Explore the vast range of titles available.

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.

BackgroundThis study examined the financial toxicity faced by breast cancer (BC) patients in Vietnam and the factors associated with the risk and degree of that toxicity.MethodsA total of 309 BC patients/survivors completed an online survey (n=209) or a face-to-face interview (n=100) at two tertiary hospitals. Descriptive statistics and χ2 tests were used to identify and analyse the forms and degree of financial toxicity faced by BC patients/survivors. A Cragg hurdle model assessed variation in risk and the degree of financial toxicity due to treatment.Results41% of respondents faced financial toxicity due to BC treatment costs. The mean amount of money that exceeded BC patients/survivors’ ability to pay was 153 million Vietnamese Dong (VND) ( $6602) and ranged from 2.42 million VND to 1358 million VND ($ 104–58,413). A diagnosis at stage II or III of BC was associated with 16.0 and 18.0 million VND (~$690–777) more in the degree of financial toxicity compared with patients who were diagnosed at stage 0/I, respectively. Being retired or married or having full (100%) health insurance was associated with a decrease in the degree of financial toxicity.ConclusionsA significant proportion of Vietnamese BC patients/survivors face serious financial toxicity due to BC treatment costs. There is a need to consider the introduction of measures that would attenuate this hardship and promote uptake of screening for the reduction in financial toxicity as well as the health gains it may achieve through earlier detection of cancer.

Background China and Vietnam have made impressive progress towards universal health coverage (UHC) through government-led health insurance reforms. We compared the different pathways used to achieve UHC, to identify the lessons other countries can learn from China and Vietnam. Methods This was a mixed method study which included a literature review, in-depth interviews and secondary data analysis. We conducted a literature search in English and Chinese databases, and reviewed policy documents from internal contacts. We conducted semi-structured interviews with 16 policy makers, government bureaucrats, health insurance scholars in China and Vietnam. Secondary data was collected from National Health Statistics Reports, Health Insurance Statistical Reports and National Health Household Surveys carried out in both countries. We used population insurance coverage, insurance policies, reimbursement rates, number of households experiencing catastrophic heath expenditure (CHE) and incidence of impoverishment due to health expenditure (IHE) to measure the World Health Organization’s three dimensions of UHC: population coverage, service coverage, and financial coverage. Results China has increased population coverage through strong political commitment and extensive government financial subsidies to expand coverage. Vietnam expanded population coverage gradually, by prioritizing the poor and the near-poor in an incremental way. In China, insurance service packages varied across regions and schemes and were greatly determined by financial contributions, resulting in limited service coverage in less developed areas. Vietnam focused on providing a comprehensive and universal service packages for all enrollees thereby approaching UHC in a more equitable manner. CHE rate decreased in Vietnam but increased in China between 2003 and 2008. While Vietnam has decreased the CHE gap between urban and rural populations, China suffers from persistent disparities among population income levels and geographic location. CHE and CHE rates were still high in lower income groups. Conclusion Political commitment, sustainable financial sources and administrative capacity are strong driving factors in achieving UHC through health insurance reform. Health insurance schemes need to consider covering essential health services for all beneficiaries and providing government subsidies for vulnerable populations’ in order to help achieve health for all.

