance review.
• Appendix C: Details of universal coverage costing simulations.
• Appendix D: Inefficiencies in pharmaceutical spending.

Authors and Contributors

The report was authored by:

• Aparnaa Somanathan, Ajay Tandon, Huong Lan Dao, Kari L. Hurt, and Hernan L. Fuenzalida-Puelma.

Contributors include:

• World Health Organization (WHO), UNICEF, Rockefeller Foundation, and Vietnam Social Security (VSS).
• Local research institutions such as Hanoi Medical University and Health Strategy and Policy Institute (HSPI).

Legal and Licensing Information

• This report is available under the Creative Commons Attribution 3.0 IGO license.
• It is a product of the World Bank staff with external contributions.
• The World Bank does not guarantee accuracy of data or endorse any views expressed in the report.