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Health insurance system in Viet Nam

Ha Noi, 2011

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Outline of presentation

Background information Health insurance system Achievements and issues in

implementation Currently reforms

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Background information

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General Information

Population: 87 Million

- >70% living in rural area

GDP per capita: 1.100 USD

Population Grow Rate: 1.22% Life expectancy: 74.3

Malnutrition (children under 5 year): 19.9%

Physician/10,000 population: 6.52

Beds in health facilities/10,000 population: 25.72

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Health care system

Public system: 4 levels of service delivery:

Primary health care: CHS, Inter-commune Polyclinics

First referral: district hospitals

Second referral: provincial general and special hospitals

Tertiary: regional and central hospitals, general and

specialized

Recent reforms: decentralization and more autonomy for

public hospitals

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Main financing source:

State budget

Social Health insurance

User fees paid directly to health facilities

Private health insurers

Official development assstance (ODA)

History of HI in Vietnam

1989-1992: experimentation with HI: health sector reforms as result of economic crisis

1992-1997: Introduction of HI at national level: First HI Decree in 1992 (Decree 299/HDBT)

1998-2002: Centralization of Health insurance administration: New HI Decree (update) in 1998 (Decree 58/1998/ND-CP)

History of HI in Vietnam

2003-10/2009: Transfer of HI to VSS, new HI Decree in 2005 (Decree 63/2005/ND-CP) and new Department of HI in MOH

10/2009 up to now: First HI Law, Decree 62/2009 (detailing and guiding a number of articles of the Law on HI), Circular 09/2009 (providing guidance on health insurance), Circular 10/2009 (guiding registration and referral for insured)

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SHI schemes and their target population 1992-2005

SHI Schemes

SHI HCFP VHI

Children U6 Employee in public sectors, private enterprises; Pensioners Civil servants …

The poor & minorities

Farmers and Self-employed

FCFCU6 Free care for children

under 6

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SHI schemes and their target population 2005-6/2009

SHI Schemes

SHI VHI

Children U6 Employee in public sectors, private enterprises; Pensioners Civil servants …

The poors and minories

Farmers and Self-employed

FCFCU6 Free care for children

under 6

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SHI schemes and their target population From 7/2009

SHI Schemes

SHI VHI

Children U6 Employee in public sectors, private enterprises; Pensioners Civil servants …

The poors and minories

Farmers and Self-employed

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HI coverage (as of % population)

12.5

20 23.4

28.4

40.6 4244.6

58.2 60

65

0

10

20

30

40

50

60

70

1998 2003 2004 2005 2006 2007 2008 2009 2010 2011Year

Coverage rate

Contribution Rates (from 1/1/2010)

Based on individual, not family coverage

Compulsory scheme: 4,5% of salary (employer 3%, employee 1.5%),

Scheme for the poor: 4,5% minimum salary (paid by government)

Near poor: 50% of the premium is support by the Government

Voluntary: 4,5% minimum salary (paid by participant) approximately 20 USD

Benefits

Examination and treatment, function rehabilitation,

regular pregnancy check-ups and birth giving;

Examination for screening and early diagnosis of some

diseases;

Transferal from district hospitals to higher-level hospitals

(for some particular group)

Benefits

Different group: 100% (children under 6, officer serving in the

people in security force, People with meritorious services to the revolution. )

95% (pensioner, poor, ethnic people…) 80% (others)

Not at the primary care provider: 70%: district hospital 50%: province hospital 30%: national hospital

High-tech, high costs: 40 minimum salary/use

Payment methods

3 payment methods:

Fee for service: Not good in controlling costs and overuse

Capitation: pilot in several district hospitals commune station. (roadmap: At least 2011: 30%, 2013: 60%, 2015 all of district hospital)

Diagnostic related groups: Researching in several central hospital

Health care expenditure 2010

9608

1036413035

15481

25513

19322

-5000

0

5000

10000

15000

20000

25000

30000

2008 2009 2010

Health care fund Expenditure for health care Balance

3.100

( Unit: billion VND)

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Challenges and Issues

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Membership - Coverage

- Not covered fully targeting groups due to low compliance, especially in private owned enterprises, joint-venture enterprises

- Separate member’s dependants - The affordability is low, especially in rural

areas due to low income - Adverse selection in voluntary health

insurance program: only elderly and those in need of health treatment enroll in HI

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Benefit packages

- Focus in treatment at hospitals

- Inequality of benefits between member groups

- HI does not affect out of pocket expenditures due to high co-payment and ceiling payment for high tech services

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Responsiveness and quality of care

- There are differences in infrastructure and quality of care between provinces, cities that affecting quality and equity in receiving benefits of the insured patients

- Issues of awareness, action and cooperation of health care staff and

health care providers to HI

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Management and implementation

- Limitation of capacity in developing policies, implementation and monitoring

- Lack of skilled staff especially in collecting, analysis data and information serving for developing policies

- Lack of cooperation and consistence in monitoring, register, statistic and report between VSS and health care providers

Long term Objective

Universal Coverage of Health Insurance

Challenges and Issues

1. How to enforce the HI Law 2. Reduce adverse selection in examination

and treatment. 3. Manage and control drug price 4. Reduce the discrimination between

insured and uninsured 5. Difficulty in investigation of financial

model and implementing agenda to achieve universal cover.

Challenges and Issues

Risk of financial viability of HI fund: Dodge the HI enrollment (50% workers in

business) Increased health care costs The current methods of payment (Fee - For-

Services) is difficult to control expense and easy for abuse of health care service

HI assessors are lack both of quantity and quality

Challenges and Issues

Ability of response of the health care facilities:

Differences (in infrastructure and quality

of care) between provinces, cities

affecting quality and equity in receiving

benefit of HI patients

Awareness, action and cooperation of

health care staff and health care

providers

Plans to Reach the Universal Coverage Objective

Target universal coverage

Enhance communication and propaganda

Study and complete payment mechanism

Strengthen local-level health system

Heighten health service quality

Improve IT system

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CURRENT REFORMS

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ORIENTATIONS

Strengthening the health insurance system to ensure the balance of

health insurance fund and to reach the universal health insurance coverage in next

coming years

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Reforms required …

Participation is compulsory for all people

Revising benefit package

Changes in payment methods to ensure the efficiency as well as benefit of the insured

Strengthening the capacity of HI system

Strengthening the access to health care and improve health service quality

Thank you for your atention