Healthcare access in Vietnam: what’s new in 2017 ?

While Vietnam is innovating in many sectors, healthcare system is also part of this revolution. Although a great progression, the country is still face to many challenges for an optimum healthcare access to all the population.

 

 Patients and their relatives buying drugs at the National Lung Hospital in Hanoi-Linh Pham-NYT

Patients and their relatives buying drugs at the National Lung Hospital in Hanoi-Linh Pham-NYT

 

Aging population and consumption changes: new challenges for Vietnam

Since Vietnam has opened its borders to the rest of world, vietnamese people has been encoutering better living standards and public health has improved. The country has outperformed its results related to primary basic care improving life expectancy and infant mortality is quite low.

Vietnam-Life expectancy and infant mortality

Vietnam-Life expectancy and infant mortality – WHO data

However, as many other southeast Asian countries, Vietnam is not spared by the Non-Communicable and age-related diseases for which Vietnam has difficulties to manage. To date, old people represent 10% of Vietnam’s population, and more than 50% of the country’s annual healthcare expenditure are concerned by them. In addition, new consumption modes, bad food and pollution are favoring an increasing number of patients with diabetes, heart injuries and cancers each year. In 2012, the International Agency for Research on Cancer (IARC) reported that there are around 125,000 new cases per year for both sexes. It is estimated that there will be 190,000 new cases in 2020. Unfortunately, most of time, patients are face to bad prognosis and most of them are diagnosed present advanced diseases.

Some key facts can explain these main healthcare-related issues: adapted infractures are missing and most of time, population can’t have access to great diagnosis and treatments as they usually represent high-cost health deliveries.

 

Invest in the Universal Health Coverage  to enlarge the number of beneficiaries

Vietnam has made great progress in improving its health system. Since 1986, policy makers have been working on a social Health Insurance (HI) scheme that could benefit to everyone in Vietnam:

  • 1986: Free healthcare is planned in the Đổi mới
  • 1989: First voluntary HI pilot begins for provinces’ entire population
  • 1992 – 2009: Series of decrees conducting to the HI law
    • 2003: Ordinance on Private Medical and Pharmaceutical practices (OPMPP)
    • 2009: Promulgation f the law on Medical Examination and Treatment (LMET) that take effect in 2011
  • 2015: Implementation of compulsory health insurance under the Revised HI law

Obviously, the series of health reforms have deeply affected Vietnam’s healthcare system. Today all vietnamese citizens are supposed to benefit from a Health Insurance. In 2009, it represents a reimbursement of  USD$ 66 per annum per person (including USD$ 9 for pharmaceuticals), which is roughly similar to Pakistan and India. In fact, at this time, most healthcare expenditure is out-of-pocket and the national Health Insurance is only covering a small part of the population.

 

Health Insurance contribution to health expendiure in Vietnam

Health Insurance contribution to health expendiure in Vietnam – MOH data – 2011

 

New master plan to modernize Vietnamese healthcare system

Vietnam’s efforts to attempt to enlarge healthcare access continues. Nonetheless, public services are overloaded. Public health structures are mainly located in major cities as Hanoi and Ho Chi Minh City, and many people from provinces do not trust in local hospitals. Consequently, “big hospitals” overloading is becoming part of vietnameses’ daily life: patients travel 50 km a day to get the hospital and then, they can wait for a whole day before being examined by a physician.

HCMC's Cho Ray Hospital_Minh Hung

HCMC’s Cho Ray Hospital_Minh Hung

Conscious of the alarming situation, the Minister of Health has launched a new master plan that aims to organize differently the healthcare system. The master plan defines priorities for the period 2016-2020. Among those, bed occupancy rates are the main priorities. Modernization of hospitals is also part of this ambitious project. To do that, Pham Le Tuan, Deputy Ministry of Health in Vietnam has recently announced that the country would need approximatively USD$ 7.5 billion to upgrade its facilities and its healthcare system between 2016 and 2020. 

Beyond modernizing medical equipment, the government intends to reshape the healthcare system in order to improve non-communicable diseases management and geriatric services. In addition, “family medicine” system is highly promoted. Indeed it can be a great solution as it is a well-known system largely adopted in occidental countries like France. Effectively, it can bring some solutions to healthcare delivery as it is cost-effective. To date, with foreign organizations help like the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA), primary healthcare delivery can be set up through rural areas: there are an average of 10,000 commune health stations in vietnamese provinces. Both public and private sectors have adopted this system. As Family Medicine is still considered as something new in Vietnam, Vietnamese people may not trust easily to this system yet.

Despite all these initiatives, hospitals wards remain dangerously crowded. Besides, more and more vietnamese citizens like middle-income households prefer private foreign clinics and hospitals. Almost 40,000 vietnamese ( USD$ 1 billion) travel abroad to be treated, particularly in Singapor or South Korea. To change that and to deliver higher services quality, Vietnam will encourage the creation of private hospitals.

 

Perspectives

Vietnam’s healhcare system has improved but more efforts have to be achieved. Beyond that, it would be important and necessary to think how to regain population trust in local physicians, help them to get access to diagnosis and prevention,  and sustain vietnamese physicians’ training.

 

Sources:

Cancer Control in Vietnam: Where are we? Cancer Control

Vietnam health system and health infrastructure: achievements, challenges and orientation, Vietnam Ministry of Health, 2015.

Vietnam: Changes in Health Insurance Regulations, Mayer & Brown, 2015.

South-East Asia, The New Emerging Healthcare Market Challenge, Clearstate, 2016

An International Consultation: The Development of Family Medicine in Vietnam, International Family Medicine, Alain Montegut et al., 2011

From the President: Family Medicine Reform in Vietnam, WONCA, January 2016

The Vietnamese healthcare industry: moving to next level, PWC, P. Gaskill and Nguyen Luong Hien

Overloading continues to plague Vietnam’s major hospitals, Thanh Nien News, Minh Hung, July 2014

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