Provision of Healthcare in Vietnam
Medical Country of Origin Information ReportAugust 2023

Manuscript completed in August 2023
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Luxembourg: Publications Office of the European Union, 2023
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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

Acknowledgements
The EUAA acknowledges International SOS as the drafters of this report.
The report has been reviewed by International SOS and EUAA.

3

EUROPEAN UNION AGENCY FOR ASYLUMContents
Acknowledgements........................................................................................................................ 3Contents .......................................................................................................................................... 4
Disclaimer ........................................................................................................................................ 6
Glossary and Abbreviations .......................................................................................................... 7
Introduction ..................................................................................................................................... 9
Methodology ......................................................................................................................................... 9
Defining the terms of reference ................................................................................... 9
Collecting information ..................................................................................................... 9
Currency ............................................................................................................................. 9
Quality control ................................................................................................................... 9
Sources ................................................................................................................................................. 10
Maps ............................................................................................................................................... 11
1.

General Information ..........................................................................................................13
1.1. Geographic context ...................................................................................................................13
1.2. Demographic context ................................................................................................................13
1.3. Economic context ...................................................................................................................... 16

2.

Healthcare System ............................................................................................................ 17
2.1. Health system organisation ..................................................................................................... 17
2.1.1. Overview ................................................................................................................ 17
2.1.2. Public sector ........................................................................................................ 20
2.1.3. Private sector ...................................................................................................... 26
2.2. Healthcare resources .............................................................................................................. 28
2.3. Pharmaceutical sector............................................................................................................. 30
2.4. Patient pathways ........................................................................................................................31

3.

Economic Factors ............................................................................................................. 33
3.1. Risk pooling mechanisms........................................................................................................ 33
3.1.1. Public health insurance, national or state coverage .................................33
3.1.2. Private health insurance schemes ................................................................ 36
3.2. Out-of-pocket health expenditure ........................................................................................ 37
3.2.1. Cost of consultations ........................................................................................ 39

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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

3.2.2. Cost of medication...............................................................................................41
4.

List of Useful Links ........................................................................................................... 45

Annex 1: Bibliography .................................................................................................................. 46
Oral sources, including anonymous sources ............................................................................ 46
Public sources.................................................................................................................................... 46
Annex 2: Terms of Reference ...................................................................................................... 58
General information ......................................................................................................................... 58
Healthcare system ............................................................................................................................ 58
Economic factors............................................................................................................................... 60
List of useful links.............................................................................................................................. 625

EUROPEAN UNION AGENCY FOR ASYLUM

Disclaimer
This report was written according to the EUAA COI Report Methodology (2023). The report isbased on carefully selected sources of information. All sources used are referenced.
The information contained in this report has been researched, evaluated and analysed withutmost care. However, this document does not claim to be exhaustive. If a particular event,person, or organisation is not mentioned in the report, this does not mean that the event has
not taken place or that the person or organisation does not exist.
Furthermore, this report is not conclusive as to the determination or merit of any particularapplication for international protection. Terminology used should not be regarded asindicative of a particular legal position.
‘Refugee’, ‘risk’ and similar terminology are used as generic terminology and not in the legal
sense as applied in the EU Asylum Acquis, the 1951 Refugee Convention and the 1967
Protocol relating to the Status of Refugees.
Neither the EUAA, nor any person acting on its behalf, may be held responsible for the use
which may be made of the information contained in this report.
The drafting of this report was finalised on 5 June 2023. Any event taking place after this dateis not included in this report. More information on the reference period for this report can befound in the methodology section of the Introduction.

6

PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORTGlossary and Abbreviations
Term

Definition

AIDS

Acquired Immunodeficiency Syndrome

COI

Country of Origin Information

COVID-19

Coronavirus Disease 2019

DOHA

Direction of Healthcare Activities

EASO

European Asylum Support OfficeEU

European Union

EU+ countries

Member States of the European Union and associated countries

EUAA

European Union Agency for Asylum

EUR

Euro

GDP

Gross Domestic ProductHIV

Human Immunodeficiency Virus

ISO

International Organization for Standardization

MedCOI

Medical Country of Origin Information

Member States

Member States of the European Union

MOH

Ministry of HealthmRNA

Messenger Ribonucleic Acid

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EUROPEAN UNION AGENCY FOR ASYLUM

TermDefinition

ORS

Oral Rehydration Salts

USD

United States Dollar

VN

Vietnam

VND

Vietnamese Dong

VSS

Vietnam Social Security

WHO

World Health Organization

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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

Introduction
Methodology
The purpose of the report is to provide information on access to healthcare in Vietnam. This
information is relevant to the application of international protection status determination(refugee status and subsidiary protection) and migration legislation in EU+ countries.

Defining the terms of reference
The terms of reference for this Medical Country of Origin Information Report can be found in
Annex 2. The drafting period finished on 14 April 2023, peer review occurred between 14 – 28
April 2023, and additional information was added to the report as a result of the quality review
process during the review implementation up until 5 June 2023. The report was internallyreviewed subsequently.

Collecting information
EUAA contracted International SOS (Intl.SOS) to manage the report delivery including datacollection. Intl.SOS recruited and managed a local consultant to write the report and a publichealth expert to edit the report. These were selected from Intl.SOS’ existing pool ofconsultants. The consultant was selected based on their experience in leading comparable
projects and their experience of working on public health issues in Vietnam.

