The Health Care Fund for the Poor (HCFP) was created in 2003 to provide care for the poor, ethnic minorities, and the disadvantaged. Initially implemented as a separate social program, HCFP was rolled into the national compulsory health insurance (CHI) scheme in July of 2009 as a result of a new National Health Insurance Law. The current national health insurance system consists of two parts, compulsory health insurance (CHI) and voluntary health insurance (VHI).
The Health Care Fund for the Poor (HCFP) was created in 2003 to provide care for the poor, ethnic minorities, and the disadvantaged. Initially implemented as a separate social program, HCFP was rolled into the national compulsory health insurance (CHI) scheme in July of 2009 as a result of a new National Health Insurance Law. The current national health insurance system consists of two parts, compulsory health insurance (CHI) and voluntary health insurance (VHI).
CHI formally consists of two sub-schemes:
- Contributory scheme: Earnings-related, contribution-based Social Health Insurance (SHI) scheme for the formally employed, pensioners and full-time students
- Non-contributory scheme: A non-contributory program for the poor, children under the age of 6 and some socially protected population group, such as people of merit, the elderly, war dioxin victims.
Before 2010, the voluntary scheme (VHI) targeted full-time students, family members of the compulsorily-insured, and others who enrolled through group organizations, including communes. Since January 1, 2010 full-time students are covered by the compulsory program.
Health Care Fund for the Poor (HCFP): In 2003, Decision 139 mandated all provincial governments provide free health care to the following three groups:
- Households defined as poor according to official government poverty standards;
- All households regardless of their own assessed income living in communes covered by a program set up as a result of another policy known as Decision 135 dating from 1998, which provides support and services to especially disadvantaged communes; and
- Ethnic minorities living in the central highland provinces and the six mountainous provinces designated by Decision 186 as facing special difficulties.
Decision 139 became the Health Care Fund for the Poor (HCFP), using 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 main objectives of HCFP are to increase access to health care and reduce the financial burden of health expenditure faced by the poor and ethnic minorities.
The central government finances the bulk of the cost, but provincial governments are responsible for co-financing a percentage of the program.
In 2007, it was estimated that about 36.5 million people were covered by public health insurance in Vietnam, accounting for about 42% of the population. The poor account for over 41% of the insured and voluntary health insurance members account for a further 25.7%. The number of people with health insurance coverage increased sharply from 2005, mostly as a result of government policy promoting the purchase of health insurance cards for the poor.
The figure below depicts the number of contributing members of health insurance compared to the number whose premium was subsidized by the government.
Compulsory and Voluntary Health Insurance Schemes
Program Summary
The Health Care Fund for the Poor (HCFP) was created in 2003 to provide care for the poor, ethnic minorities, and the disadvantaged. Initially implemented as a separate social program, HCFP was rolled into the national compulsory health insurance (CHI) scheme in July of 2009 as a result of a new National Health Insurance Law. The current national health insurance system consists of two parts, compulsory health insurance (CHI) and voluntary health insurance (VHI).
CHI formally consists of two sub-schemes:
- Contributory scheme: Earnings-related, contribution-based Social Health Insurance (SHI) scheme for the formally employed, pensioners and full-time students
- Non-contributory scheme: A non-contributory program for the poor, children under the age of 6 and some socially protected population group, such as people of merit, the elderly, war dioxin victims.
Before 2010, the voluntary scheme (VHI) targeted full-time students, family members of the compulsorily-insured, and others who enrolled through group organizations, including communes. Since January 1, 2010 full-time students are covered by the compulsory program.
Health Care Fund for the Poor (HCFP): In 2003, Decision 139 mandated all provincial governments provide free health care to the following three groups:
- Households defined as poor according to official government poverty standards;
- All households regardless of their own assessed income living in communes covered by a program set up as a result of another policy known as Decision 135 dating from 1998, which provides support and services to especially disadvantaged communes; and
- Ethnic minorities living in the central highland provinces and the six mountainous provinces designated by Decision 186 as facing special difficulties.
