Advancements in health financing might be accelerated through more specific instructions.
Vietnam, with a population of nearly 94% covered by health insurance, is making significant strides towards universal health coverage. However, the country still faces challenges in reducing out-of-pocket (OOP) expenditure on health, particularly among rural and low-income populations.
The Vietnamese government has shown a high-level commitment to achieving free healthcare by 2035. To this end, the country's health financing system has undergone substantial reforms, including legislative changes, universal coverage goals, and government restructuring.
One key strategy to improve health financing efficiency in Vietnam is expanding targeted health insurance coverage for the poor and disadvantaged populations. The Health Care Fund for the Poor (HCFP), established to finance healthcare for the poor, ethnic minorities, and disadvantaged communes, has increased service utilization and reduced catastrophic health spending risks. However, average OOP expenditures have not significantly declined yet. Improving the fund’s design, especially targeting mechanisms and benefit generosity, could enhance efficiency and equity.
Another crucial strategy is strengthening the commune health system as the primary service delivery level. Enhancing financial support and benefit packages at the commune level can extend population coverage and service access, reducing reliance on higher-cost hospitals and private services that drive OOP payments.
Implementing inclusive health financing schemes with generous benefits and low copayments, similar to effective regional models, is another approach. Comparative evidence from East Asia (e.g., Taiwan and Hong Kong) shows that such inclusive insurance models with lenient eligibility and comprehensive benefits lower OOP expenditures and improve financial protection.
Improving transparency and autonomy in financial management is also essential for optimising resource use. Recent reforms promoting greater autonomy of enterprises and clearer accountability can be leveraged in health financing to improve expenditure efficiency and reduce wastage.
Monitoring and improving efficiency in procurement and funding allocation are also crucial. Ensuring effective procurement and use of financial resources, including vaccines and essential medicines, enhances the cost-effectiveness of health spending.
Vietnam's focus on reducing OOP spending and boosting service coverage through the commune health system is commendable. However, addressing gaps in benefit generosity, targeting, and primary care service quality at the commune level remains crucial.
Moving from a system designed to respond to acute episodes of ill health to a system that focuses on keeping people in good health can improve the efficiency of health financing. This transition, along with reducing fragmentation in how funds are pooled, aligning coverage policies with policy objectives, and linking the remuneration of health workers to performance and the health needs of the people they serve, are all valuable strategies for improving health financing efficiency in Vietnam.
Strong political commitment across all levels of government, as demonstrated by Dr. Angela Pratt, the representative in Vietnam for the World Health Organisation, is essential for successful health financing. Rules, regulations, and monitoring are needed to ensure funds are used equitably and efficiently.
With a focus on quality primary healthcare and the commune health system, Vietnam is taking the most cost-effective and effective way of providing most of the health services that people need. Adequate public funding from the state budget and social health insurance is required for health financing.
In conclusion, the combination of targeted expansion of financing schemes for poor and disadvantaged groups, enhancement of commune health services, adoption of inclusive benefit models, improved financial management, and efficient resource use underpins strategies to improve health financing efficiency in Vietnam. These efforts collectively aim to reduce financial barriers, lower out-of-pocket spending, and broaden service access through the commune health system.
- The commitment towards achieving free healthcare by 2035 in Vietnam involves not only expanding targeted health insurance coverage but also strengthening the commune health system, as this primary service delivery level can extend population coverage and reduce reliance on private services, thereby lowering out-of-pocket expenditures.
- To improve health and wellness in Vietnam, the government is exploring regional models that implement inclusive health financing schemes with generous benefits and low copayments, as these strategies have proven effective in lowering out-of-pocket expenditures and improving financial protection.
