Vietnam is the 15th most populous country in the world with just over 97 million people and one of the fastest growing economies in the world. One of the biggest improvements in Vietnam in recent years is its healthcare. Along with the economic reforms that the government started in the late 1980s, healthcare in Vietnam also went through reforms that generated many positive health benefits. The transformation from a fully public services system to a mixed public-private provider system in Vietnam introduced more selections and different alternatives for people to get better services. Since 1990, life expectancy has gone up, child mortality rates have significantly dropped and the number of malnourished children has gone down. Also, the country’s maternal mortality rate has dropped by 75% since 1990.
In 1989, Vietnam first introduced health insurance and in 1992 began implementing the Vietnamese National Health Insurance. By 2010, nearly 60% of the population was enrolled in the program. By 2015, the government was committed to achieving universal health coverage. Since then, Vietnam has made great progress in expanding social health insurance. Today, 87.7% of the population in Vietnam is covered by health insurance. Which was ahead of its goal. The key to its success is not the scale of investment in healthcare, which amounts to a modest US$142 per person annually, including both public funding and out-of-pocket expenses, but rather how the government uses its resources.
Today Vietnam’s evolving health system is a mixed public-private system. The public system is organized under an administrative hierarchy, with the Ministry of Health at the top and provincial and municipal health authorities below. The four levels of Vietnam’s health care delivery system provide access to care for all. There are central-level providers directly managed by the Ministry of Health and providers at the provincial, district, and commune levels. At the bottom of the hierarchy is a network of village health workers who make house calls. Skilled birth attendants serve Vietnam’s 53 ethnic minorities which is 13.8% of the population. Currently, the government subsidizes 80% of hospital fees for the poor and near-poor, as well as 100% for poor people and ethnic minorities living in disadvantaged areas, and 30% for farmers and fishermen who have average living conditions.
Even though healthcare in Vietnam has improved significantly, there are still many problems in the system. There is an imbalanced distribution of human resources and a severe shortage of specialized physicians in fields like cancer, cardiac and pediatrics. In 2015, Vietnam only had around eight physicians per 10,000 population. That is very low when compared to other Southeast Asian countries. Also, it is insufficient to meet the medical needs of its rapidly aging population. Public hospitals also have a chronic bed shortage. The total number of hospital beds in Vietnam in 2016 increased to 254,885 from 209,485 in 2011. In the packed public hospitals, the Health Ministry estimated that the bed occupancy can reach up to 170%. It is not uncommon to see multiple patients sharing hospital beds or waiting outside the hospital on bamboo mats.
The lack of resources to meet the demand of patients means that not everyone would be guaranteed the best care. Many big domestic corporations have started to create hospital and clinic chains across the country that offer high-quality medical care. The number of private clinics and hospitals now far exceeds the public ones. Private facilities are often overpriced. The Health Ministry estimated that only 7% of Vietnamese used private-sector health services. The rest use the overcrowded public facilities. There’s also been some foreign investment in the healthcare sector to help. Vietnam requires that healthcare facilities at central and provincial levels help build up the capacity of those at the district and commune levels. The goal is to alleviate the stress of those at higher-level hospitals. While there have been great strides made with the healthcare system in Vietnam there is still a need for more in regards to access and quality.