Background Financial risk protection (FRP) is central to Universal Health Coverage (UHC), aiming to shield individuals from financial hardship when accessing essential healthcare services. This study estimates trends and projections for FRP indicators in Vietnam from 2010 to 2030 at both national and sub-national levels, assesses the probability of achieving UHC targets, and analyses demographic-, geographic-, and socioeconomic-related inequalities. Methods Data from 168,812 households collected in six nationally representative surveys (2010–2020) were analysed. FRP coverage was evaluated using indicators including catastrophic health expenditure (CHE), impoverishing health expenditure (IHE), further impoverishing health expenditure (FIE), financial hardship expenditure (FHE), and the revised SDG 3.8.2 indicator, across multiple thresholds (10%, 15%, 25%, 40%). Bayesian models projected trends and estimated the probability of achieving the 2030 UHC targets. Inequality analyses using relative, slope, and concentration indices were conducted across ethnicity, dependency ratio, urban-rural residence, region, wealth quintile, and educational level. Findings National FRP coverage was relatively high in 2020 (78.1%–94.9%), with modest improvements projected for 2030 (81.4%–95.4%). However, probabilities of achieving UHC targets remain low, with only protection from IHE showing moderate prospects (83.6%). Ethnic minorities, rural households, and those with high dependency ratios were consistently disadvantaged, especially regarding IHE and FHE. Regional disparities were pronounced, with lower coverage in Central highland and Central Coast regions, compared to the Southeast and Red River Delta regions. Significant socioeconomic inequalities persisted, disproportionately affecting the poorest and least educated groups. Inequality gaps widened over time, particularly among regions and educational levels. Interpretation Our findings suggest that Vietnam is unlikely to achieve full financial risk protection by 2030, given modest projected improvements and low probabilities of meeting UHC targets. Persistent and widening inequalities, particularly by region and educational level, underscore the need for targeted health financing reforms that prioritize disadvantaged groups such as ethnic minorities, rural households, and those with high dependency ratios. Strengthening social health insurance, expanding fiscal space for health, and integrating financial protection policies with broader poverty reduction and social development programs will be critical for advancing equity and moving closer to UHC in Vietnam.

Background There is a paucity of research on the cost of breast cancer (BC) treatment from the patient’s perspective in Vietnam. Methods Individual-level data about out-of-pocket (OOP) expenditures on use of services were collected from women treated for BC ( n  = 202) using an online survey and a face-to-face interview at two tertiary hospitals in 2019. Total expenditures on diagnosis and initial BC treatment were presented in terms of the mean, standard deviation, and range for each type of service use. A generalised linear model (GLM) was used to assess the relationship between total cost and socio-demographic characteristics. Results 19.3% of respondents had stage 0/I BC, 68.8% had stage II, 9.4% had stage III, none had stage IV. The most expensive OOP elements were targeted therapy with mean cost equal to 649.5 million VND ($28,025) and chemotherapy at 36.5 million VND ($1575). Mean total OOP cost related to diagnosis and initial BC treatment (excluding targeted therapy cost) was 61.8 million VND ($2667). The mean OOP costs among patients with stage II and III BC were, respectively, 66 and 148% higher than stage 0/I. Conclusions BC patients in Vietnam incur significant OOP costs. The cost of BC treatment was driven by the use of therapies and presentation stage at diagnosis. It is likely that OOP costs of BC patients would be reduced by earlier detection through raised awareness and screening programmes and by providing a higher insurance reimbursement rate for targeted therapy.

