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Health Financing and Delivery in Vietnam
the biggest group, though general practitioner clinics are also important; the private hospital sector, by contrast, is highly undeveloped (Government of Vietnam-Donor Working Group on Public Expenditure Review 2000).
Overview of the Chapters The book begins in chapter 2 with an assessment of recent trends in the performance of Vietnam’s health sector, focusing on health outcomes and financial protection. In many respects, Vietnam’s performance relative to health outcomes continues to be strong. Between 2000 and 2005, Vietnam saw reductions in age-specific mortality across all ages, in contrast to Thailand, where rates increased at some ages, and Malaysia, where the decline in mortality stagnated. Vietnam’s age-specific death rates compare favorably now with those of Malaysia. But trends in some health indicators have been less favorable, and improvements have in general been larger among Vietnam’s better-off and in Vietnam’s better-off regions. With respect to financial protection Vietnam scores badly (the risk of “catastrophic” health expenditures is high by international standards); furthermore, the improvements of the 1990s do not appear to have been continued into the 2000s. The book looks at health insurance in chapter 3. It finds that coverage has expanded considerably recently, but argues that this recent growth of coverage will not continue, and that new policy measures beyond those currently being debated will be required to further expand coverage. The book also finds that insurance affords relatively little financial protection in Vietnam, in part because coverage is so shallow, but also because of weak cost control by the health insurance agency. The book goes on in chapter 4 to propose and to estimate the costs of reforms to health insurance that would both expand and deepen coverage. The more ambitious reform would see a shift to a single-payer model, with the health insurer being responsible for the vast majority of total health spending in Vietnam (currently it accounts for just 10 percent). This reform would facilitate the uprating of user fees, and would also involve a shift away from