Vietnam’s Health System Since DOI MOI
2001). Reassuringly, growth rates were similar across all income groups (World Bank 2001). A further consequence of Doi Moi in the health sector was the rapid growth of household out-of-pocket spending. This was part of the so-called socialization of health care. As in China, the decollectivization of agriculture removed the main financing pillar of the primary health care system, namely revenues from the local agricultural commune. Commune health center (CHC) employees, as a result, looked to drug sales and fees to keep CHC revenues (and their incomes) constant. Drug sales in general, fees in public facilities, and private medicine all contributed to a rapid growth of out-of-pocket spending on health. By 1993, out-of-pocket spending accounted for 71 percent of total health spending, a major break with the past (World Bank 2001). It was not long before Vietnam’s central government introduced a variety of policy adjustments. • Beginning in 1991, it introduced national target programs (NTPs) aimed at specific public health problems. Targets were set and resources were allocated strategically across different parts of the country. NTPs have survived—albeit with variations over time— to the present day, and have become a policy instrument by which the central government has attempted to exert influence over local governments in spending and priority setting. • In 1994, the central government also assumed the responsibility for paying the salaries of CHC employees who had previously been paid by their commune (the responsibility passed to the provincial government in 2002). Government spending on CHCs more than doubled between 1994 and 1995, and the markup on drugs fell (in one study the share of CHC worker income financed through drug sales fell from 13.5 percent in 1991 to 6.4 percent in 1995) (Government of Vietnam-Donor Working Group on Public Expenditure Review 2000; World Bank 2001; Glewwe 2003). • In 1995, the central government introduced a schedule of user fees for consultations and physical examinations, inpatient days, technical services, and lab tests; drugs are not covered by the
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