Health Financing and Delivery in Vietnam: Looking Forward

Health Financing and Delivery in Vietnam: Looking Forward

ISBN-10:
0821377825
ISBN-13:
9780821377826
Pub. Date:
01/23/2009
Publisher:
World Bank Publications
ISBN-10:
0821377825
ISBN-13:
9780821377826
Pub. Date:
01/23/2009
Publisher:
World Bank Publications
Health Financing and Delivery in Vietnam: Looking Forward

Health Financing and Delivery in Vietnam: Looking Forward

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Overview

Vietnam’s successes in the health sector are remarkable. Between 2000 and 2005, Vietnam achieved reductions in mortality rates for all ages, while some of its neighbors saw little change or even increases. To date, its infant and under-five mortality rates are comparable to those of countries with substantially higher per capita incomes. According to the data assembled in 'Health Financing and Delivery in Vietnam', the country continues to perform strongly in the sector, but its health care system is facing new challenges, as do those of other countries. By international standards, for example, a large percentage of Vietnamese households make out-of-pocket health care payments that exceed a reasonable fraction of their income. The country has been expanding the breadth of health insurance coverage, but questions remain on how to further expand coverage, how to decrease health care costs, and how to increase the overall quality of care. 'Health Financing and Delivery in Vietnam' reviews the country’s successes and the challenges it faces, and suggests some options for further reforming the country’s health system. These include the issue of stewardship—what different parts of government (for example, the Health Ministry and the health insurer) should be doing at each level of government, and what different levels of government (for example, the central government and the provincial government) ought to be doing. 'Health Financing and Delivery in Vietnam' will be of interest to readers working in the areas of public health and social analysis and policy.

Product Details

ISBN-13: 9780821377826
Publisher: World Bank Publications
Publication date: 01/23/2009
Series: Health, Nutrition, and Population Series
Pages: 184
Product dimensions: 6.00(w) x 8.90(h) x 0.10(d)

Table of Contents

Foreword ix

Acknowledgments xi

Overview 1

1 Vietnam's Health System Since DOI MOI 25

The Evolution of Vietnam's Health System 27

Recent Health Policy Agenda 32

Vietnam's Health System Now 34

Overview of the Chapter 42

2 Recent Trends in Vietnam's Health Sector Performance 45

Health Outcomes 46

Health Inequalities 51

Financial Protection 56

3 Health Insurance 61

Schemes and Target Groups 62

Contribution Rules, Benefit Packages, Provider Arrangements 63

Coverage 65

Insurance, Access to Health Services, and Financial Protection 70

VSS Revenues and Expenditures-Recent Trends 73

Adverse Selection and Factors Affecting Coverage 77

Moral Hazard and the Impacts of Health Insurance 85

4 Reforming Health Insurance 87

Expanding Coverage 90

Deepening Coverage to Further Reduce Out-of-Pocket Payments 99

Reforms to Contain Health Insurance Program Costs 102

5 Service Delivery 107

Institutional Background and Policy Makers' Concerns 108

Provider Performance 113

Prices and Provider Payment 121

Autonomy 124

6 Reforming Service Delivery 131

Delivery Reform Depends on Insurance Reform 132

Improving the Quality of Care 134

Provider Payment Reform 136

Autonomy Reform 140

7 Decentralization and Government Stewardship 143

Current Health Responsibilities of Government in Vietnam 144

The Future Horizontal Division of Responsibilities 146

The Future Vertical Division of Responsibilities 151

Notes 155

References 159

Index 165

Figures

1 Revenue Sources in Vietnam's Health System, 1998, 2000, and 2005 5

2 Out-of-Pocket Health Spending, Vietnam 2006 6

3 Who Benefits from Government Health Spending in Vietnam? 7

4 Trends inAge-Adjusted Mortality-Vietnam Compared to Malaysia and Thailand 8

5 Catastrophic Household Health Expenses, Vietnam and Other East Asian Countries 9

6 Trends in Insurance Coverage through VSS, Vietnam 1993-2006 10

7 Enrollment Numbers by Target Group, 2006 11

8 Trends in Inpatient Admissions and Outpatient Visits 16

9 Source of Hospital Revenues, Vietnam 1998-2005 17

1.1 Vietnam's Total Health Spending in Context 35

1.2 Revenue Sources in Vietnam's Health System, 1998, 2000, and 2005 36

1.3 Out-of-Pocket Health Spending, Vietnam 2006 36

1.4 Vietnam's Government Health Spending in Context 37

1.5 Government Health Spending as a Share of Government Spending vs. Total Government Spending as a Share of GDP 37

1.6 Inter-regional Inequalities in Government Health Spending, 2002 and 2006 39

1.7 Who Benefits from Government Health Spending in Vietnam? 40

2.1 Vietnam's Under-Five Mortality Trends in Historical and International Context 47

2.2 Trends in Childhood Health Indicators, 1997-98 to 2002-03 49

2.3 Trends in TB Mortality and Prevalence 50

2.4 Trends in Age-Adjusted Mortality-Vietnam Compared to Malaysia and Thailand 50

2.5 Faster Infant Mortality Reduction in Vietnam's Richer South 52

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