The reform of provider payment systems, from retrospective to prospective payment, has been heralded as the right move to contain costs in the light of rising health expenditures in many countries. However, there are concerns on quality trade-off. The heightened attention given to prospective payment system (PPS) reforms and the rise of empirical evidence regarding PPS interventions among developing countries suggest that a systematic review is necessary to understand the effects of PPS reforms in developing countries. A systematic search of 14 databases and a hand search of health policy journals and grey literature from October to November 2016 were carried out, guided by a set of inclusion and exclusion criteria. Data were extracted based on the Consolidated Health Economics Evaluation Reporting Standards checklist. Drummond’s 10-item checklist for economic evaluation, Cochrane Collaboration’s tool in assessing risk of bias for randomized trials, and Risk of Bias in Nonrandomized Studies of Interventions were used to critically appraise the evidence. A total of 12 studies reported in China, Thailand and Vietnam were included in this review. Substantial heterogeneity was present in PPS policy design across different localities. PPS interventions were found to have reduced health expenditures on both the supply and demand side, as well as length of stay and readmission rates. In addition, PPS generally improved service quality outcomes by reducing the likelihood or percentage of physicians prescribing unnecessary drugs and diagnostic procedures. PPS is a promising policy tool for middle-income countries to achieve reasonable health policy objectives in terms of cost containment without necessarily compromising the quality of care. More evaluations of PPS will need to be conducted in the future in order to broaden the evidence base beyond middle-income countries. 卫生服务提供者付费制度从后付费变为预付费, 在许多国家医 疗支出增长的情况下, 这一改革被称为控制成本的正确之举。 但有疑虑指出质量可能会因此下降。对预付费制度 （PPS） 改革的关注增加, 并且也积累了发展中国家PPS 干预的实证 证据, 因此有必要进行系统综述来了解发展中国家PPS改革的 效果。根据纳入和排除标准, 我们从2016 年10 月至11 月对 14 个数据库进行了系统检索, 同时对卫生政策期刊和灰色文 献进行了手动检索。根据卫生经济学评价报告标准共识清单 提取数据。根据 Drummond 的经济学评价10 条目清单、 Cochrane 联盟随机研究偏倚风险评估工具和非随机干预研究 偏倚风险评估工具对证据质量进行评估。综述共纳入12项中 国、泰国和越南的研究。不同地区报告的 PPS 政策设计呈现 显著异质性。PPS 干预从供给侧和需求侧同时减少了卫生支 出, 缩短了住院时间, 降低了再住院率。此外, 通过减少不必 要处方和诊断检查, PPS 普遍改善了服务质量。中等收入国家 可使用 PPS 这一政策工具实现控制成本的合理卫生政策目标, 同时不损及卫生服务质量。未来还需要更多的 PPS 评估来将 产生中等收入国家以外的证据。 La reforma de los sistemas de pago a los proveedores, desde el pago retrospectivo hasta el pago prospectivo, ha sido anunciada como el movimiento correcto para contener los costos a la luz de los crecientes gastos de salud en muchos países. Sin embargo, existen preocupaciones sobre la compensación de la calidad. La mayor atención prestada a las reformas del sistema de pago prospectivo (SPP) y el aumento de la evidencia empírica con respecto a las intervenciones del SPP entre los países en desarrollo sugieren que es necesaria una revisión sistemática para comprender los efectos de las reformas del SPP en los países en desarrollo. Se llevó a cabo una búsqueda sistemática de 14 bases de datos y una búsqueda manual de revistas de políticas de salud y literatura gris de octubre a noviembre de 2016, guiadas por un conjunto de criterios de inclusión y exclusión. Los datos fueron extraídos con base en la lista de verificación de los Estándares Consolidados de Informes de Evaluación de la Economía de la Salud. Para evaluar críticamente la evidencia se usaron la lista de 10 elementos de Drummond para la evaluación económica, la herramienta de la Colaboración Cochrane para evaluar el riesgo de sesgo para los ensayos aleatorizados y el Riesgo de Sesgo en los Estudios No-aleatorizados de las Intervenciones. Un total de 12 estudios reportados en China, Tailandia y Vietnam se incluyeron en esta revisión. La heterogeneidad sustancial estuvo presente en el diseño de políticas de SPP en diferentes localidades. Se encontró que las intervenciones de SPP habían reducido los gastos de salud tanto en el lado de la oferta como en el de la demanda, así como también la duración de la estadía y las tasas de readmisión. Además, el SPP generalmente mejoró los resultados de calidad del servicio al reducir la probabilidad o el porcentaje de médicos que prescriben medicamentos y procedimientos de diagnóstico innecesarios. El SPP es una herramienta de política prometedora para que los países de medianos ingresos alcancen objetivos razonables de política de salud en términos de contención de costos sin comprometer necesariamente la calidad de la atención. Se necesitarán más evaluaciones del SPP en el futuro a fin de ampliar la base de la evidencia más all á de los países de medianos ingresos.

