Moving toward universal coverage of social health insurance in Vietnam : assessment and options

Over the past two decades Vietnam has made enormous progress towards achieving universal coverage (UC) for its population. Significant challenges remain, however, in terms of improving equity with continuing low rates of enrollment. Ensuring financial protection also remains an elusive goal. The Master Plan for Universal Coverage approved in 2012 by the Prime Minister directly addresses both these deficiencies in coverage. The objective of this report is to assess the implementation of Vietnam SHI and provide options for moving towards UC. This is a joint assessment with development partners, World Health Organization, United Nations Children's Fund (Unicef) and Rockefeller Foundation. Expanding breadth of coverage, particularly for those hard to reach groups such as the near-poor and informal sector would require substantially increasing general revenue subsidies and fully subsidizing the premiums for the near-poor. High enrollment rates would, however, have little impact on financial protection and equity if OOP costs remain high. Achieving UC will require sustained efforts to improve efficiency in the system, and gain better value for money from available budgetary resources; without these efforts, any further progress towards UC would be financially unsustainable. There is considerable scope for improving efficiency in Vietnam. Fragmentation in the pooling of funds gives rise to unnecessary costs. Inefficiencies in resource allocation and purchasing arrangements include: (i) an overly generous benefits package; (ii) provider payment mechanisms and the mix of incentives facing providers which result in an oversupply of services; (iii) high prices, overconsumption and inappropriate use of pharmaceuticals; and (iv) the structure and incentives embedded within the delivery system. The organization, management and governance of SHI are fragmented and often dysfunctional. The present institutional setting for SHI needs to be assessed and changed. Education has played an important role in making Vietnam a development success story over the last twenty years. In the 1990s and early 2000s Vietnam experienced rapid economic growth and poverty reduction in the wake of a rapid shift of employment from low-productivity agriculture to higher-productivity nonfarm jobs. Vietnam's committed effort to promote access to quality primary education for all has enabled this transformation and contributed to the country's reputation for having a young, well-educated work force. Skilling Up Vietnam argues that to continue its success story, Vietnam needs to renew its focus on education: not just expanding attainment, but equipping its workforce with the right skills will be needed to foster to Vietnam's continued economic modernization in the coming decade and more. Despite the evidence of impressive basic literacy and numeracy achievements among Vietnamese youth and workers presented in this book, many Vietnamese businesses report that a significant obstacle to their activity is the shortage of workers with adequate skills. Drawing on a survey of employers in urban areas, the book finds that, in addition to job-specific skills, Vietnamese employers value cognitive skills, such as problem solving and critical thinking, and behavioral skills, such as team work and communication. Reorienting Vietnam's education system toward teaching these types of skills will help prepare Vietnamese workers for a modern market economy. Skilling Up Vietnam proposes a three-step holistic skills strategy that looks at today's workforce as much as the future workforce. Vietnam's skills development efforts should focus on promoting school readiness through early childhood development, ensuring a strong cognitive and behavioral foundation in general education, and building job-relevant technical skills through a more connected system among employers, students and universities, and vocational schools.

To address the growth in resultant out-of-pocket (OOP) payments and associated problems of financial barriers to access, the government issued several policies aimed at expanding coverage throughout the 1990s and 2000s, particularly for the poor and other vulnerable groups. Universal coverage (UC) can be an elusive concept and is about three objectives: (a) equity (linking care to need, and not to ability to pay); (b) financial protection (ensuring that health care use does not lead to impoverishment); (c) effective access to a comprehensive set of quality services (ensuring that providers make the right diagnosis and prescribe a treatment that is appropriate and affordable; and (d) to ensure that the financing needed to achieve UC is mobilized in a fiscally sustainable manner, and is used efficiently and equitably. The objective of this report is to assess the implementation of Vietnam social health insurance (SHI) and provide options for moving toward UC, with a view to contributing to the law revision process. It analyzes progress to date on the two major goals of the master plan. The report assesses Vietnam's readiness to meet these goals, the challenges it will face in achieving UC, and key reforms needed to overcome those challenges. It does so through a health financing lens, focusing on how resources are mobilized, pooled, and allocated, and how services are purchased. The report also examines the stewardship of financing that is, the organization, management, and governance of SHI as it has direct implications for achieving UC. The report ends by pulling together the recommendations in the form of an implementation road map.

Moving towards universal coverage? : assessing the way forward -- Master plan goal (1) : increasing enrollment rates -- Master plan goal (2) : improving financial protection and equity -- Estimating the cost of moving towards universal coverage -- Mobilizing resources for universal coverage : the macro-fiscal context -- Reducing fragmentation in the pooling of funds -- Strengthening resource allocation and purchasing -- Strengthening the organization, management, and governance of SHI -- An implementation road map for moving towards UC in Vietnam. Foreword Acknowledgments About the authors Acronyms Executive summary Vietnam's economic transformation and the role of education Skills for current and future jobs Skills formation and the importance of the early years Cognitive and behavioral foundation skills in the general education system Job-specific skills to promote employability Figures.