OVERVIEW IN VIETMANS HEALTHCARE

Vietnam’s private and public health system is focused on achieving universal, affordable coverage across
the country.

The current health system in Vietnam is a mixed public-private provider system. The public system, the
largest part, is organized under an administrative hierarchy, with the central level under the Ministry of
Health and local levels under provincial and municipal authorities. There are four levels of service
delivery: the central level (central and regional hospitals and research institutes), managed directly by
the Ministry of Health; the provincial and district levels; the commune level; and at the bottom a
network of village health workers who make house calls. Serving in the vast mountainous areas,
especially among the minority peoples whose numbers are few, are networks of skilled birth attendants.
At each level, we have a two-track system. One focuses on prevention, which includes the public health
system—like the CDC [Centres for Disease Control and Prevention] in the United States—and mother
and child health care; together they may be called the “public health centre” system. The other is
devoted to clinical acute care. These two tracks are distinct and different systems, but they collaborate
closely. They are sometimes housed in the same hospital, and sometimes separately.

HEALTHCARE WORK FORCE

Most doctors are trained in public, government-run medical schools, and the government covers all or
most of the costs of training. Medical students just pay a small fee. It is very cheap compared to United
States. There are now one or two private medical schools. We limit them because the quality of medical
education is an important consideration, and private investments for private medical schools are often
inadequate.

PRIVATE HEALTHCARE DELIVERY

Most private hospitals today are small, are not that well-equipped, and do not yet have famous doctors.
But even when their services and facilities are good, the public still lacks faith in their competence and
just uses them for simple diseases. The second problem is that their prices are higher. For example, a
patient insured with social health insurance must pay the additional costs charged by the private
provider—that is, the difference between social health insurance payments and private provider
charges.

HEALTH FINANCING REFORM AND UNIVERSAL COVERAGE

There is one health insurance scheme, which covers all enrolees, and everyone pays the same premium.
Private households pay for their health insurance premiums, with varying government subsidies
according to the enrolee’s economic status.

The government subsidizes 100 percent of premiums for the poor, children under six, the elderly over
eighty years old, war veterans, and people under other social protection schemes. Some other groups—
pupils in elementary school, students in junior high school and above, the near-poor, and workers in the
agriculture and forestry and fishery sectors who make average incomes (900,000 Vietnamese Dong, or
$45, per month)—receive about a 30 percent government premium subsidy to buy a health insurance
card. Households where all members are enrolled receive premium discounts.
There is no ceiling for health insurance payments based on the seriousness of sickness. However, the
category of the insured leads to different levels of insurance reimbursements: Worker households have
80 percent reimbursement with a 20 percent copayment; retired people and the near-poor have
95 percent reimbursement with a 5 percent copayment; and for the poor, children under six, and people
under other social protection schemes, the government covers 100 percent of costs with no copayment
from patients. Insurance covers medical examinations and treatments including cancer treatment;
rehabilitation; prenatal care and delivery; screening; and transportation for travel from the district level
to higher levels of health care for children under six, the poor, war veterans, and others under various
social protection schemes in case of emergency or when inpatient treatment calls for higher-level
technical and professional services.

Excluded services are post discharge care at nursing facilities, early detection of pregnancy, medical
checkups, family planning services and infertility treatment, prostheses and aesthetic surgery (related to
artificial arms, legs, teeth, and so forth), hearing aids, abortions (except for medically necessary
abortions), vision care including glasses, et cetera.

PREVENTION AND CONTROL OF INFECTIOUS DISEASES

Vietnam has a history of successfully tackling emerging infectious diseases like SARS [severe acute
respiratory syndrome]. Vietnam is the first country in the world to successfully control SARS, thanks to
our health system infrastructure—from commune health center up to the central level—of systems of
surveillance for early detection, control, isolation, and follow-up treatment.

Malaria, HIV/AIDS, tuberculosis, influenza, and parasitic diseases; the incidence decreased a lot in the
past ten to twenty years, although in some provinces on the border between Vietnam and Cambodia, in
the forested and mountainous areas there are strains that are multidrug resistant.