Within the last twenty years a large-scale bottom-up privatization has taken place in Vietnam, changing and dismantling the public health care system. This process has led to severe tensions inherent in the transitional society of Vietnam between equity and access to health care support - especially for the poor, elderly, migrants, and ethnic minorities - on the one hand, and its efficiency on the other hand. The book traces the reform efforts to modernize the health care system by the Communist Party of Vietnam and the Vietnamese government. The author bases her findings on little known primary literature and interviews with key stakeholders of the policy network involved in the reform of the health care system, thereby painting an authentic atmospheric picture of the profound changes in the health care system in Vietnam.

Over the past two decades Vietnam has made enormous progress towards achieving universal coverage (UC) for its population. Significant challenges remain, however, in terms of improving equity with continuing low rates of enrollment. Ensuring financial protection also remains an elusive goal. The Master Plan for Universal Coverage approved in 2012 by the Prime Minister directly addresses both these deficiencies in coverage. The objective of this report is to assess the implementation of Vietnam SHI and provide options for moving towards UC. This is a joint assessment with development partners, World Health Organization, United Nations Children's Fund (Unicef) and Rockefeller Foundation. Expanding breadth of coverage, particularly for those hard to reach groups such as the near-poor and informal sector would require substantially increasing general revenue subsidies and fully subsidizing the premiums for the near-poor. High enrollment rates would, however, have little impact on financial protection and equity if OOP costs remain high. Achieving UC will require sustained efforts to improve efficiency in the system, and gain better value for money from available budgetary resources; without these efforts, any further progress towards UC would be financially unsustainable. There is considerable scope for improving efficiency in Vietnam. Fragmentation in the pooling of funds gives rise to unnecessary costs. Inefficiencies in resource allocation and purchasing arrangements include: (i) an overly generous benefits package; (ii) provider payment mechanisms and the mix of incentives facing providers which result in an oversupply of services; (iii) high prices, overconsumption and inappropriate use of pharmaceuticals; and (iv) the structure and incentives embedded within the delivery system. The organization, management and governance of SHI are fragmented and often dysfunctional. The present institutional setting for SHI needs to be assessed and changed.

Vietnam's successes in the health sector are legendary. Its rates of infant and under-five mortality are comparable to those of countries with substantially higher per capita incomes. However, challenges remain in how to further expand coverage, increase quality of care, and contain the rapidly increasing health care costs.

This book presents a detailed overview of the healthcare environment in Viet Nam. Given the general lack of understanding of healthcare in the Vietnamese context, it discusses the background and history, current status and the future of healthcare in the country. The first part of the book provides a summary of the current state of Vietnamese healthcare, incorporating discussions on the training and professional practice environment and the development, implementation and impact of national insurance policies. In addition, it highlights the cultural aspects of health provision and behaviours, technology integration and health trends from a number of angles based on standard global reporting dimensions. The second part elaborates on the 5-year strategic plan for national healthcare management and the top 5 barriers to meeting these planned objectives. It documents key investors and project objectives and outcomes, as well as the top 10 health issues in Vietnam including an overview of national and international initiatives to tackle these issues, addressing financial and social burdens in the process. In the third part, the book outlines the opportunities and barriers for improvement in healthcare outcomes for Viet Nam, providing evidence to support future work by local or international researchers. It is a fundamental text for anyone looking to work or research in the Vietnamese healthcare environment and provides an outline for project planning and targeted programs of work to achieve measureable improvements in Viet Nam.

This book describes the nature of public-private partnerships (PPPs) in the health sector in Vietnam. It defines health-related PPPs, describes their key characteristics, and develops a taxonomy of the different types of PPPs that exist in practice, illustrated by international examples. It also assesses the regulatory and institutional framework for the health PPP program in Vietnam, as well as financing and accountability mechanisms for PPPs at its national and subnational levels. It provides an overview of the PPP project pipeline in Vietnam and analyzes important issues in the health PPPs’ design, preparation, and implementation, using eight case studies involving projects in different phases of the project cycle. This book also examines barriers that have hampered the successful design and implementation of health care PPPs in Vietnam. These barriers may be broadly categorized as barriers in the PPP policy and regulatory framework, in the public sector, in the private sector, and in the financial sector. It proposes feasible and actionable recommendations so that the government can consider tackling the identified barriers and advance the successful design and implementation of health PPPs.

Vietnam's Health Care Fund for the Poor (HCFP) uses government revenues to finance health care for the poor, ethnic minorities living in selected mountainous provinces designated as difficult, and all households living in communes officially designated as highly disadvantaged. The program, which started in 2003, did not as of 2004 include all these groups, but those who were included (about 15 percent of the population) were disproportionately poor. Estimates of the program's impact-obtained using single differences and propensity score matching on a trimmed sample-suggest that HCFP has substantially increased service utilization, especially in-patient care, and has reduced the risk of catastrophic spending. It has not, however, reduced average out-of-pocket spending, and appears to have had negligible impacts on utilization among the poorest decile.