Decision 139 became the Health Care Fund for the Poor (HCFP), using 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 main objectives of HCFP are to increase access to health care and reduce the financial burden of health expenditure faced by the poor and ethnic minorities.
The central government finances the bulk of the cost, but provincial governments are responsible for co-financing a percentage of the program.
In 2007, it was estimated that about 36.5 million people were covered by public health insurance in Vietnam, accounting for about 42% of the population. The poor account for over 41% of the insured and voluntary health insurance members account for a further 25.7%. The number of people with health insurance coverage increased sharply from 2005, mostly as a result of government policy promoting the purchase of health insurance cards for the poor.
The figure below depicts the number of contributing members of health insurance compared to the number whose premium was subsidized by the government.
The central Vietnamese government is responsible for financing the bulk of the cost. Provincial governments, however, also contribute a smaller percentage of funds to the program. Poor beneficiaries do not pay premiums and are exempt from copayments. The entire cost of the scheme, 4.5% of minimum wage, is covered by revenues from the state budget.
The central Vietnamese government is responsible for financing the bulk of the cost. Provincial governments, however, also contribute a smaller percentage of funds to the program. Poor beneficiaries do not pay premiums and are exempt from copayments. The entire cost of the scheme, 4.5% of minimum wage, is covered by revenues from the state budget.
Funding for Vietnam’s various universal coverage schemes varies greatly by population segment. The following presents an overview of each program’s financing:
Compulsory program (CHI)
- Pensioners: 4.5% of monthly allowances, paid by VSS with subsidies from state budget.
- Meritorious persons, etc.: 4.5% of minimum wage, paid from state budget.
- Formal sector workers and civil servants: 4.53% salary, 1.5% paid by worker, 3% by employer.
- Insurance for the Poor: 4.5% of minimum wage, paid from state budget.
- Voluntary program (VHI): 4.5% of minimum wage.
Note that when the insurance program was initially introduced, there was no cost sharing. In 1998, cost sharing was introduced, with a 20 percent coinsurance rate but no deductible. In 2005, the 20 percent coinsurance rate was eliminated, only to be reintroduced again since January 1, 2010. Copayment is exempted for some groups, such as people of merit.
Compulsory and Voluntary Health Insurance Schemes
Funding
The central Vietnamese government is responsible for financing the bulk of the cost. Provincial governments, however, also contribute a smaller percentage of funds to the program. Poor beneficiaries do not pay premiums and are exempt from copayments. The entire cost of the scheme, 4.5% of minimum wage, is covered by revenues from the state budget.
Funding for Vietnam’s various universal coverage schemes varies greatly by population segment. The following presents an overview of each program’s financing:
Compulsory program (CHI)
- Pensioners: 4.5% of monthly allowances, paid by VSS with subsidies from state budget.
- Meritorious persons, etc.: 4.5% of minimum wage, paid from state budget.
- Formal sector workers and civil servants: 4.53% salary, 1.5% paid by worker, 3% by employer.
- Insurance for the Poor: 4.5% of minimum wage, paid from state budget.
- Voluntary program (VHI): 4.5% of minimum wage.
Note that when the insurance program was initially introduced, there was no cost sharing. In 1998, cost sharing was introduced, with a 20 percent coinsurance rate but no deductible. In 2005, the 20 percent coinsurance rate was eliminated, only to be reintroduced again since January 1, 2010. Copayment is exempted for some groups, such as people of merit.
It is the responsibility of the provinces to identify beneficiaries for the HCFP. While ethnic minorities and communes are fairly easy to identify because they are well documented, developing a list of the poor is more challenging. Local governments use already existing lists produced for other government programs in addition to household surveys. About 15 million additional persons, classified as poor, are now covered by the compulsory health insurance.
