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Health Financing and Delivery in Vietnam
in 1980 and continued to decline each year until 1992, while consultations per capita began declining in 1984 (World Bank 2001). During the late 1980s, the government launched its Doi Moi liberalizing economic reforms aimed at rejuvenating the economy. They included the decollectivization of agriculture, tax reform to expand revenues, reduced government spending, the closure and selling off of unprofitable state-owned enterprises and the downsizing of remaining ones, currency reform and international trade liberalization, and an encouragement of the private sector (Glewwe 2003). The effects of these reforms on economic growth and poverty appear to have been considerable: GDP growth jumped from 4.2 percent in the mid-1980s to 6.9 percent from 1988 to 1994, and to 7.4 percent from 1994 to 2000; meanwhile, the rate of poverty fell from 75 percent in 1984 to 58 percent in 1993, and then to 37 percent in 1998 (Glewwe 2003). As part of these general reforms, the government also introduced liberalizing reforms in the health sector, broadly along the lines advocated by health sector staff of the World Bank at the time (De Ferranti 1985). Chief among them were the introduction of user fees and the sale of drugs in public facilities, and the legalization in 1989 of private medicine (including drug stores). These reforms—and the Doi Moi reforms more generally—had several consequences for health sector outcomes. The improvements in living standards had beneficial knock-on effects for health outcomes: stunting among under-five children fell from 50 percent in 1993 to 35 percent in 1998 (Glewwe 2003); child mortality continued to fall after the introduction of the Doi Moi reforms and may have fallen faster after their introduction (Wagstaff and Nguyen 2003). The hospital bed occupancy rate started increasing immediately (from 1991 onward), and consultations per capita also began to increase, albeit not until 1993 (World Bank 2001). Public sector contacts per capita grew between 1993 and 1998, by 13 percent per year on average in the case of public hospitals and 10 percent annually in the case of CHCs (World Bank 2001). Contact rates in the private sector grew even faster, by 20 percent per annum in the case of private clinics, 25 percent per annum in the case of drug vendors, and 53 percent per annum in the case of traditional healers (World Bank