Bethesda, MD--In August, Vietnam's Minister of Health, Nguyen Thi Kim Tien, was interviewed for Health Affairs by Tsung-Mei Cheng. Among the topics discussed was an overview of the unique characteristics of Vietnam's health system; its strengths and weaknesses; health financing reform aimed at reaching the goal of universal health coverage; the prevention and control of infectious diseases; and how Vietnam has performed in achieving the Millennium Development Goals. Health Affairs has previously published Cheng's interviews with other world health ministers, including Thomas Zeltner of Switzerland (2010) and Chen Zhu of China (2012).
Vietnam’s Health Care System Emphasizes Prevention And Pursues Universal Coverage
By Tsung-Mei Cheng
Cheng is a health policy research analyst at the Woodrow Wilson School of Public and International Affairs, Princeton University, in New Jersey.
This interview will also appear in the November issue of Health Affairs.
Some highlights from the interview:
- The Vietnamese parliament has voted to spend about 30 percent of the country's state fund for public health. However, that goal has yet to be reached.
- The 2008 Law of Health Insurance requires patients use the communal health facility they have registered for through their social health insurance, except in cases of an emergency. If a patient insists on visiting a different facility, the insurance will not cover the service and the patient will need to pay out of pocket for that care.
- While the goal of the 2008 law was universal coverage by 2014, that goal has not yet been reached (the minister says about 70 percent have enrolled). Participation in social health insurance is mandatory, but the minister admits that enforcement has been weak. Vietnam's "master plan" aims for 80 percent by 2020.
- Medical training is comparable to that of other nations, with many countries supporting the postgraduate training of new Vietnamese physicians. Graduates are free to choose positions in either the public or private sector. While many prefer to work in cities, one training model accepts students with substandard entrance exams into government medical schools in exchange for future service in their native provinces for a minimum of five years.
- Over 90 percent of Vietnamese babies are delivered by trained midwives.
- Nguyen stated that Vietnam is the first country to successfully control SARS, and the incidence of other infectious diseases such as HIV/AIDS and TB has declined in the past ten to twenty years. The exception is malaria, which Vietnam had conquered five years ago but is now witnessing a return among migrant workers along the borders with Cambodia and Laos. Minister Nguyen states that drugs for treatment are available and costs for epidemic outbreaks are borne by the government.
- Looking ahead at achieving Millennium Development Goals, the minister called the greatest difficulty "overcoming the disparities between residents in mountainous areas and members of the minority groups, on the one hand, and the residents of urban areas on the other hand....Infant mortality, maternal and child mortality, and the incidence of malnutrition are still high in some very remote areas, while they are all very low in cities. But on average, for the country as a whole we achieved the goals."
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