It is the responsibility of the provinces to identify beneficiaries for the HCFP. While ethnic minorities and communes are fairly easy to identify because they are well documented, developing a list of the poor is more challenging. Local governments use already existing lists produced for other government programs in addition to household surveys. About 15 million additional persons, classified as poor, are now covered by the compulsory health insurance.
When the SHI program initially began, only large employers were required to enroll their workers in the scheme. However, in 2005 the government expanded the mandate to companies of all sizes. Of Vietnam’s 7.7 million formal sector workers, 4.8 million (63%) are in the contributory scheme, but 2 million formal sector workers (26%) remain without coverage. Furthermore, SHI enrollment appears to be higher among the “better-off,” while middle-income groups currently have the lowest enrollment rates.
Under the VHI, until the end of 2009, full-time students were typically enrolled en masse by insurance agents operating at schools and colleges. As of January 2010, full-time students are automatically enrolled as a part of the CHI.
Family members/dependents of the compulsorily insured can enroll in the VSS scheme of their own accord. Others can enroll through group organizations, including communes. Prior to 2007, dependents were required to enroll all household members together and group organizations required a 20% minimum rate of participation. However, these stipulations have since been eliminated. Nonetheless, voluntary enrollment among the non-student population has stayed low with no signs of improvement.
Enrollment in HCFP is a bit more complex. Provinces are tasked with identifying beneficiaries under the target groups. Identification has not been a challenge for at least two of the target groups, as communes and ethnic minority households are well documented. In the case of poor households, who have proved to be the most difficult group to identify, local governments begin by building upon lists of officially poor households produced for other government programs. Then commune officials conduct further household surveys to produce a proposed list of HCFP beneficiaries, which is then discussed and voted upon at a public meeting presided over by the village or commune leader. Officials from the district government’s labor and social affairs offices (MOLISA) then review the list, which can be revised before it is sent to the provincial department of labor and social affairs for final approval.
Until recently, provinces were free to decide whether to enroll HCFP beneficiaries in the government’s SHI program, or to manage the risk themselves and provide direct reimbursement to providers. However, this latter option, which was initially the most popular with provinces, has since been phased out through a 2005 government directive updating Decision 139. According new Health Insurance Law, effective since July, 2009, the poor are included in the compulsory health insurance program. About 15 million additional persons, classified as poor, are now covered by compulsory health insurance.
Compulsory and Voluntary Health Insurance Schemes
Population covered
It is the responsibility of the provinces to identify beneficiaries for the HCFP. While ethnic minorities and communes are fairly easy to identify because they are well documented, developing a list of the poor is more challenging. Local governments use already existing lists produced for other government programs in addition to household surveys. About 15 million additional persons, classified as poor, are now covered by the compulsory health insurance.
When the SHI program initially began, only large employers were required to enroll their workers in the scheme. However, in 2005 the government expanded the mandate to companies of all sizes. Of Vietnam’s 7.7 million formal sector workers, 4.8 million (63%) are in the contributory scheme, but 2 million formal sector workers (26%) remain without coverage. Furthermore, SHI enrollment appears to be higher among the “better-off,” while middle-income groups currently have the lowest enrollment rates.
Under the VHI, until the end of 2009, full-time students were typically enrolled en masse by insurance agents operating at schools and colleges. As of January 2010, full-time students are automatically enrolled as a part of the CHI.
Family members/dependents of the compulsorily insured can enroll in the VSS scheme of their own accord. Others can enroll through group organizations, including communes. Prior to 2007, dependents were required to enroll all household members together and group organizations required a 20% minimum rate of participation. However, these stipulations have since been eliminated. Nonetheless, voluntary enrollment among the non-student population has stayed low with no signs of improvement.
Enrollment in HCFP is a bit more complex. Provinces are tasked with identifying beneficiaries under the target groups. Identification has not been a challenge for at least two of the target groups, as communes and ethnic minority households are well documented. In the case of poor households, who have proved to be the most difficult group to identify, local governments begin by building upon lists of officially poor households produced for other government programs. Then commune officials conduct further household surveys to produce a proposed list of HCFP beneficiaries, which is then discussed and voted upon at a public meeting presided over by the village or commune leader. Officials from the district government’s labor and social affairs offices (MOLISA) then review the list, which can be revised before it is sent to the provincial department of labor and social affairs for final approval.
