Wednesday, 17 Jan 2018

Vietnam targets 95% coverage of universal social health insurance by 2025

Updated at Tuesday, 19 Dec 2017, 19:19
The Hanoitimes - Vietnam enshrined universal social health insurance (SHI) coverage in its 2013 Constitution. Vietnam targets 95% coverage of universal social health insurance by 2025.
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. The government has set national SHI targets of over 90% coverage by 2020 and 95% coverage by 2025.
Vietnam enshrined universal social health insurance (SHI) coverage in its 2013 Constitution.
The Ministry of Health (MOH) has a comprehensive human resource development plan for 2012–2020. Recent efforts have focused on strengthening pre-service training and developing competency-based curricula for doctors and nurses, as well as upgrading general doctors to family doctors and expanding the scope of their primary care responsibilities. The number of establishments accredited to provide continuing medical education (CME) is increasing, and professional mentoring is used to strengthen competencies in lower-level facilities. New regulations under consideration include the creation of a Medical Council and requirements for licensing exams alongside periodic renewal of professional licenses.

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. 
Ngoc Thuy
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