HEALTH SYSTEM MODEL

OF VIETNAM
GROUP 9-
 Sneha Gupta
 Sneha Khurana
 Dr.Srishti Singh
 Sunita Godara
 Surabhi Vinod
 Surbhi Kumari
 Sushant Unhawane
 Tanushri Dutta
 Dr.Tavleen Kaur Malik
 Tripti Tyagi
 Dr.Vandana Bhatt
INTRODUCTION: Vietnam is a southeast Asian country.
HISTORY : Starting from its independence in 1945 ,Vietnam
health model embraced public healthcare for over 40 years
where all the healthcare services were provided free of charge to
all citizens. In 1989 the first healthcare service fees were charged
to be continued till now but the poor and children under 6
continue to be completely covered by public insurance.
THE HEALTH SYSTEM MODEL: The ministry of health
oversees the whole model and system and divides its duties into
3 pillars: prevention ,Treatment and Administration. Each of
these pillars is managed at various levels i.e., communal level,
district level ,provincial level and national level. At each level
the health centers specialize in primary care while hospitals
specialize in treatment of developed and complex diseases and
health departments coordinate administrative activities.
 STATISTICS
TOTAL POPULATION OF VIETNAM 2016 94,569,000

Life Expectancy at birth m/f (2016) 72/81

Gross National Income per capita (PPP 5,030

international dollar, 2013)

Probability of dying under 5 (per 1000 live 21

births, 2018)

Probability of dying between 15 and 60 182/66

years m/f ( per 1000 population, 2016)

Total expenditure on health per capita 390

(international dollars ,2014)

Total expenditure on health as % of GDP 7.1

(2014)
 RAISING REVENUES
• Transfers from government domestic revenue allocated to health
purposes. In Vietnam, this is best approximated as the “state budget for
health.” i.e., the state budget for health includes only central-level
spending on health and transfers to sub-national governments that are
dedicated to the health sector. Local governments at the province,
district, and commune levels may allocate additional funds to health
from their local budgets. These amounts are not captured in the state
budget spending on health.
• Social health insurance contributions. In Vietnam, this includes
contributions to the health insurance fund managed by VSS from
employees, employers, and households.
• Compulsory prepayment other than social health insurance, such
as when private insurers participate in the market to fulfill mandatory
coverage requirements. The use of this financing modality is limited in
Vietnam.
• Transfers distributed by the government from foreign origin, allocated
to health purposes, such as through external financing for health that
flows through the government system and budget.
 INDICATOR VALUE
VIETNAM 2017

Current health expenditure by financing 130 ( USD per capita)

schemes

Current health expenditure by revenues 130 ( USD per capita)

of health care financing schemes

Capital health expenditure 8 ( USD per capita)

Gross Domestic Product 2342 ( In current USD per capita)

Purchasing Power Parity (NCU per Int$) 7716

Gross domestic product - Price index 100

 REVENUE FOR HEALTH
• Direct taxes paid by households and companies on income, earnings, or profits,
and
paid directly to government or another public agency; examples include income tax,
payroll tax (including mandatory social health insurance contributions), and corporate
income or profits taxes.
• Indirect taxes paid on what a household or company spends, not on what they earn,
and paid to government indirectly via a third-party e.g. a retailer or supplier. Common
examples are value-added tax (VAT), sales taxes, excise taxes on the consumption of
products such as alcohol and tobacco, and import duties.
• Non-tax revenues e.g. from state-owned companies including “natural resource
revenues” common in many mineral-rich countries e.g. oil and gas.
• Financing from external (foreign) sources is typically categorized as public
whenthese funds flow through recipient governments.

https://apps.who.int/iris/rest/bitstreams/858619/retrieve
 STRUCTURE OF HEALTH FINANCING REFORMS

• Like the health financing systems of other socialist countries in the

past, Viet Nam’s health financing has been based on general
government revenue. The healthcare system has been successful in
developing a health-care network that provides free primary health
care and referral care services to all citizens.
• At the end of the 1970s, the country underwent a serious
economic crisis and in 1986 the government launched its Doi Moi
(or “renovation”) reforms of the economy.
• In the health sector, four major reforms were introduced, namely:

The introduction of user charges,

The introduction of health insurance,
Permission for private practice in health care,
And opening of the pharmaceutical market
 COPAYMENT
• Copayment was re-introduced in January 2010 under the new
health insurance law and was applied to the set price list for
government health services at district, secondary and tertiary level
as well as the drugs from the reimbursement list .
• All insured members were instructed to pay copayments, except of
three specific member groups who are exempted, i.e. high ranking
police officers; meritorious people, and children under six years of
age, however for referred patients, the level of copayment varied
such as 5% of copayment applies to pensioners, the poor and
members who receive a social protection allowance, while 20% of
copayment applies to the remaining membership groups.
• The copayment policy limits the risk-protection function of SHI.
Uninsured patients are particularly at risk, as they pay by user
charges (fee-for service), i.e. 100% of the price of the set price list.
 POOLING RISK
• Disadvantaged groups in Vietnam especially ethnic minorities and those
living in poor, remote, and mountainous provinces had worse health
outcomes than the national average.
• The Government of Vietnam issued several policies. In 1994, the policy
stated that the poor should be exempted from paying user fees and by
1999, the policy ordered to enroll at least 30% of poor in compulsory
health insurance.
• This policy when put into practice, faced huge administrative difficulties,
such as identifying the poor, issuing the card that certifies their status as
“poor", enabling the poor to get free health care, defining benefits attached
to the card holders, etc.
• By 2009, it was made mandatory that all the poor have to enroll in
compulsory health insurance with government funds subsidizing their
premium.
• In 2016, SHI covered 87% of the total population including the poor and
other vulnerable groups.
 PURCHASING SERVICES
 The benefit package is regulated by the Social Health Insurance Law 2008
 According to the SHI law 3 types of provider payment mechanisms are
therefee-for-service, capitation, and payment by diagnosis-related groups
(DRGs).
 Insured members can use health services only from the commune health
centredistrict hospital where they are registered, or else be referred to higher
care levels. When seeking care in other commune health centres or district
hospitals, their out-of-pocket expenditure will be reimbursed later at their
place of residence, while emergency care is free of charge.
 Inclusion criteria: All ambulatory and hospital basic as well as advanced
diagnostic and therapeutic services , Inclusion of expensive high-tech medical
services,transportation costs in case of referral, Preventive health care except
for screening tests for early diagnosis of some cancers for insured and
uninsured.
 Exclusion criteria: rehabilitation, home care, drug addiction
treatment,prosthesis,teeth, glasses and hearing aids are not covered, nor are
treatment of occupational diseases and accidents at the workplace.
 DEVELOPMENT OF NEW PROVIDER-
PAYMENT SYSTEM IN VIETNAM
• Transitional economy in Vietnam makes “the rich to get richer
and the poor to get poorer” which results in inequality in access
to care. Private health expenditure accounted for more than 60%
of total health expenditure , in which out-of-pocket money for
health accounted for 25% of nonfood expenditure of 15.1% of
households.
• In Vietnam, payment methods for providers are mixed among
centrally controlled global budget, fee-for-service, and out-of-
pocket money. Years of deficit of the national health insurance
fund requires alternative reimbursement methods such as
capitation in primary care and case payment in secondary and
tertiary care.
• Secondary and tertiary hospitals receive more budgets from
the government compared to lower level hospitals and primary
care, which usually costs less. Most of secondary and tertiary
hospitals are located in big cities where higher income people
reside while the poor usually lives in rural and remote areas.
• Vietnam national health insurance consists of both
compulsory and voluntary schemes which cover 60.92% of the
population. Health insurance reduces out-of-pocket money of
the insured by 24% compared to the uninsured.
• 26% of hospital incomes were from health insurance
reimbursement and it keeps increasing. Fee-for-service via
health insurance contributes to health resources and reduces
financial burden for the government.
 QUALITY OF CARE
• The quality and availability of healthcare services varies
dramatically on the cities or in rural areas.
• Earlier the healthcare services available in Vietnam is below
that which is available in surrounding countries.
• The quality of healthcare of Vietnam reform through the
Direction of Healthcare Activities(DOHA).
• The DOHA scheme has accelerated the necessary up-skilling of
healthcare at lower level public hospitals across Vietnam. These
reforms are highly relevant for other countries with limited
healthcare resources.
• Alongside rapid economic development ,the health status of
people in Vietnam has significantly improved in recent years
,with the life expectancy from 71 years in 1990 to 76 years in
2015.
• Demographic changes ,rise in disposable income, and a steady
economic growth has led to a growing demand for healthcare
services in Vietnam .
• In 2017, healthcare expenditure accounted for 7.5% of the GDP
and between 2017 and 2021 it is predicted to grow at a
compound annual growth rate (CAGR) of around 12.5%.
• With an increasing demand for quality healthcare services and
new issues likely to emerge in the health sector in future years.

References: www.ncbi.nlm.nih.gov
 UNIVERSAL HEALTH COVERAGE
• The UHC service coverage index developed jointly by the World Bank and
the World Health Organization (WHO), this index is used to monitor
progress on the health service coverage dimension of SDG 3.8.1 (UHC).
• Vietnam’s score on this index is 73 (out of 100), comparing favorably to
the average of 59 for South-eastern Asia and to the global average of 64.
• THREE DIMENSIONS OF COVERAGE
 WHO IS COVERED?

POPULATION TARGATED BY POPULATION ENROLLED (% OF

HEALTH INSURANCE TOTAL

ENTIRE POPULATION TARGETED 87% (2016)

 WHAT IS COVERED?

SCOPE OF SERVICES BIRTHS ATTENDED BY SKILL BIRTH

HEALTH STAFF

COMPREHENSIVE 93.8% (2014)

 HOW MUCH IS COVERED ?

OUT OF POCKET EXPENDITURE AS DECREASE IN OUT OF POCKET

% OF TOTAL HEALTH EXPENDITURE EXPENDITURE AS % OF THE TOTAL
HEALTH EXPENDITURE SINCE
REFORM

41% (2016) 17%

(58% IN 2010)
 CONCLUSION
• Vietnam even belonging to a lower-middle
income country performs well in global index
of universal health coverage.
• Vietnam is one of the most rapidly ageing
countries n Asia, which eventually increases
future health care demand and health
spending.
• Vietnam has shown splendid transition from
total health expenditure from 2000 to 2016,
and intents to maintain in future also.