Currency
The currency in Vietnam is the Vietnamese dong (VND). The currency name, the ISO code andthe conversion amounts are taken from the InforEuro website of the European Commission.
The rate used is that prevailing at the date of the source, i.e. the access date of the publicationor the interview, that is being cited. The prevailing rate is taken from The European
Commission website, InforEuro. 1

Quality control
Quality control of the report was carried out both on content and form. Form and content werereviewed by Intl.SOS and EUAA.
The accuracy of information included in the report was reviewed, to the extent possible, basedon the quality of the sources and citations provided by the consultants.

1

European Commission, Exchange rate (InforEuro), n.d., url
9EUROPEAN UNION AGENCY FOR ASYLUM

Sources
In accordance with EUAA COI methodology, a range of different published sources have been
consulted on relevant topics for this report. These include governmental and academic
publications, reports by non-governmental and international organisations, as well as
Vietnamese media. All sources that are used in this report are outlined in Annex 1:
Bibliography.
In addition to publicly available sources of information, three oral sources were contacted forthis report. The oral sources are pharmacists in Ho Chi Minh City, known by the contractor andselected for reliability. MedCOI always protects sources when they may be at risk if identified,
so in this report they have been anonymised for security reasons. All oral sources aredescribed in the Annex 1: Bibliography. Key informant interviews were carried out in April
2023.

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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

Maps
Map 1: Vietnam2

2

Furian, P.H., Vietnam Political Map stock illustration, © iStock 519518622, 12 April 2016, url
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Map 2: Map of Vietnam's provinces 3

3

Juliartblog, Vietnam vector map, © iStock 199817692, n.d., url
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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

1.

General Information

1.1.

Geographic context

Vietnam is a tropical Southeast Asian nation bounded by China, Laos, and Cambodia. It has atotal land area of 331 210 square kilometres and, in 2020, it had a population of over 97 million
people. 4
The Democratic Republic of Vietnam was renamed the Socialist Republic of Vietnam on
25 April 1976. 5 This reunification came after a long period of war. Hirschmann et al. note thechallenges in establishing the numbers of civilian deaths during this time. The Vietnamese
government reported 3.1 million war-related civilian deaths between 1954 and 1975. Between
1965 and 1975, Hirschmann et al. calculate there were approximately 1 million war-related
civilian deaths. 6
Vietnam covers a wide range of climates, terrains, and ecosystems typified by hightemperatures and high humidity. This variation has a significant impact on the population's
health, as certain regions are more susceptible to certain diseases than others due to theirenvironment. The presence of mosquitoes favours malaria (forests) and dengue (widespread,but mostly in major urban areas). 7 The long coastline of 3 260 km, means that most of the
population is exposed to waterborne pathogens (diarrhoeal diseases, cholera) because of
their proximity to the ocean and other water bodies. 8
The country experiences natural disasters, such as floods and typhoons, which canexacerbate existing health problems. Climate-sensitive diseases, such as dengue fever,malaria, influenza, and diarrhoeal diseases, exert increasing pressure on the health sector andadversely affect the health of the population. 9 Due to energy-intensive economic activities andan increasing volume of vehicles, air quality is deteriorating. Hanoi and Ho Chi Minh City, thetwo largest cities in Vietnam, are now among the 15 most polluted cities in Southeast Asia. 10

1.2.

Demographic context

Vietnam is rapidly urbanising. In 2005, 27.1 % of Vietnam's population resided in urban areas;in 2021, this percentage had increased to 36.6 %. 11 UN-Habitat notes that urban growth has
outpaced growth in infrastructure, housing, low-emission transportation and equitable service
World Bank (The), Population, total - Vietnam, 2023, url
Vietnam, Embassy of the Socialist Republic of Vietnam in the United States, History, n.d., url
6
Hirschman, C., et al., Vietnamese Casualties During the American War: A New Estimate, December 1995, url, p.
807
7WHO, Institutional Repository for Information Sharing, Dengue Situation Updates 2022, 2022, url
8WHO, Western Pacific, Vietnam, Home, Health topics, Acute watery diarrhoea and cholera, 2023, url
9Tran Thi Tuyet Hanh, et al., Vietnam Climate Change and Health Vulnerability and Adaptation Assessment, 2018,
22 June 2020, url, p. 1
10US, ITA, Vietnam - Country Commercial Guide, 15 December 2022, url
11
Statista, Demographics, Urban population in Vietnam from 2012 to 2021, 9 January 2023, url
4

5

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EUROPEAN UNION AGENCY FOR ASYLUM

delivery. 12 The population growth rate has declined from approximately 1.7 % in 1999 to 0.8 %in 2021. 13 In 2021, the median age was 32 years. 14 The population of Vietnam is aging: figure 1
shows how the age structure changed, for males and females, between 1990 and 2019 and it
shows a projection to the year 2100. 15
Figure 1: Population age structure for males and females in 1990, 2019 (reference
scenario), and 2100 (reference scenario) 16

