Over the past two decades Vietnam has made enormous progress to expand health insurance coverage to its population. Further progress will require significant additional public financing, as well as efforts improve efficiency and strengthen insurance organization and management. It contains recommendations and next steps for Vietnam to follow.
Vietnam's successes in the health sector are legendary. Its rates of infant and under-five mortality are comparable to those of countries with substantially higher per capita incomes. However, challenges remain in how to further expand coverage, increase quality of care, and contain the rapidly increasing health care costs.
Vietnam's Health Care Fund for the Poor (HCFP) uses government revenues to finance health care for the poor, ethnic minorities living in selected mountainous provinces designated as difficult, and all households living in communes officially designated as highly disadvantaged. The program, which started in 2003, did not as of 2004 include all these groups, but those who were included (about 15 percent of the population) were disproportionately poor. Estimates of the program's impact-obtained using single differences and propensity score matching on a trimmed sample-suggest that HCFP has substantially increased service utilization, especially in-patient care, and has reduced the risk of catastrophic spending. It has not, however, reduced average out-of-pocket spending, and appears to have had negligible impacts on utilization among the poorest decile.
This book describes the nature of public-private partnerships (PPPs) in the health sector in Vietnam. It defines health-related PPPs, describes their key characteristics, and develops a taxonomy of the different types of PPPs that exist in practice, illustrated by international examples. It also assesses the regulatory and institutional framework for the health PPP program in Vietnam, as well as financing and accountability mechanisms for PPPs at its national and subnational levels. It provides an overview of the PPP project pipeline in Vietnam and analyzes important issues in the health PPPs’ design, preparation, and implementation, using eight case studies involving projects in different phases of the project cycle. This book also examines barriers that have hampered the successful design and implementation of health care PPPs in Vietnam. These barriers may be broadly categorized as barriers in the PPP policy and regulatory framework, in the public sector, in the private sector, and in the financial sector. It proposes feasible and actionable recommendations so that the government can consider tackling the identified barriers and advance the successful design and implementation of health PPPs.
No two markets for voluntary health insurance (VHI) are identical. All differ in some way because they are heavily shaped by the nature and performance of publicly financed health systems and by the contexts in which they have evolved. This volume contains short structured profiles of markets for VHI in 34 countries in Europe. These are drawn from European Union member states plus Armenia Iceland Georgia Norway the Russian Federation Switzerland and Ukraine. The book is aimed at policy-makers and researchers interested in knowing more about how VHI works in practice in a wide range of contexts. Each profile written by one or more local experts identifies gaps in publicly-financed health coverage describes the role VHI plays outlines the way in which the market for VHI operates summarises public policy towards VHI including major developments over time and highlights national debates and challenges. The book is part of a study on VHI in Europe prepared jointly by the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe. A companion volume provides an analytical overview of VHI markets across the 34 countries.
Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal system. Several African nations have introduced new programs in the past decade, and many are testing options for reform. For the past twenty years, Eastern Europe has been shifting from government-run care to insurance-based competitive systems, and both China and India have experimental programs to expand coverage. These nations are betting that insurance-based health care financing can increase the accessibility of services, increase providers' productivity, and change the population's health care use patterns, mirroring the development of health systems in most OECD countries. Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance–based care is key to the public policy debate of whether to extend insurance to low-income populations—and if so, how to do it—or to serve them through other means. Using recent household data, this book presents evidence of the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. The contributors also discuss potential design improvements that could increase impact. They provide innovative insights on improving the evaluation of health insurance reforms and on building a robust knowledge base to guide policy as other countries tackle the health insurance challenge.
This book is about 24 developing countries that have embarked on the journey towards universal health coverage (UHC) following a bottom-up approach, with a special focus on the poor and vulnerable, through a systematic data collection that provides practical insights to policymakers and practitioners. Each of the UHC programs analyzed in this book is seeking to overcome the legacy of inequality by tackling both a “financing gap†? and a “provision gap†?: the financing gap (or lower per capita spending on the poor) by spending additional resources in a pro-poor way; the provision gap (or underperformance of service delivery for the poor) by expanding supply and changing incentives in a variety of ways. The prevailing view seems to indicate that UHC require not just more money, but also a focus on changing the rules of the game for spending health system resources. The book does not attempt to identify best practices, but rather aims to help policy makers understand the options they face, and help develop a new operational research agenda. The main chapters are focused on providing a granular understanding of policy design, while the appendixes offer a systematic review of the literature attempting to evaluate UHC program impact on access to services, on financial protection, and on health outcomes.
Vietnam's rapid growth has transformed the country, reducing poverty from about 75 percent of the population to about 50 percent. At the same time, its transition from a planned to a market economy has created new challenges for public policy in a wide range of areas. This volume explores issues such as which macroeconomic and structural reforms led to growth, what effect reform has had on the household economy, and how the transition has affected education, health, fertility, and child nutrition. It provides an analysis of economic and social policies and shows how micro-level data can be used to analyze the likely effect of different government expenditures and activities. It also focuses on the effect different policies have on the poor and challenges stereotypes about poverty-focused expenditures.
Vaccinate children against deadly pneumococcal disease, or pay for cardiac patients to undergo lifesaving surgery? Cover the costs of dialysis for kidney patients, or channel the money toward preventing the conditions that lead to renal failure in the first place? Policymakers dealing with the realities of limited health care budgets face tough decisions like these regularly. And for many individuals, their personal health care choices are equally stark: paying for medical treatment could push them into poverty. Many low- and middle-income countries now aspire to universal health coverage, where governments ensure that all people have access to the quality health services they need without risk of impoverishment. But for universal health coverage to become reality, the health services offered must be consistent with the funds available—and this implies tough everyday choices for policymakers that could be the difference between life and death for those affected by any given condition or disease. The situation is particularly acute in low- and middle income countries where public spending on health is on the rise but still extremely low, and where demand for expanded services is growing rapidly. What’s In, What’s Out: Designing Benefits for Universal Health Coverage argues that the creation of an explicit health benefits plan—a defined list of services that are and are not available—is an essential element in creating a sustainable system of universal health coverage. With contributions from leading health economists and policy experts, the book considers the many dimensions of governance, institutions, methods, political economy, and ethics that are needed to decide what’s in and what’s out in a way that is fair, evidence-based, and sustainable over time.
