The National Health Strategy 2011–2020 also gives prominence to renovating primary care to achieve national health goals, and in 2016 the Prime Minister issued a master plan for developing the grassroots health system. As such, family medicine principles are being introduced to strengthen primary care, particularly at commune health stations (CHSs), to respond to rapid population aging and non-communicable diseases (NCDs).
Vietnam enshrined universal social health insurance (SHI) coverage in its 2013 Constitution.
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Viet Nam is considered one of 10 “fast-track countries” for national performance on the health-related MDGs, but it faces regional and ethnic disparities. The full immunization and skilled birth attendance rates are well over 90%; government investments have extended and upgraded the network of district and provincial hospitals; and existing CHSs cover 99% of administrative jurisdictions in the country. However, there are substantial and persistent geographic, ethnic, and living standards disparities in health outcomes including malnutrition, maternal and under-5 mortality, and access to essential services, such as antenatal care. There are also substantial deficits in health facility capacity in rural (mountainous and coastal) areas, particularly shortages of well-qualified and experienced staff.
Quality assurance systems have been set up in all hospitals; national protocols and guidelines have been developed for many medical conditions and are being applied in hospitals; and health professional education reform is shifting toward competency-based training, from undergraduate through to postgraduate levels. Nevertheless, in this hospital-centric system, the CHS does not yet satisfy the primary care needs of the population: staff often have inadequate competencies, lack expertise in areas such as basic first aid and screening and management of NCDs, and have few opportunities for continuing education; the list of pharmaceuticals that they can dispense is limited; and few basic medical tests or imaging services are available. Consequently, patients lack confidence in the quality of primary care facilities, often choosing to seek care at higher-level hospitals despite substantially higher co-payments and inconvenience.
Vietnam’s health spending continues to grow, but allocative and technical efficiency could be substantially improved to attain greater health improvements with existing funds. Between 1995 and 2014, total health expenditure increased steadily, from 5.2% to 7.1% of GDP. State budget spending on health rose from 7.9% to 14.2% of government spending over the same period. Out-of-pocket spending has continued to increase in absolute terms, but has fallen in relative terms, from 63% to 37% of total health expenditure. Continued growth in health spending will be difficult to maintain due to government budget and borrowing constraints making efficiency imperative, particularly in the face of rapid population aging and the availability of new, costlier technologies.
Provider payment arrangements do not incentivize providers to focus on cost-effectiveness, resulting in overuse of high-tech services. Increases in prices, coupled with the expanded scope of the SHI package, translate into greater costs to be reimbursed by the SHI fund without a commensurate increase in resources. At the system level, the large share of public subsidies allocated to secondary and tertiary hospitals diverts funds from strengthening primary and preventive care.
