2014年-世界发展银行全球_Universal_Health_Coverage_for_Inclusive_and_Sustainable_Development___Country_Summary_Report_for_Vietnam_13页_221kb

Summary of the Country Summary Report for Vietnam under the Japan-World Bank Partnership Program for Universal Health Coverage

Core Content

This report provides an overview of Vietnam's progress toward achieving Universal Health Coverage (UHC), highlighting its legal framework, health financing system, human resources for health, and the sequencing of health reforms. It also outlines key lessons that can be shared with other countries aiming to implement UHC.

Main Points

1. Vietnam's Development Context

• Vietnam is recognized as a development success story, having transformed from one of the poorest countries in the world to a lower middle-income country in 25 years.
• Economic growth has been robust, averaging nearly 8% annually over the past decade.
• Poverty rates have significantly declined, from 58% in 1993 to 12% in 2009.
• Health outcomes have improved, with infant and under-five mortality rates declining substantially between 2001 and 2009.

2. Universal Health Coverage (UHC) in Vietnam

• Vietnam has made UHC a national goal, aiming to cover 80% of the population by 2020.
• As of 2012, 64% of the population was covered, with the majority of the uncovered population working in the informal sector.
• The health system includes both contributory and non-contributory insurance schemes, with the latter targeting the poor, ethnic minorities, and disadvantaged groups.

3. Legal and Statutory Basis

• The Vietnamese Constitution (1992) recognizes the right to health protection and prioritizes vulnerable groups.
• A national health insurance program was launched in 1993, later expanded with the creation of the Health Care Fund for the Poor (HCFP) in 2003.
• HCFP was merged with the national contributory insurance scheme in 2009 to reduce fragmentation.

4. Health Financing

• Vietnam's health financing system has evolved from a government-revenue-based model to a multi-source system, including social health insurance (SHI).
• SHI premiums account for 14% of total health expenditure (THE), which is 6.8% of GDP in 2010.
• Government subsidies, mainly from VAT and local taxes, support the non-contributory programs.
• Private spending still constitutes over 50% of THE, and out-of-pocket (OOP) spending has decreased from 63% to below 50% since 2005.
• However, financial protection remains a challenge, especially for the poorest quintile, which experiences higher rates of catastrophic expenditure and impoverishment.

5. Cost Management

• Vietnam has three payment mechanisms: fee-for-service, capitation, and case-based payment.
• Fee-for-service is the dominant system, with rates set by a national fee schedule last updated in 2012.
• Cost escalation has led to the introduction of various cost management initiatives.
• Case-based payments are being piloted, while capitation payment at the district level has had unintended consequences, such as reduced funding for primary care.

6. Human Resources for Health (HRH)

• Vietnam has invested in expanding the number of health professionals, with 70% of commune health stations having medical doctors.
• The country has 24 medical universities, 30 junior colleges, and 35 secondary medical schools.
• Despite increased numbers, the quality of health workers remains a concern.
• There is a shortage of nurses, midwives, and preventive/family medicine practitioners, particularly in disadvantaged and rural areas.
• The government is addressing these issues through regulatory and accreditation reforms, and by implementing financial incentives and training programs.

7. Sequencing of Reforms

• Health reforms began in the late 1980s with the "Doi Moi" policy, which introduced structural changes such as private sector growth and fee-based services.
• The 1993 Health Insurance Law marked a significant step in diversifying funding sources and increasing contributions from health workers.
• The 2009 Health Insurance Law was a milestone, establishing the foundation for a national system and a roadmap for UHC by 2020.
• Despite progress, multiple programs and funds have led to fragmentation and inconsistencies in resource management.

Key Lessons

• National Ownership and Political Commitment: Vietnam's success in UHC is largely due to strong national ownership and sustained political commitment, supported by legislative frameworks.
• Legal Foundations: Embedding healthcare access in the Constitution has provided a solid institutional basis for UHC reforms.
• Financial Protection: While OOP spending has declined, financial protection remains a challenge, particularly for the poor.
• System Integration: Merging HCFP with the national insurance system in 2009 helped reduce fragmentation.
• Human Resources Development: Investing in HRH is critical, but improving the quality and distribution of health professionals remains a priority.
• Cost Management and Efficiency: Effective cost management and system efficiency are essential for long-term sustainability of UHC.
• Targeted Subsidies and Coverage Expansion: Expanding coverage to the informal sector and improving financial protection for vulnerable groups are key next steps.

Conclusion

Vietnam has made significant strides in expanding health coverage and improving health outcomes through sustained political commitment, legal reforms, and financial strategies. However, challenges remain in achieving full UHC, particularly in financial protection, HRH quality, and system efficiency. The country is actively working to address these issues through reforms and policy adjustments, with the aim of ensuring sustainable and inclusive health coverage for all.