health insurance system in viet nam - coopami
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1
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
4
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
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