Healthcare system in Vietnam

Public Health, Policy and Practice

Tran Thuy Ngan
Hoang Gia Linh
 Introduction
About the country
• Vietnam is a South-East Asian country
• Population: 90 million
• Lower middle-income country with GDP US$ 2,000 per capita per year

Health indicators
• Life expectancy at birth increased: from 69 in 2000 to 73 in 2013
• Maternal mortality decreased: from 170 per 100,000 live births in 1990 to 65 per
100,000 live births in 2013
• The under 5 mortality decreased: from 34 per 1,000 live births in 2000 to 23 per 1,000
live births in 2013
• Polio-free status achieved in 1997
• Elimination of neonatal tetanus achieved in 2005
• Shift from communicable diseases to non-communicable diseases: proportion of
communicable diseases decreased from 38% in 1996 to 25% in 2013.
In 2013, proportion of non-communicable diseases was 62%
 Healthcare system
At present, the public health care sector widely covers from central to grassroots levels

Central level • Issuing law and other legal documents, making long-term plans and strategies
(Ministry of Health) • Managing national hospitals, research institutes, universities and colleges

• State-level department of health

• General and specialized hospitals (maternity, obstetric, paediatric, traditional medicine,
Provincial level tuberculosis and lung disease hospitals)
• Specialized medical centers (reproductive health, preventive medicine, HIV/AIDS,
communication and health education, food safety and population agencies)

• General hospitals and preventive medicine centers at district level

District level
• Other district agencies engaged in health: population, food safety management

• Provide basic services:mother and child health care, family planning, treatment for acute
Commune level respiratory infections, immunization and treatment of common illnesses
 Healthcare system
Private health facilities
• Late 1990s and early 2000s
• Including private hospitals, medical and maternity clinics
• Mainly developed in highly populated urban areas
• Licensed by the Ministry of Health
• 2013: 155 private hospitals and more than 30,000 private clinics
Health information management system
• Reports are mostly paper-based and manually created → difficult to obtain the
accurate data and analyze
• Health workers in lower level report monthly to higher levels → takes time

Need of a computerized, universal and comprehensive health

information management system
 Health equity
Quality of healthcare between cities vs rural location
• Most patients prefer to go to better provisioned public hospitals in
major cities (Hanoi, Ho Chi Minh)
• Not only serve the needs of citizens residing in the cities but also people
travelling from the surrounding countryside
• Some hospitals in central level are always overcrowded: reaching 120-160% bed
occupancy [3]
• What are the reasons?
• High quality, advanced and well-equipped hospitals and clinics: clustered
around major urban areas
• In rural areas, accessing quality healthcare is more challenging: lack the
diagnostic equipment and training to carry out some treatments [3]
 Health equity
Quality of healthcare between cities vs rural location
• Most critical issue
Disintegration of health facilities at the primary care level
 Government efforts
• Project 1816: Satellite Hospital Program
• Rotate experts from central-level hospitals through local hospitals to
train their colleagues on the procedures and devices necessary to
provide more treatment options locally
 Health insurance
• In 1989, health insurance was introduced in Vietnam and began to be
implemented in 1992
• In 2014, the Law of Health Insurance was revised with the aim of
Universal Health Insurance Coverage
• Health insurance provided by the government includes 3 types: medical
insurance, accident insurance and a part of social insurance
• For employees
• Who are in contract with an organization for more than 3 months
• Total cost for medical insurance is 4.5 of salary (3% paid by employers)
• Use of government insurance
• Most people use government insurance for major surgery and treatments: long
process, high cost (for example: orthopedic surgery, cancer treatment…).
• For minor cases such as health check-up, patients often disregard of the insurance
because of the complicate procedure
 Health insurance
• Health insurance coverage over the years [4]
 References
1. World Health Organization (2016). Human resources for health country profiles – Vietnam.
2. Le DC, Kubo T, Fujino Y, Pham TM, Matsuda S. Health Care System in Vietnam: Current Situation
and Challenges. Asian Pacific Journal of Disease Management. 2010. 4. 23-30.
10.7223/apjdm.4.23.
3. Hoang, C. K., Hill, P., & Nguyen, H. T. (2018). Universal Health Insurance Coverage in
Vietnam: A Stakeholder Analysis From Policy Proposal (1989) to Implementation
(2014). Journal of Public Health Management and Practice, 24, S52-S59.
4. Ministry of Health. Annual Report on Healthcare Activities 2011-2018
Vietnam. Hanoi, Vietnam: Ministry of Health; 2011-2018