In 2021, the life expectancy at birth for men was 69 years, 17 and for women 78 years. 18 The
distribution of morbidity and mortality is shifting from communicable to noncommunicablediseases. During the period between 1986 and 2015, the proportion of hospitalisations
attributable to noncommunicable diseases rose from 38 % to 66 %, while the proportion ofdeaths attributable to noncommunicable diseases rose from 42 % to 73 %. 19 Teo et al. identify
cancer, hypertension, and diabetes as accounting for the majority of Vietnam’s disease
burden. They note that the healthcare requirements of Vietnam's population are changing
from acute episodic care to disease management for noncommunicable diseases and chronic
conditions. 20 Nguyen et al. describe progress to manage noncommunicable diseases as being
slow at the national level and among key subpopulations, and they note that inequalities

UN-Habitat, Viet Nam, n.d., urlWorld Bank (The), Population growth (annual %) – Vietnam, n.d., url
14
UN, Department of Economic and Social Affairs, Population Division (2022), Median age of population (Viet Nam),
2022, url
15
IHME, Viet Nam, How many older versus younger people are in the population, and how will these patternschange?, 2023, url
16
IHME, Viet Nam, How many older versus younger people are in the population, and how will these patternschange?, 2023, url
17World Bank (The), Life expectancy at birth, male (years) – Vietnam, 2022, url
18
World Bank (The), Life expectancy at birth, female (years) – Vietnam, 2022, url
19
Vietnam MOH, 7-1 - Xu Hướng Tiến Triển Của Mắc Bệnh, Tử Vong Của Các Loại Bệnh Ở Cấp Toàn Quốc GiaiĐoạn 1976-2016 [7-1 - Progression Trend of Disease and Death of Diseases at Nationwide in the Period 19762016], 2017, url
20
Teo, H.S., and Huong, D.L., Improving Efficiency in the Health Sector: An Assessment of Vietnam's Readiness for
Integration of Care, April 2020, url, p. 1
12
13

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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

between genders, ethnic groups, geographic regions, and socioeconomic groups are
increasing. 21
Figure 2: Top 10 causes of total number of deaths in 2019 and percent change 2009-2019,
all ages combined 22

Note: Figure redrawn from IHME, Viet Nam, What causes the most deaths? (2023)

Progress has been made in recent years: Millennium Development Goals were achieved, suchas reducing the under-five mortality rate, 23 increasing the immunisation rate, 24 and reducing
the prevalence of HIV/AIDS, 25 the reduction of maternal mortality, 26 and infant and under-5
mortality rates. 27 Furthermore, despite the challenges described above, the country has seen
an improvement in both access to and quality of healthcare. 28
The 2019 Census found that the ethnic minority population in Vietnam accounts forapproximately 15 % of the country's population.29 There are 54 different ethnic groups, inmajority located in the mountainous or remote areas of the country, including the Central
Nguyen, P.T., et al., Trends in, projections of, and inequalities in non-communicable disease management
indicators in Vietnam 2010-2030 and progress toward universal health coverage: A Bayesian analysis at
national and sub-national levels, 11 July 2022, url, p. 1
22
IHME, Viet Nam, What causes the most deaths? 2023, url
23World Bank (The), Mortality rate, under-5 (per 1,000 live births) – Vietnam, 2023, url
24World Bank (The), Immunization, DPT (% of children ages 12-23 months) – Vietnam, 2023, url
25World Bank (The), Incidence of HIV, ages 15-49 (per 1,000 uninfected population ages 15-49) – Vietnam, 2023, url
26
WHO, World health statistics 2022: monitoring health for the SDGs, sustainable development goals, 2022, url,
p. 87
27
Lee, H.Y., et al., Trends and determinants of infant and under-five childhood mortality in Vietnam, 1986–2011, 1
March 2016, url
28
Vietnam, MOH, Tài liệu Hội nghị Y tế toàn quốc ngày 06/01/2021 [Documents of the National Medical Conference
on January 6, 2021], Executive Direction Information, 6 January 2021, url, p. 47
29
Vietnam, GSO, Press Release Preliminary Results the 2019 Population and Housing Census, 11 July 2019, url,bullet point 5
21

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EUROPEAN UNION AGENCY FOR ASYLUM

Highlands, the Northwest, and the Northeast regions of Vietnam; therefore, with lower accessto healthcare. The largest ethnic minority groups in Vietnam are the Tay, Thai, Hmong, Khmer,
and Nung. 30

1.3.

Economic context

Vietnam is a lower middle-income nation. In 2021, the Gross Domestic Product (GDP) per
capita was roughly 3 750 USD [3 090 EUR] per year. 31 In 2011, Miguel and Roland wrote thatthe economic effects of the war have largely dissipated and have not led to inter-regional
economic divergence. 32 Health and environmental effects of the war continue to be felt. For
example, Vietnamese adults exposed, as adolescents, to higher intensity bombing suffer ahigher number of somatic health complaints than their counterparts, 33 and chemicals usedduring the war persist in the environment. 34
The Vietnamese economy faces a double burden of malnutrition from imbalances in diet anddiet-related noncommunicable diseases.35 There is a high prevalence of chronic malnutrition
in Vietnam: in 2020, 19.6 % of children under five were of low height for their age. 36 This is
known as stunting, and it is caused by chronic or recurrent undernutrition, which the World
Health Organization (WHO) attributes to poverty, poor maternal health and nutrition, frequentillness and/or inappropriate feeding and care in early life. 37 With the increased availability ofprocessed and refined foods in Vietnam, 38 there is also an increase in chronic health issues,
such as overweight and obesity, diabetes, and cardiovascular diseases. 39