Until recently, provinces were free to decide whether to enroll HCFP beneficiaries in the government’s SHI program, or to manage the risk themselves and provide direct reimbursement to providers. However, this latter option, which was initially the most popular with provinces, has since been phased out through a 2005 government directive updating Decision 139. According new Health Insurance Law, effective since July, 2009, the poor are included in the compulsory health insurance program. About 15 million additional persons, classified as poor, are now covered by compulsory health insurance.
HCFP offers a comprehensive benefits package that includes both inpatient and outpatient care. Excluded are interventions covered by vertical programs such as HIV/AIDS prevention and treatment, treatments not yet approved by the MoH, various “luxury” interventions such as cosmetic surgery, certain dental procedures, and treatment of self-inflicted injuries and drug addiction, among others.
HCFP offers a comprehensive benefits package that includes both inpatient and outpatient care. Excluded are interventions covered by vertical programs such as HIV/AIDS prevention and treatment, treatments not yet approved by the MoH, various “luxury” interventions such as cosmetic surgery, certain dental procedures, and treatment of self-inflicted injuries and drug addiction, among others.
The benefits package is essentially the same for everyone, except the poor, children under 6, pensioners, and meritorious persons who are exempted from copayment or have lower copayment rate. The following services are covered under all health programs: medical consultation, diagnosis and treatment, X-ray and laboratory tests, functional examination, imaging diagnosis, drugs listed by the MoH, blood and transfusion, surgery, antenatal examination and delivery. In addition to these items, the insurance also covers the cost (up to a certain limit) of a defined list of high-technology treatments (including magnetic resonance imaging (MRI), hemodialysis and laser surgery among a total of 177 specified high-tech procedures).
The following exemptions, some of which are covered by the national target programs, are imposed: leprosy, tuberculosis, malaria, schizophrenia, epilepsy, STD, vaccination, convalescence, early-detected pregnancy, medical check-ups, family planning services and infertility treatments, prosthesis, aesthetic surgery, artificial arm, leg, tooth, glasses, hearing-aid machines, occupational diseases, war injuries, accidents at work place, treatment for suicide, self-inflicted injuries, drug addiction, medical appraisal, forensic appraisal, mental examination, home care, rehabilitation and delivery.
Compulsory and Voluntary Health Insurance Schemes
Benefits package
HCFP offers a comprehensive benefits package that includes both inpatient and outpatient care. Excluded are interventions covered by vertical programs such as HIV/AIDS prevention and treatment, treatments not yet approved by the MoH, various “luxury” interventions such as cosmetic surgery, certain dental procedures, and treatment of self-inflicted injuries and drug addiction, among others.
The benefits package is essentially the same for everyone, except the poor, children under 6, pensioners, and meritorious persons who are exempted from copayment or have lower copayment rate. The following services are covered under all health programs: medical consultation, diagnosis and treatment, X-ray and laboratory tests, functional examination, imaging diagnosis, drugs listed by the MoH, blood and transfusion, surgery, antenatal examination and delivery. In addition to these items, the insurance also covers the cost (up to a certain limit) of a defined list of high-technology treatments (including magnetic resonance imaging (MRI), hemodialysis and laser surgery among a total of 177 specified high-tech procedures).
The following exemptions, some of which are covered by the national target programs, are imposed: leprosy, tuberculosis, malaria, schizophrenia, epilepsy, STD, vaccination, convalescence, early-detected pregnancy, medical check-ups, family planning services and infertility treatments, prosthesis, aesthetic surgery, artificial arm, leg, tooth, glasses, hearing-aid machines, occupational diseases, war injuries, accidents at work place, treatment for suicide, self-inflicted injuries, drug addiction, medical appraisal, forensic appraisal, mental examination, home care, rehabilitation and delivery.
