Many countries are working to establish a health financing system that allows them to
move towards universal coverage – defined as access to key promotive, preventive,
curative and rehabilitative health interventions for all at an affordable cost – thereby
achieving equity in access and financial risk protection as well as in health financing
(WHO, 2005). This is particularly challenging for low- and middle-income countries
in light of their heavy reliance on out-of-pocket (OOP) payments for health care
(WHO, 2010). The challenge is to improve the health financing system in order to
achieve universal coverage as an overall policy goal.
The Government of Vietnam is clearly committed to universal coverage and has
approved a number of important laws relating to health financing and health insurance.
In addition to some good health indicators, there are impressive achievements as to
Vietnam's health financing, namely a population coverage rate of about 60%,
continuous commitment to state subsidized premium payments, and developments in
the payment system. Viet Nam’s health financing policy puts a strong emphasis on
equity in health. Shifting from a tax-based health financing system, Viet Nam has been
introducing social health insurance (SHI) since 1992. The country’s health insurance
law was promulgated in 2008, with the goal of universal coverage by 2014.
Yet, the goal of universal coverage with SHI is challenging. As in other
developing countries, the majority of Viet Nam’s population works in the informal
sector. The share of household out-of-pocket (OOP) payments for health, despite its
rapid decrease in recent years, is still very high and accounts for some 55% of total
health expenditure (THE). Despite these successes and achievements, there are a
number of bottlenecks in institutional design and organizational practice. These
impede Vietnam from achieving the levels of health financing performance that the
country could potentially attain, given its resources and priorities, and are therefore of
great concern with regard to achieving universal coverage.