Vietnam, Socialist Republic of Vietnam, Ethnic Groups in Vietnam, n.d., urlWorld Bank (The), GDP per capita (current US$) – Vietnam, 2023, url
32
Miguel, E., and Roland, G., The long-run impact of bombing Vietnam, 2011, url, p. 12
33
Glass, D.J., et al., Weathering within war: Somatic health complaints among Vietnamese older adults exposed tobombing and violence as adolescents in the American war, February 2023, url, p. 5
34
Olson, K.R., and Cihacek, L., The fate of Agent Blue, the arsenic based herbicide, used in South Vietnam during
the Vietnam War, November 2020, url, p. 565
35
Rupa, J.A., et al., Does food market modernisation lead to improved dietary diversity and diet quality for urban
Vietnamese households? 21 May 2019, url, p. 501
36World Bank (The), Prevalence of stunting, height for age (% of children under 5) – Vietnam, 2023, url
37
WHO, Malnutrition, 2023, url
38
Baker, P., and Friel, S., Food systems transformations, ultra-processed food markets and the nutrition transition in
Asia, 2016, url, p. 5
39
Global Nutrition Report, Country Nutrition Profiles, Viet Nam, 2023, url
30
31

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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

2.

Healthcare System

2.1.

Health system organisation

2.1.1.

Overview

The current healthcare system in Vietnam is a hybrid public-private system. The public system
plays an essential role in ensuring that preventive and curative care is provided to the entire
population. 40
Following the reunification of the country, the Vietnamese government sought to improve
public health. It established free healthcare, promoted the use of preventive measures tocontrol infectious diseases (such as malaria, human immunodeficiency virus, viral hepatitis),and it expanded access to medical treatment. The government also established national
health insurance and implemented health education programmes. 41
According to the MOH, there is a consistent risk of diseases returning, including those that canbe prevented by vaccines such as measles and diphtheria, and vaccination rates are low insome regions, among some ethnic groups and among migrants. The prevention of
noncommunicable diseases, such as cancer, cardiovascular disease, diabetes, andhypertension remains limited and there is an ongoing issue of food poisoning. 42
The COVID-19 pandemic destabilised the public health activities provided by rural healthcentres. The Expanded Programme on Immunisation was disrupted, especially in remotecommunes where ethnic minorities, difficult conditions, and language differences lead to low
cooperation with vaccination campaigns. Some preventable infectious diseases that had been
under control for many years have returned. In the Central Highlands, unobserved diphtheria
affected children: nearly 200 cases of diphtheria were recorded, and 4 babies died. In 2020,
the number of diphtheria cases increased 15-fold compared to 2019. 43
Policies and initiatives to address these challenges are delivered through the national networkof hospitals, clinics, and health centres. Access to healthcare remains a significant issue,
especially in rural areas where many people do not have access to basic medical care. 44 The
healthcare service and management system have four administrative levels:•

communeHoa, N. T., el al., Primary care quality in Vietnam: Perceptions and opinions of primary care physicians incommune health centers - a mixed-methods study, 29 October 2020, url, p. 3
41
Vietnam, The State of the Socialist Republic of Vietnam, Số: 2474/QĐ-TTg. Quyết định: phê duyệt chiến lược pháttriển thanh niên Việt Nam giai đoạn 2011 – 2020 [No: 2474/QD-TTg. [Decision Approving the Vietnamese
Youth Development Strategy during 2011-2020], 30 December 2011, url
42
Vietnam, MOH, Tài liệu Hội nghị Y tế toàn quốc ngày 06/01/2021 [Documents of the National Medical Conference
on January 6, 2021], Executive Direction Information, 6 January 2021, url, p. 7
43Vietnam, MOH, Tài liệu Hội nghị Y tế toàn quốc ngày 06/01/2021 [Documents of the National Medical Conference
on January 6, 2021], Executive Direction Information, 6 January 2021, url, p. 16
44Vietnam, MOH, Tài liệu Hội nghị Y tế toàn quốc ngày 06/01/2021 [Documents of the National Medical Conference
on January 6, 2021], Executive Direction Information, 6 January 2021, url, p. 120
40

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EUROPEAN UNION AGENCY FOR ASYLUM•

district•provincial•

central.45

The district and commune levels provide primary healthcare services. Primary care is thefoundation of the health system and is central to the Vietnamese national health programme. 46
The central and provincial levels provide secondary and tertiary care with specialised
healthcare professionals. 47
DOHA, or Direction of Healthcare Activities (Chỉ đạo tuyến in Vietnamese), is the English
translation for the MOH guidance on the supply of healthcare and the relation between higher
and lower level hospitals. 48 As since the 1990s it has been noted that patients were mainly
accessing healthcare through higher level hospitals, DOHA required health facilities at thehigher administrative levels to train and support those at lower administrative levels, through aprocess known as ‘trickle-down’ healthcare. The DOHA scheme also upgraded the facilities
and equipment in lower level facilities across Vietnam. 49 DOHA is amended and adjusted
based on the demand for medical care, but it continues to be an important term in the context
of medical care reform. 50 It monitors several Public Health indicators in order to achievetargets for improving health standards (see Table 1). 51