Public health insurance (PHI) has been implemented with different levels of participation in many countries, from voluntary to mandatory. In Vietnam, a law amendment made PHI compulsory nationwide in 2015 with a tolerance phase allowing people a flexible time to enroll. This study aims to examine mechanisms under which the amendment affected the enrollment, healthcare utilization, and out-of-pocket (OOP) expenditures by middle- and low-income households in this transitioning process. Using the biennial Vietnam Household Living Standard Surveys, the study applied the doubly robust difference-in-differences approach to compare outcomes in the post-amendment period from the 2016 survey with those in the pre-amendment period from the 2014 survey. The approach inheriting advantages from its predecessors, i.e., the difference-in-differences and the augmented inverse-probability weighting methods, can mitigate possible biases in policy evaluations due to the changes within the group and between groups over time in the cross-section observational study. The results showed health insurance expansion with extensive subsidies in premiums and medical coverage for persons other than the full-time employed, young children or elderly members in the family, significantly increased enrollments in the middle- and low-income groups by 9% and 8%, respectively. The number of visits for PHI-eligible services also increased, approximately 0.5 more visit per person in the middle-income and 1 more visit per person in the low-income. The amendment, however, so far did not show any significant effect on reducing OOP payments, neither for the low nor the middle-income groups. To further expand PHI coverage and financial protections, policymakers should focus on improving public health facilities, contracting PHI to more accredited private health providers, and motivating the high-income group’s enrollments.

Background: Over the recent decades, Vietnam has attained remarkable achievements in all areas of health care. However, shortcomings including health disparities persist particularly with a rapidly aging population. This has resulted in a shift in the disease burden from communicable to noncommunicable diseases such as dementia, cancer, and diabetes. These medical conditions require long-term care, which causes an accelerating crisis for the health sector and society. The current health care system in Vietnam is unlikely to cope with these challenges. Objective: The aim of this paper was to explore the opportunities, challenges, and necessary conditions for Vietnam in transforming toward a patient-centered care model to produce better health for people and reduce health care costs. Methods: We examine the applicability of a personalized and integrated Bespoke Health Care System (BHS) for Vietnam using a strength, weakness, opportunity, and threat analysis and examining the successes or failures of digital health care innovations in Vietnam. We then make suggestions for successful adoption of the BHS model in Vietnam. Results: The BHS model of patient-centered care empowers patients to become active participants in their own health care. Vietnam’s current policy, social, technological, and economic environment favors the transition of its health care system toward the BHS model. Nevertheless, the country is in an early stage of health care digitalization. The legal and regulatory system to protect patient privacy and information security is still lacking. The readiness to implement electronic medical records, a core element of the BHS, varies across health providers and clinical practices. The scarcity of empirical evidence and evaluation regarding the effectiveness and sustainability of digital health initiatives is an obstacle to the Vietnamese government in policymaking, development, and implementation of health care digitalization. Conclusions: Implementing a personalized and integrated health care system may help Vietnam to address health care needs, reduce pressure on the health care system and society, improve health care delivery, and promote health equity. However, in order to adopt the patient-centered care system and digitalized health care, a whole-system approach in transformation and operation with a co-design in the whole span of a digital health initiative developing process are necessary.

Background: This research examined differences in the utilisation of healthcare services and financial burden between and within insured and uninsured older persons and their households under the social health insurance scheme in Vietnam. Methods: We used nationally representative data from the Vietnam Household Living Standard Survey (VHLSS) conducted in 2014. We applied the World Health Organization (WHO)’s financial indicators in healthcare to provide cross-tabulations and comparisons for insured and uninsured older persons along with their individual and household characteristics (such as age groups, gender, ethnicity, per-capita household expenditure quintiles, and place of residence). Results: We found that social health insurance was beneficial to the insured in comparison with the uninsured in terms of utilization of healthcare services and financial burden. However, between and within these two groups, more vulnerable groups (i.e., ethnic minorities and rural persons) had lower utilization rates and higher rates of catastrophic spending than the better groups (i.e., Kinh and urban persons). Conclusion: Given the rapidly ageing population under low middle-income status and the “double burden of diseases”, this paper suggested that Vietnam reform the healthcare system and social health insurance so as to provide more equitable utilisation and financial protection to all older persons, including improving the quality of healthcare at the grassroots level and reducing the burden on the provincial/central health level; improving human resources for the grassroots healthcare facilities; encroaching public–private partnerships (PPPs) in the healthcare service provision; and developing a nationwide family doctor network.