This chapter provides a unique look at policymakers' commitment to equity in health in the face of multiple political and economic pressures. The Vietnamese have had a traditional focus on equity, early on creating an impressive health infrastructure that extended throughout the country. Vietnam's overall health performance in terms of life expectancy is remarkably high given its level of economic development. In 1989, however, the legislature implemented Doi Moi (meaning change to the new), resulting in privatization of trade and social services (including health), and the opening up of markets. Cuts in public spending and introduction of user fees for public services were part of this prescription. Faced with these challenges, the chapter presents policymakers' approaches to developing a health financing system that would be both equitable and efficient.