Le, D. C., et al., Health Care System in Vietnam: Current Situation and Challenges, 1 March 2010, url, p. 24
Hoa, N. T., el al., Primary care quality in Vietnam: Perceptions and opinions of primary care physicians incommune health centers - a mixed-methods study, 29 October 2020, url, p. 3
47
Atlantic Philanthropies (The), et al., Viet Nam Health Care System, 2017, url, p. 5
48
Takashima, K., et al, A review of Vietnam's healthcare reform through the Direction of Healthcare Activities(DOHA), 30 October 2017, url, pp. 2-3
49
Takashima, K., et al, A review of Vietnam's healthcare reform through the Direction of Healthcare Activities(DOHA), 30 October 2017, url, p. 6
50
Takashima, K., et al, A review of Vietnam's healthcare reform through the Direction of Healthcare Activities(DOHA), 30 October 2017, url, p. 2
51
Vietnam, MOH, Tài liệu Hội nghị Y tế toàn quốc ngày 06/01/2021 [Documents of the National Medical Conference
on January 6, 2021], Executive Direction Information, 6 January 2021, url, p. 47
45

46

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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

Table 1: Assessment of the implementation of the development plan's economic and social
targets in 2020 52
TargetObtained

Key targets assigned by the National Assembly and the Government in 2020
Percentage of population participating in
health insurance

90.7 %

90.85 %

Number of hospital beds per 10,000 people28

28Specific targets for industries and fields assigned by the Government in 2020
Number of doctors per 10,000 people

99

Sex ratio of new-borns

114.6 boys/100 girls

112.1
boys/100 girls

Mortality rate of children under 1 year (per1 000 live births)

14

13.9

Percentage of children under 5 years of age
malnourished (weight for age)

12 %11.5 %

Mortality rate of children under 5 years old(per 1 000 live births)

20.4

22.3

Percentage of communes meeting thenational criteria for health80 %94.4 %

Percentage of health stations in communes,
wards and townships with working doctors

94 %

94 %

52

Vietnam, MOH, Tài liệu Hội nghị Y tế toàn quốc ngày 06/01/2021 [Documents of the National Medical Conference
on January 6, 2021], Executive Direction Information, 6 January 2021, url, p. 47
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2.1.2.

Public sector

The administrative structure for healthcare facilities in Vietnam is set out in Article 81 of
Chapter VIII of the 2009 Law on Examination and Treatment, which covers the organisational
system of medical examination and treatment establishments. 53 There are four levels ofadministrative structure (see Table 2): 54
Table 2: Administrative structure for healthcare in Vietnam 55
Administrative tier

Level

Coverage

CentralI

National

Provincial

II

1–2 million people

DistrictIII

100 000 to 200 000 people

CommuneIV

5 000 to 10 000 people

Figure 3 shows how Level I central hospitals are controlled by the MOH or managed by major
municipalities, such as Hanoi or Ho Chi Minh City. These perform the most advanced medicalor surgical services. Lower-level provincial hospitals are under the control of local provincial
governments for allocating finance and human resources, while the health departments ofprovinces are responsible for their management. Lower-level district hospitals are under thecontrol of local districts for allocating finance and human resources and the healthdepartments of districts are responsible for their management. Both the provincial and district
hospitals are under the supervision of the MOH. 56

Vietnam, The President, Law on Medical Examination and Treatment, Order No. 17/2009/L-CTN of December 4,
2009, on the promulgation of law, 2009, url
54
Coker D, et al., Establishing a Standardized Surveillance System for Health Care-Associated Infections in
Vietnam, 2022, url , p. 2
55
Coker D, et al., Establishing a Standardized Surveillance System for Health Care-Associated Infections in
Vietnam, 2022, url, p. 2
56
Takashima, K., et al., A review of Vietnam's healthcare reform through the Direction of Healthcare Activities(DOHA), 30 October 2017, url, p. 2
53

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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

Figure 3: Organisational chart of Vietnam’s healthcare system, illustrating roles andresponsibilities of each component (adapted from the Ministry of Health) 57

Figure 4 shows the number of Inpatient Department beds per 10 000 population. 58 It isestimated that hospitals in Vietnam handle over 50 % of all healthcare visits and account forover 95 % of all health insurance expenditures. It is still deemed that people visit hospitals as
their initial point of care instead of the available primary care health centres. 59

Meiqari, L., et al., Access to hypertension care and services in primary health-care settings in Vietnam: asystematic narrative review of existing literature, 23 May 2019, url, p. 2
58
Vietnam, GSO, Number of patient beds (*), n.d., url
59
WHO, Hospitals in Viet Nam, 2023, url
57

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EUROPEAN UNION AGENCY FOR ASYLUM

Figure 4: Inpatient beds per 10 000 inhabitants: 2011-2021 60

Note: Data for 2021 is incomplete. Items: Number (Thou. beds); Health establishments: Bed per 10 000 inhabitant(Bed); Year: 2011 – Prel. 2021

In 2017, public hospitals were distributed as follows: 48 central hospitals and 1 015 provincial
and district hospitals. 61 Table 3 shows how provincial and district hospitals, and other healthestablishments, are distributed by economic region. 62
Table 3: Number of health establishments under provincial departments of health byeconomic region (2017)63
Economic regions

