Healthcare System in Viet Nam

Do Kim Ngan Seoul, October 18th 2010

Overview of Vietnam
Geographical Location: South East Asia bordering with China, Laos, Cambodia and the East Sea
Capital: Hanoi

Area: 330,660km2
Population: 85.8 millions (2009) GDP per capita: 1024 USD (2008) Districts: 63

Population Growth
Phn b dn s theo tui, 1979
75+ 70-74 60-69 50-59 40-49 30-39 20-29 10-19 0-9
-20 -15 -10 -5 0 5 10 15 20

Phn b dn s theo tui, 2008

75+ 70-74 60-69 50-59 40-49 30-39 20-29 10-19 0-9
(15) (10) (5)

Male Nam

Female N

Nam Male

N Female

Phn trm
Ngun: Tng cc Thng k, Tng iu tra dn s 1979.

Phn trm

10

15

Ngun: Tng cc Thng k, iu tra bin ng DS-KHHG 2008.

1979

2008
3

Main Health Index

Life Expectancy: 73 (2008) Average Population Growth Rate: 1.2% Population of age over 60: 9.6% Infant mortality rate: 16.0 per 1,000 live births Under-five mortality: 25.9 per 1,000 live births Maternal mortality rate: 75.0 per 100,000 live births

Source: Health Statistical Profile 2007, MOH

Organization
Central Ministry of Health National Hospital Research Institute Medical School Provincial Prov. Health Dept.
(Peoples Committee)

Provincial Hospt

Medical School
Preventive Medicine

District

Dist. Health Dept.

District Hospt Preventive Medicine District Health Center

Commune

Commune Health Post

5

Organization
Classification Number

National Hospital Provincial Hospital and Clinic District Hospital and Health Center Commune Health Post

60 371 610

10.320

Health Service Delivery

Public: 1.062 hospts (92%) with 144,129 beds

Private:
88 hospts (8%) with about 5000 beds 30.000 small clinics

Doctor: 55.000 (6.4/10.000 inhabitats)

Nurse: 77.000 (8.9/10.000 inhabitats) Pharmacist: 10.390 (12/10.000 inhabitats)

Health Service Delivery

Residents
Primary care

Private Practice, Health Post Private Practice, Health Center, Small size Hospitals Small and Medium size Hospitals, general hospitals Specialized, Occupational Hospitals

First Referral

Second Referral

Tertiary care

Acute General Hospitals, Specialized Hospitals, Occupational Hospitals

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Government Budget

Budget public health facilities Allocate govt. Budget for purchasing HI for targeted groups (Health care for the poor: 14m. People) Govt. pays for health services for children under 6 years old 85% for curative care 13.8% for preventive care

Health Financing Trend (99-06)

% of GDP
7 6 5 4 3 2 1 0 1999 2000 2001 2002 2003 2004 2005 2006

Source: MOH, Vietnam

Major HI milestones
year
1963

Korea
Medical Insurance Act: voluntary participation for company employees and the self-employed

Vietnam

1976 Amendment of MIA to make HI compulsory 1977 CHI with company >500 emp, Medical Aid Program

Free healthcare for all

1979 CHI with company of >300 employees Start HI scheme for govt. & private school employees; 1979 KMIC established 1981 CHI with company of >100 employees 1983 CHI with company of >16 employees 1988 HI scheme for the rural self-employed 1989 HI scheme for the urban self-employed 100 User fee introduced SHI introduced with voluntary 1992 participation 1997 Merge insurers for the self-employed into KMIC 1998 CHI : govt.employees 2000 Establishment of NHIC Healthcare Fund for the poor 2002 established 2003 Merge of finances of the HI funds Free care for children under 6

5.4 12.5 20.0

23.1 28.4
46.0
10

2005
2008 2014

No copayment, Healthcare for the poor fund transferred to HI Health Insurance Law passed, reintroduce copayment Start CHI universally

Organization
Merged to Social Health Insurance Administered at national level but funds are managed by provinces Administered at provincial level under the surveillance of MOH 1992 1998 2003
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Organization
Central Vietnam Social Insurance Corporation MOF, MOH, MOLISA Fund Management Surveillance Policy making Provincial

Prov. Social Insurance

Issue Health Insurance Card Surveillance

District

Dist. Social Insurance

Collect revenue Distribute Health Insurance Card District Health Center

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Vietnam Health Insurance System

Premium

Government

Medical Aid Healthcare for children under 6 Subsidy

VHI Coop

Tax Services

National Programs

Fee for Services

Pharmacy

Population

OOP Medical Services

Hospitals

Clinics
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Vietnam Health Insurance System

Program
Social Health Insurance

Population coverage
12%

Target group
Formally employed, retired, disabled, meritorious people The poor, ethnic minorities, inhabitants in disadvantaged areas All children under 6 years of age Self-employed, informal sector workers, dependents of CHI, students and school children

Financing
6% payroll tax ( 4% employers and 2% employees Central Govt. 75%, Provincial Govt. 25% Central Government Private premium contributions based on ability to pay

Health care fund for the poor Free healthcare for children under 6 Voluntary Health Insurance

18% 11% 11%

Total

52%

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Revenues and expenses of HI Fund

7000 6000 5000 4000 3000 2000 1000 0 -1000 -2000 -3000

19 93

19 94

19 95

19 96

19 97

19 98

19 99

20 00

20 01

20 02

20 03

20 04

20 05

20 06

Thu/ Income

Chi/ Expenses

Cn i thu chi/ Balance

15

20 07

Major Characteristic of the System

Public Sector dominance:

Public hospital and clinics: 92% Wide basic healthcare network and primary healthcare

Overload
Poor service at primary and first referral leading to overload at higher referral Severe disparity in the geographic distribution of health resources
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Major Characteristic of the System

Low quality of service

Public dominance State budget for health is not of highest priority Low independence of hospitals in facility renovation decision and implementation Low competition among service providers

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Thank you very much for your attention!

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