Transcript Health Financing and Delivery in Vietnam

Health Financing and
Delivery in Vietnam
Kevin Arts
April 25, 2012
Background
 Vietnam has excellent health outcomes…
 Life expectancy
 U5 mortality rate
 Maternal mortality rate
 Public health
 *Communicable disease
 …given its development status and spending.
History of Health System
 Independence (1954 – 1975)
 Unification (1975 – 1985)
 Doi Moi (1986 – Present)
Economic Effects of Doi Moi
Poverty Rate
GDP Growth
80
8
70
7
60
6
50
5
40
4
30
3
20
2
10
1
0
0
Mid-1980s
1988 to 1994
1994 to 2000
Health Sector Reforms
 Market Mechanisms
 Policy Adjustments
 1991: National Target Programs
 1993: Social Health Insurance
 1994: Salary Support
 1995: Fee Schedule
+
 Supply-Side Subsidies
Recent Reforms
 2003: Decision 139
 2005: Benefit reform*
 2000s: Autonomization*
Challenges and Solutions
 Breadth of Coverage
Insurance Coverage
 Few Low-Hanging Fruit
13%
 Inequities
No Coverage
1%
4%
Mandatory Insurance for
Workers
Policy Beneficiary
46%
15%
Insurance for Poor
Student Insurance
Voluntary Group
Insurance
Family & Other Voluntary
7%
7%
Source: Lieberman and Wagstaff 2009
7%
Free Health Certificate
Challenges and Solutions
 Depth of Coverage
Revenues by Source
 Out-of-Pocket
1%5%
7%
 Catastrophic Health Costs
Out-of-Pocket
Gov. Budget
Support
20%
Gov. Subsidies
67%
Source: Lieberman and Wagstaff 2009
Voluntary
Contributions
Earnings-related
Contributions
Challenges and Solutions
 Rising Cost of Care
 Throughput
 Case mix
 Unexplained
Hospital Cost Inflation
30
25
20
15
10
5
0
1994 - 1996
1998 - 2000
Total Cost
Source: Lieberman and Wagstaff 2009
2004 - 2005
Cost Per Case
Conclusion
 Vietnam has high health outcomes on relative
and per dollar bases…
 Due to economic growth and policy
interventions…
 But problems remain with respect to breadth and
depth of coverage + cost of care + inequities
Sources
 International Labor Organization (2006), “Vietnam Social Health
Insurance: Current Issues and Policy Recommendations.”
 Lieberman, Samuel and Adam Wagstaff (2009), “Health Financing and
Delivery in Vietnam: Looking Forward, “ The World Bank.
 Trinh Kuu, Duke (1998), “Vietnamese Health Care,” Stanford Medical
Review.
 The World Bank (2012), “World Development Indicators: Vietnam.”
 World Health Organization (2011), “Viet Nam: Health Profile.”