Hospital

Regional
polyclinic

Sanatorium
andrehabilitation
hospital

Medicalservice unit

Red River Delta

211

9

95

2 476

Vietnam, GSO, Number of patient beds (*), n.d., url
Vietnam, GSO, Number of health establishments by management level(*) by Items, Year and Management level[2017], n.d., url
62
Vietnam, GSO, Number of health establishments under provincial departments of health by province(*), n.d., url
63
Vietnam, GSO, Number of health establishments under provincial departments of health by province(*), n.d., url
60
61

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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

Economic regions

Hospital

Regional
polyclinic

Sanatorium
andrehabilitation
hospital

Medicalservice unit

North Midlands andMountain areas

197

8

197

2 558

North and Central
Coastal areas

242

9

85

2 900

Central Highlands

80

2

50

726

Southeast

116

3

41

871

Mekong River Delta

169

2

104

1 589

Total

1 015

33

572

11 120Note: Data on GSO webpage selected as follows: Cities, provinces: as in column 1; Year: 2017; Healthestablishments: as in Row 1

At Commune Health Centres (also known as Commune Health Stations) primary care
physicians work with nurses, midwives, pharmacists, and others. The primary care physicians
will often have a leadership role in the Commune Health Centres, as well as in providing
clinical services, such as patient examination and treatment. There is no requirement for a
primary care physician to have postgraduate training in family medicine or other specialities. 64
In 2019 and 2020 respectively, 89 % and 88 % of such centres were staffed with physicians(2020 target: 90 %). 65
The extensive network of small, usually rural, Commune Health Centres across the country
was designed as the primary healthcare solution. However, despite the MOH’s efforts toimprove quality of primary healthcare, patients directly consult secondary or tertiary levels ofcare. This is likely because a higher service quality is expected from those levels, even if at ahigher out-of-pocket cost. 66 The reimbursement provided by social health insurance isdiscussed below (see section 3.1.1). From 1 January 2021, the health insurance fund has

Hoa, N.T., et al., Primary care quality in Vietnam: Perceptions and opinions of primary care physicians incommune health centers - a mixed-methods study, 29 October 2020, url, p. 3
65
Vietnam, MOH, 1.1 - Chỉ tiêu mục tiêu [Target Indicators], Medical Statistics Yearbook, 2019, url
66
Hoa, N.T., et al., Primary care quality in Vietnam: Perceptions and opinions of primary care physicians incommune health centers - a mixed-methods study, 29 October 2020, url, p. 3
64

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EUROPEAN UNION AGENCY FOR ASYLUM

covered the inpatient treatment expenditures for patients who are insured but who go to a
provincial hospital which is different to their registered hospital. 67
The preference to go directly to hospitals of a higher-level means that beds may be shared by
two or three patients. 68 Bed occupancy has reached 120–160 %, particularly in the central
hospitals of large cities. Overcrowding is attributed to multiple factors:•

limited healthcare quality in lower-level facilities in districts and communes, andeven in provincial hospitals;•

increasing expectations of service quality;•

improved accessibility from remote areas to urban areas;•

limited differences in hospital fees between administrative levels.69

DOHA aims to reduce referrals from provinces to overburdened Level I hospitals. This ismatched by a rise in public health facilities and availability of medical equipment due to theallocation of both government and private funding for the health sector. 70 However, despite
these efforts to decentralise access to healthcare, the financial model of the health system
continues to incentivise higher-level hospitals to accept patients rather than requiring areferral. The Vietnam Social Security (VSS) reimburses hospitals for curative care, therefore
creating strong incentives for hospitals to increase the number of services they offer. This isreferred to as the fee-for-service method. The VSS has limited monitoring and power overpayment conditions and rules, leading to unrestricted fee-for-service expenditures in highlevel hospitals. 71
The health financing system is different at district level. The VSS pays district hospitals
annually for outpatient services, hospital stays, and referrals to provincial hospitals for each
insured person. This is referred to as ‘capitation-based’ payments. They place district hospitals
at significant financial risk if they exceed their annual budget, with little control over theirfinancial plan and expenditures. District hospitals are also liable for treatment costs incurredby insured patients at Commune Health Centres under their jurisdiction. 72
Finally, the Commune Health Centres have a distinct funding mechanism: the two primarysources of revenue for these centres are budget from the province which primarily covers staff
salaries and other operating expenses such as electricity, and health insurance payments for
curative care services. 73

Thoa, K., Scope and levels of health insurance benefits in Vietnam, 26 November 2022, url
Nguyen, T. K., and Cheng, T.M., Vietnam's health care system emphasizes prevention and pursues universal
coverage, 2014, url, p. 2058
69
Le, D. C., et al., Health Care System in Vietnam: Current Situation and Challenges, 1 March 2010, url
70
Takashima, K., et al, A review of Vietnam's healthcare reform through the Direction of Healthcare Activities(DOHA), 30 October 2017, url, p. 1
71
Teo, H.S., et al., The Future of Health Financing in Vietnam: Ensuring Sufficiency, Efficiency, and Sustainability,
June 2019, url, p. 41
72
Teo, H.S., and Huong, D.L., Improving Efficiency in the Health Sector: An Assessment of Vietnam's Readiness for
Integration of Care, April 2020, url, p. 18
73
Teo, H.S., and Huong, D.L., Improving Efficiency in the Health Sector: An Assessment of Vietnam's Readiness for
Integration of Care, April 2020, url, p. 19
67

