The healthcare system in Vietnam is a dynamic combination of both public and private sectors, focusing on preventive medicine and curative care. Substantial progress has been made in achieving universal health coverage and enhancing preventive healthcare.
According to the 2015 law, enrollment in the national health insurance system is mandatory for all Vietnamese citizens. Social health insurance (VSS) funds all services and products, including medicines, medical services, and procedures, listed in the national health insurance system.
Healthcare administration in Vietnam is organized across four levels: national, provincial, district, and commune healthcare centres. Despite these efforts, Vietnam faces significant challenges, including outdated and overcrowded hospitals. While the government has increased the healthcare budget, it remains insufficient to meet the growing needs. Healthcare professionals, particularly doctors, work under stressful conditions with relatively low wages.
Common causes of death in Vietnam include stroke, ischemic heart disease, diabetes, chronic obstructive pulmonary disease (COPD), lung cancer, road injuries, cirrhosis, chronic kidney disease, lower respiratory tract infections, and Alzheimer's disease.
Organization of Healthcare Services:
The Vietnam healthcare system operates at four levels: national, provincial, district, and commune healthcare centres, with 63 provinces, 700 districts, and 11,000 commune healthcare centres.
Delivery of Healthcare Services:
Healthcare delivery is segmented into three levels: primary healthcare services provided by districts and commune healthcare centres, secondary healthcare services by provinces, and tertiary healthcare services by national institutions.
Patients often opt for provincial healthcare services due to perceived low-quality care, resulting in higher co-payments if they bypass the referral system.
Financing of Healthcare Services:
The MOH defines social health insurance as mandatory health insurance and the premium depends on the financial status of the person. The health benefits depend on the medical condition.
The healthcare benefits provided by the public sector are similar to private sectors which have tied up with national health insurance.
Nearly 95% of people who got treatment in 2020 have health insurance.
Commune Health Centers rely on two primary income streams: provincial funding for staff salaries and operational costs, and health insurance reimbursements for curative care services.
However, there is a lack of well-defined criteria for determining reimbursement amounts for curative services.
VSS provides district hospitals with yearly compensation based on a 'capitation-based' payment model, covering outpatient services, hospital stays, and referrals to provincial hospitals for insured individuals. This model places district hospitals at financial risk if they exceed their annual budget, with limited control over their financial plans.
Challenges
The challenges in the Vietnamese healthcare system include overcrowded hospitals, disparities between public and private healthcare services, and high out-of-pocket spending, accounting for nearly 40% of total health expenditure.
Pharmaceutical Sector
Vietnam's list of essential medicines was published in 2018, and the pharmaceutical market is in its early stages, with the involvement of small local firms.
The Drug Administration of Vietnam (DAV) oversees product registration, involving three key steps: obtaining a drug trading or manufacturing license, conducting clinical trials through a licensed establishment, and applying for market authorization.
Pricing regulation requires pharmaceutical companies to submit prices to DAV, while social health insurance funds products listed in the Health Insurance Medicines List. Pharmacist-supplied drugs are not reimbursed, and establishments signing contracts with VSS must reimburse listed products.