Beneficiaries of the national health insurance scheme are able to seek care at all public facilities. Additionally, the VSS has begun contracting with a small number private providers. Of those currently registered with the VSS, the majority are general practitioner clinics. Enrollees in all public schemes are required to register with a local facility and are expected to use that facility when they require treatment. Referrals are sanctioned when the registered facility lacks the necessary expertise to treat the patient’s condition. Health services in Vietnam are delivered by both public and private providers.
Beneficiaries of the national health insurance scheme are able to seek care at all public facilities. Additionally, the VSS has begun contracting with a small number private providers. Of those currently registered with the VSS, the majority are general practitioner clinics. Enrollees in all public schemes are required to register with a local facility and are expected to use that facility when they require treatment. Referrals are sanctioned when the registered facility lacks the necessary expertise to treat the patient’s condition. Health services in Vietnam are delivered by both public and private providers.
The health public care network is organized under state administrative units: central, provincial, district, commune and village level, with the MoH at the central level. In the public sector, there are 980 hospitals (39 central, 331 provincial and 610 district hospitals) and 11,544 primary health centers. Communes Health Centers (CHCs) provide primary health care services, including consultation, outbreak prevention and surveillance, treatment of common diseases, maternal and child health care, family planning, hygiene, and health promotion. Although CHCs are widespread, they are underutilized. On average, a CHC serves just 7,000 people. Hospitals, on the other hand, exhibit high occupancy rates, often exceeding 100%. This trend may reflect perceptions in quality of care, or may represent the strong bias in reimbursements towards higher-level facilities and inpatient care.
Across Vietnam, there are approximately 35,000 private clinics and 85 private hospitals, accounting for 8.7 % of the total number of hospitals nationwide, with 5,800 beds, accounting for 3.8% of the total number of hospital beds nationwide.
VSS has begun contracting with private providers, but they still represent a small portion of care provided under the national insurance program. Of private providers registered with VSS, general practitioner clinics represent the largest groups.
VSS reimburses approved facilities, which include all public facilities and some contracted private facilities. Enrollees may also use non-contracted facilities, including providers abroad, but reimbursement in this case is to the patient, who pays the facility directly and subsequently files a claim, and is limited to the costs incurred on average by public facilities in Vietnam.
Compulsory and Voluntary Health Insurance Schemes
Service delivery system
Beneficiaries of the national health insurance scheme are able to seek care at all public facilities. Additionally, the VSS has begun contracting with a small number private providers. Of those currently registered with the VSS, the majority are general practitioner clinics. Enrollees in all public schemes are required to register with a local facility and are expected to use that facility when they require treatment. Referrals are sanctioned when the registered facility lacks the necessary expertise to treat the patient’s condition. Health services in Vietnam are delivered by both public and private providers.
The health public care network is organized under state administrative units: central, provincial, district, commune and village level, with the MoH at the central level. In the public sector, there are 980 hospitals (39 central, 331 provincial and 610 district hospitals) and 11,544 primary health centers. Communes Health Centers (CHCs) provide primary health care services, including consultation, outbreak prevention and surveillance, treatment of common diseases, maternal and child health care, family planning, hygiene, and health promotion. Although CHCs are widespread, they are underutilized. On average, a CHC serves just 7,000 people. Hospitals, on the other hand, exhibit high occupancy rates, often exceeding 100%. This trend may reflect perceptions in quality of care, or may represent the strong bias in reimbursements towards higher-level facilities and inpatient care.
Across Vietnam, there are approximately 35,000 private clinics and 85 private hospitals, accounting for 8.7 % of the total number of hospitals nationwide, with 5,800 beds, accounting for 3.8% of the total number of hospital beds nationwide.
VSS has begun contracting with private providers, but they still represent a small portion of care provided under the national insurance program. Of private providers registered with VSS, general practitioner clinics represent the largest groups.