68

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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

However, there are no clear criteria to determine how much the Commune Health Centres
should be reimbursed for curative services. 74
The WHO and MOH note the absence of a mechanism to control the over, or unnecessary,
supply of services and drugs and the way that ordinary healthcare services are provided byhigh-level hospitals, which is an inefficient use of health insurance funds and of household
resources, due to greater distance to travel, longer waiting times and higher treatment andmedication prices. 75 In summary, poor cost controls, distorted incentives, and a lack of suitablepayment methods limit the potential for care integration in Vietnam's current provider payment
system. The higher-level facilities are well reimbursed for the care they provide, which reduces
their incentive to restrict the numbers of patients they treat. Community and district facilities
are in competition for patients since the provision of services at community level reduces thevolume and revenue at district level.76
Since 2018 it has been a priority to provide financial autonomy to hospitals: 253 units now
manage all recurrent budget items and control 80 % to 90 % of their budget, while four Level I
hospitals enjoy full autonomy from the government. This means that hospitals need toestablish efficient payment systems for medical examination and treatment. The MOH notesthat change is slow: a 2015 decree 77 requires hospitals to create an autonomy plan, but many
continue to use the previously established mechanism. 78 The 2015 decree also requires achange from the current centralised management of hospitals by the MOH to hospitals
becoming independent service delivery organisations. 79 In this latter scenario, the state retains
public ownership and accountability structures but leaves decision-making power to thehospital management team. Healthcare and insurance cost predictions are inaccurate, whichmakes it challenging for hospitals to be self-sufficient in regular spending. This has knock-on
effects on the fees that patients pay and, given that 99 % of public hospital patients are poor, it
increases inequity. 80
In the context of empowerment of hospitals, the Vietnamese government has lowered statebudget funding and raised user fees to promote their autonomy. This programme raised
curative care user fees to help public hospitals recover government subsidies and movetoward financial autonomy. As intended, financial autonomy allows hospitals to supplement
staff salaries. Teo et al. argue that these different elements lead Level I facilities torecommend costly, high-tech services, which are likely not to be medically necessary, but

Teo, H.S., and Huong, D.L., Improving Efficiency in the Health Sector; Improving Efficiency in the Health Sector:
An Assessment of Vietnam's Readiness for Integration of Care, April 2020, url, p. 19
75
WHO and Vietnam MOH, Health financing strategy of Vietnam (2016–2025), 2016, url, p. 37
76
Teo, H.S., and Huong, D.L., Improving Efficiency in the Health Sector: An Assessment of Vietnam's Readiness for
Integration of Care, April 2020, url, p. 19
77
Vietnam, Socialist Republic of Vietnam, Nghị định. Số: 16/2015/NĐ-CP, [Decree No.: 16/2015/NĐ-CP], 14 February
2015, url
78
Vietnam, Socialist Republic of Vietnam, Nghị định. Số: 43/2006/NĐ-CP [Decree. No.: 43/2006/NĐ-CP.], 25 April
2006, url
79
Vietnam, Socialist Republic of Vietnam, Nghị định. Số: 16/2015/NĐ-CP, [Decree No.: 16/2015/NĐ-CP], 14 February
2015, url
80
Vietnam, MOH, Tài liệu Hội nghị Y tế toàn quốc ngày 06/01/2021 [Documents of the National Medical Conference
on January 6, 2021], Executive Direction Information, 6 January 2021, url, p. 194
74

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EUROPEAN UNION AGENCY FOR ASYLUM

which are seen by patients as a sign of quality. This adds to Level I hospital overcrowding andthe shunning of smaller healthcare facilities. 81
This transition also presents administrative and unexpected hurdles. Complex procurement
and bidding laws mitigate against fast change. On 11 November 2022, the Finance Ministry
introduced Circular No. 68 which amended procurement rules to require quotations from atleast three medical providers before setting the market price of a drug or assets, goods, orservices. 82 The Sai Gon Giai Phong News reports that the Oncological Hospital in Ho Chi Minh
City is experiencing shortages of medicines and parts for its devices. This is attributed to theintroduction of Circular No. 68. Indeed, the hospital is required to get quotations from threedifferent sources but there is only one manufacturer which can supply the specialised medical
devices, and which can thus supply a quotation. The Sai Gon Giai Phong News states that thehospital is not able to buy machine parts for repair and that this leads to longer waiting times
for patients. In January 2023, Deputy Director Diep Bao Tuan is reported as saying that over
470 hospital inpatients were awaiting surgery or radiation therapy. 83 The Sai Gon Giai PhongNews also reports that in February 2023, Viet Duc Hospital, in Hanoi, was only able to perform
one-third of the emergency surgeries that it usually performs. 84

2.1.3.

