Vietnam’s Health System Since DOI MOI Figure 1.6: Inter-Regional Inequalities in Government Health Spending, 2002 and 2006
Gini coefficient / concentration index
0.40
2002 2006
0.30 0.20 0.10 0.00 –0.10 –0.20 –0.30 –0.40
GDP per capita
total govt. exp.
health govt. exp.
national targeted program transfers
Source: Calculated from financial data from MOF (accessed 15 June 2007). Data for 2002 and 2004 are actual/final accounts. Data for 2006 are planned accounts. Health expenditures for 2002–06 are for recurrent health expenditures only. Note: The Gini coefficient and concentration index are calculated from population-weighted data on the eight regions.
inequalities in figure 1.6 mask within-province inequalities in Vietnam: Provinces enjoy considerable discretion in how they allocate budgets (including funds from targeted programs) across districts and communes, and there may be considerable inequities between poor and rich parts of a province (World Bank 2005). Also noteworthy in figure 1.2 is the small (albeit increasing) share of total health spending covered by SHI. The smallness reflects both the limited (albeit rising) coverage rate and the shallowness of coverage. The latter reflects the fact that most out-of-pocket payments are incurred not in government facilities, but rather at drug stores and private facilities that are not covered by the insurance scheme. What of the pooling function of health financing? In contrast to many countries, Vietnam spends the majority of its government health spending on goods and services rather than salaries, though the share going to salaries has risen in recent years (Government of VietnamDonor Working Group on Public Expenditure Review 2000; Knowles et al. 2005). But as in many countries, the bulk of Vietnam’s government health spending goes to urban hospitals (75 percent to
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