VSS reimburses approved facilities, which include all public facilities and some contracted private facilities. Enrollees may also use non-contracted facilities, including providers abroad, but reimbursement in this case is to the patient, who pays the facility directly and subsequently files a claim, and is limited to the costs incurred on average by public facilities in Vietnam.
The MoH is responsible for overseeing all health insurance programs, while the VSS is the main agency implementing the schemes. The Ministry of Labor - Invalids and Social Affairs (MOLISA) is tasked with identifying the beneficiaries of the HCFP.
The MoH is responsible for overseeing all health insurance programs, while the VSS is the main agency implementing the schemes. The Ministry of Labor - Invalids and Social Affairs (MOLISA) is tasked with identifying the beneficiaries of the HCFP.
The VSS is a government agency responsible for the administration of the various social insurance programs, including the collection of insurance premiums. In addition to collecting revenues, VSS’s main responsibility is to issue health insurance cards and reimburse service providers.
The MoF manages the tax-transfer process that provides the resources that local governments use to provide budget support to public facilities and to pay the VSS for subsidized enrollees. VSS collects mandatory (and voluntary) contributions to the health insurance program, then pools these with the subsidies from the MoF, and pays the providers for care received by people covered by VSS.
Compulsory and Voluntary Health Insurance Schemes
Institutional structures
The MoH is responsible for overseeing all health insurance programs, while the VSS is the main agency implementing the schemes. The Ministry of Labor - Invalids and Social Affairs (MOLISA) is tasked with identifying the beneficiaries of the HCFP.
The VSS is a government agency responsible for the administration of the various social insurance programs, including the collection of insurance premiums. In addition to collecting revenues, VSS’s main responsibility is to issue health insurance cards and reimburse service providers.
The MoF manages the tax-transfer process that provides the resources that local governments use to provide budget support to public facilities and to pay the VSS for subsidized enrollees. VSS collects mandatory (and voluntary) contributions to the health insurance program, then pools these with the subsidies from the MoF, and pays the providers for care received by people covered by VSS.
Although there has been some innovation in provider reimbursement over the past few years, fee-for-service (FFS) remains the dominant payment mechanism. Rates are set by the fee schedule, and have remained unchanged since the schedule was created in 1995.
Although there has been some innovation in provider reimbursement over the past few years, fee-for-service (FFS) remains the dominant payment mechanism. Rates are set by the fee schedule, and have remained unchanged since the schedule was created in 1995.
In light of concerns that FFS payments encourage providers to treat patients more than is clinically necessary, the Vietnamese government has begun exploring alternative methods of payment. Additionally, an incentive-based structure for providers has been put in place that has tied provider payment to the financial performance of the facility.
The FFS rates were created by an interministerial commission consisting of representatives from MoH, the Ministry of Finance (MoF), the Ministry of Labor, War Invalids, and Social Affairs (MOLISA) and the State Price Commission (SPC).
The fees in the schedule are a mixture of per-item charges and per diem rates, with ranges for each type, and variations according to the type of hospital (higher class hospitals being able to charge more). With the exception of the addition of 1,022 new procedures in 2006, fees have been unchanged since the major initiative of 1995, not even to adjust for inflation. However, the government plans to update the fee schedule to reflect current rates.
Note that drugs prices are not regulated by VSS (though they are monitored), and providers have the scope, in practice, to levy unofficial charges.
The New Health Insurance Law 2008 provides for several different provider payment methods, including FFS, capitation, diagnostic-related group (DRG) or other modes of payment. Innovation in provider payment remains a top priority for reforms to improve the health insurance system.
Beyond fees, Vietnam has an incentive structure for providers tied to the financial performance of their facility. Under Decree 33/1995, providers had limited ability to retain a portion (30%) of gross revenues from user fees. However, under this system, opportunities for incentive payments are highly variable based on the facility and the population they serve, and this structure had high potential for creating further imbalances in the system. This incentive structure has since been replaced by Decrees 10/2002 and 43/2006, which allow hospitals greater discretion over financial operations, management of human resources, organization of services, and choices of services offered. By providing greater autonomy to facilities over the management of their costs and revenues, the government hopes to better align the incentives of providers (hospital staff) with the overall financial performance of the health facility.
Contracting between VSS and a health care provider is normally done for providers who operate as a separate legal entity. In effect, these are limited to provincial, central, and district level hospitals. Commune Health Centers (CHC) and inter-commune polyclinics can provide services to insured members but they are supervised by District Health Centers (DHC) and hence they do not possess a legal entity status to operate a bank account. VSS therefore cannot contract directly with them but must coordinate commune level health service provision under the supervision of the DHCs.
With regard to quality control, the VSS plays little to no role in overseeing the quality of care. They serve primarily as the bill-payer and general orchestrator of the system. There are currently no clinical guidelines enforced by the MoH or VSS, and there is no credible quality assurance mechanism. Providers are largely free to treat patients as they choose.
Compulsory and Voluntary Health Insurance Schemes
Provider payment mechanisms
Although there has been some innovation in provider reimbursement over the past few years, fee-for-service (FFS) remains the dominant payment mechanism. Rates are set by the fee schedule, and have remained unchanged since the schedule was created in 1995.
In light of concerns that FFS payments encourage providers to treat patients more than is clinically necessary, the Vietnamese government has begun exploring alternative methods of payment. Additionally, an incentive-based structure for providers has been put in place that has tied provider payment to the financial performance of the facility.
The FFS rates were created by an interministerial commission consisting of representatives from MoH, the Ministry of Finance (MoF), the Ministry of Labor, War Invalids, and Social Affairs (MOLISA) and the State Price Commission (SPC).
The fees in the schedule are a mixture of per-item charges and per diem rates, with ranges for each type, and variations according to the type of hospital (higher class hospitals being able to charge more). With the exception of the addition of 1,022 new procedures in 2006, fees have been unchanged since the major initiative of 1995, not even to adjust for inflation. However, the government plans to update the fee schedule to reflect current rates.
Note that drugs prices are not regulated by VSS (though they are monitored), and providers have the scope, in practice, to levy unofficial charges.
The New Health Insurance Law 2008 provides for several different provider payment methods, including FFS, capitation, diagnostic-related group (DRG) or other modes of payment. Innovation in provider payment remains a top priority for reforms to improve the health insurance system.
Beyond fees, Vietnam has an incentive structure for providers tied to the financial performance of their facility. Under Decree 33/1995, providers had limited ability to retain a portion (30%) of gross revenues from user fees. However, under this system, opportunities for incentive payments are highly variable based on the facility and the population they serve, and this structure had high potential for creating further imbalances in the system. This incentive structure has since been replaced by Decrees 10/2002 and 43/2006, which allow hospitals greater discretion over financial operations, management of human resources, organization of services, and choices of services offered. By providing greater autonomy to facilities over the management of their costs and revenues, the government hopes to better align the incentives of providers (hospital staff) with the overall financial performance of the health facility.
Contracting between VSS and a health care provider is normally done for providers who operate as a separate legal entity. In effect, these are limited to provincial, central, and district level hospitals. Commune Health Centers (CHC) and inter-commune polyclinics can provide services to insured members but they are supervised by District Health Centers (DHC) and hence they do not possess a legal entity status to operate a bank account. VSS therefore cannot contract directly with them but must coordinate commune level health service provision under the supervision of the DHCs.
With regard to quality control, the VSS plays little to no role in overseeing the quality of care. They serve primarily as the bill-payer and general orchestrator of the system. There are currently no clinical guidelines enforced by the MoH or VSS, and there is no credible quality assurance mechanism. Providers are largely free to treat patients as they choose.
In 2007, the Health Partnership Group (HPG), which included the MoH, together with a number of external organizations providing health care support to Vietnam, agreed to conduct a Joint Annual Health Review (JAHR) of the Vietnamese health care system to assess the situation and identify priority health sector issues.
In 2007, the Health Partnership Group (HPG), which included the MoH, together with a number of external organizations providing health care support to Vietnam, agreed to conduct a Joint Annual Health Review (JAHR) of the Vietnamese health care system to assess the situation and identify priority health sector issues.
Although the VSS, MoH and other governing bodies in seem to be collecting data on enrollment, utilization, revenues and expenditures, impact studies seem to come largely from third-party sources, primarily the academic community, with the exception of the JAHR.
The JAHR can be found here: (http://www.wpro.who.int/NR/rdonlyres/E9742AA1-384E-4AF8-9203-A1DEDA1DC35...)
The objective of the JAHR was to assess the situation and identify priority health sector issues in order to formulate an instrument to support annual planning of the MoH and to create a platform for the choice of focal issues for cooperation and dialogue between the Vietnamese health sector and external stakeholders.
The first JAHR was completed in 2007 and addressed the following:
- Health status and health determinants
- Organization and management of the health system
- Health human resources
- Health financing
- Provision of health services
Based on this initial analysis, the review made recommendations on possible solutions to issues of priority for 2008 and subsequent years.
Among the data reported in the 2008 JAHR, the following is included:
- Number of health insurance members nationwide, 2005 – 2007
- Average health insurance premiums in 2006 by member group
- Household out-of-pocket health spending, 2000 - 2006
- Health service utilization by beneficiaries
- Number of contributing members of health insurance compared to the number whose premium was subsidized by the state budget, 2005-2007
The JAHR also notes that the Vietnamese government recognizes the need for better education and communication as they work toward universal coverage.
The following is a preliminary list of additional data sources and impact studies:
- Vietnam Household and Living Standards Survey (VHLSS)
- MOH Health Statistics Yearbook
- VSS
- Vietnam Demographic and Health Survey (VDHS)
- World Health Organization NHA Web site (http://www.who.int/nha/country/vnm.pdf)
Compulsory and Voluntary Health Insurance Schemes
Monitoring and evaluation
In 2007, the Health Partnership Group (HPG), which included the MoH, together with a number of external organizations providing health care support to Vietnam, agreed to conduct a Joint Annual Health Review (JAHR) of the Vietnamese health care system to assess the situation and identify priority health sector issues.
Although the VSS, MoH and other governing bodies in seem to be collecting data on enrollment, utilization, revenues and expenditures, impact studies seem to come largely from third-party sources, primarily the academic community, with the exception of the JAHR.
The JAHR can be found here: (http://www.wpro.who.int/NR/rdonlyres/E9742AA1-384E-4AF8-9203-A1DEDA1DC35...)
The objective of the JAHR was to assess the situation and identify priority health sector issues in order to formulate an instrument to support annual planning of the MoH and to create a platform for the choice of focal issues for cooperation and dialogue between the Vietnamese health sector and external stakeholders.
The first JAHR was completed in 2007 and addressed the following:
- Health status and health determinants
- Organization and management of the health system
- Health human resources
- Health financing
- Provision of health services
Based on this initial analysis, the review made recommendations on possible solutions to issues of priority for 2008 and subsequent years.
Among the data reported in the 2008 JAHR, the following is included:
- Number of health insurance members nationwide, 2005 – 2007
- Average health insurance premiums in 2006 by member group
- Household out-of-pocket health spending, 2000 - 2006
- Health service utilization by beneficiaries
- Number of contributing members of health insurance compared to the number whose premium was subsidized by the state budget, 2005-2007
The JAHR also notes that the Vietnamese government recognizes the need for better education and communication as they work toward universal coverage.
The following is a preliminary list of additional data sources and impact studies:
- Vietnam Household and Living Standards Survey (VHLSS)
- MOH Health Statistics Yearbook
- VSS
- Vietnam Demographic and Health Survey (VDHS)
- World Health Organization NHA Web site (http://www.who.int/nha/country/vnm.pdf)