Private sector

In 2020, Vietnam Investment Review reported that private hospitals were increasing in
number and that 250 hospitals were privately owned. This is 17 % of the 1 400 hospitals in
Vietnam and 5.6 % of hospital beds. 85 A 2017 article found that private hospitals provide over
60 % of outpatient services and that they are an integral part of the national health system. 86
Three-quarters of private hospitals contain fewer than 100 beds, but there are also a few large
and better-equipped private hospitals staffed by highly qualified medical personnel recruitedfrom the public health sector.87 The Medical Practitioner Society of Ho Chi Minh City states thatup to 70 % of private medical practitioners also hold positions in the public sector. 88
The imbalance between demand for hospital beds and their availability stimulates the private
sector to fill the gap. Government policies seek to ensure that private hospital beds reach 10 %of all hospital beds by 2025 and 15 % by 2030. 89 Domestic private corporations are now
Teo, H.S., et al., The Future of Health Financing in Vietnam: Ensuring Sufficiency, Efficiency, and Sustainability,
June 2019, url, p. 11
82
Vietnam, Ministry of Finance, Số: 68/2022/TT-BTC [Circular No.: 68/2022/TT-BTC], 11 November 2022, url,
Clause 2 Article 11
83
Sai Gon Giai Phong News, HCMC healthcare sector determinedly overcoming challenges, 23 February 2023, url
84
Sai Gon Giai Phong News, Y Tế - Sức Khỏe, Bệnh viện Việt Đức sẽ chỉ mổ cấp cứu từ 1-3 [Medical-Health, Viet
Duc Hospital will only perform emergency surgery from 1-3], 1 March 2023, url
85
Fitch Solutions, Support For Private Healthcare Sector To Increase In Vietnam, 1 October 2021, url
86
Takashima, K., et al, A review of Vietnam's healthcare reform through the Direction of Healthcare Activities(DOHA), 30 October 2017, url, p. 2
87
Oanh T.T.M., et al., Current Situation Assessment and Recommended Solutions to Strengthen Public Private
Partnership in Health Sector, 2011, url,
88
Medical Practitioner Society of Ho Chi Minh City, Bộ Y tế: Đầu tư bệnh viện tư nhân sẽ tăng cao [Ministry of
Health: Private hospital investment will increase], n.d., url
89
Vietnam, Central Executive Committee, Communist Party of Vietnam, Hội Nghị Lần Thứ Sáu, Ban Chấp Hành
Trung Ương Khoá Xii, Về Tăng Cường Công Tác Bảo Vệ, Chăm Sóc Và Nâng Cao Sức Khoẻ Nhân Dân TrongTình Hình Mới [The Friday Conference of the Central Executive Committee, Term XII, On Enhancing theProtection, Care and Enhancing the People's Health in the New Situation], 25 October 2017, url
81

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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

establishing chains of hospitals and clinics across the nation. Private clinics and ‘otherfacilities’ outnumber their counterparts in the public sector (Table 4). 90 However, a study
published in 2019 found that Vietnamese consumers rated private facilities, such as private
clinics and pharmacies, as providing the lowest quality of inpatient experience. 91
Table 4: Number and distribution of public and private health facilities (2014 data)92
No.

Economic
Regions

Hospitals

Clinics

Other Facilities*

Hospital Beds

Publ.

Priv.

Publ.

Priv.

Publ.

Priv.

Publ.

Priv.

1

Red River
Delta

242

37

83

116

11

4248

61 284

1 938

2

North
Midlands
andMountain
areas

167

4

153

20

14

1 302

26 120417

3North andCentralCoastal
areas

205

32

101

58

12

3 205

47 325

1 678

4CentralHighlands

45

2

43

4

7

1 161

8296

300

5

Southeast

104

57

42

296

16

4 902

4 316

4 126

6

MekongRiver Delta

147

23

60

22

28

6 055

36 114

1 045

Nguyen, M.P., and Wilson, A., How Could Private Healthcare Better Contribute to Healthcare Coverage in
Vietnam? 2017, url, p. 2
91
Hoa, N.T., et al., Patient experiences of primary care quality amongst different types of health care facilities incentral Vietnam, 2 May 2019, url, p. 1
92
Nguyen, M.P., and Wilson, A., How Could Private Healthcare Better Contribute to Healthcare Coverage in
Vietnam? 2017, url, p. 2
90

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EUROPEAN UNION AGENCY FOR ASYLUM

No.

Economic
Regions

Total

Hospitals

Clinics

Other Facilities*

Hospital Beds

Publ.

Priv.

Publ.

Priv.

Publ.

Priv.

Publ.

Priv.

910

155

482

516

88

20 87322 855

9 501* Other facilities include those outside the hospital and clinic as traditional medicine, para-clinical and health service
units. All public Commune Health Stations are excluded in the table.
Note: The authors, Nguyen, M.P. and Wilson, A., attribute this to data from GSO, Statistics Yearbooks, 2014

2.2.

Healthcare resources

Despite recent improvements (see Table 1 above), disparities in health between regions,
ethnic groups, and income levels persist. 93 The MOH summarises challenges facing healthcare
resources in Vietnam as follows:
the distribution of health workers is still not reasonable among regions and levels, andthe quality of human resources is still weak at the grassroots level, and the medical
ethics of a part of staff is not good. Human resource training has not kept up with therequirements of the renovation of health systems and activities and has not
approached international standards. Quality control is not strict. License to practice isstill confusing, not in line with international practices. 94
The consultancy firm Wise Consulting Finland Oy reported inequalities in human resources forhealth, stating that in large cities, such as Hanoi and Ho Chi Minh city, the proportion isapproximately nine physicians per 10 000 population, whereas in remote areas this can drop
to one physician per 10 000 population. 95 Table 5 shows variation between economic regionsin the number of doctors. 96 Specialised physicians and medical units in fields such as cancer,
neurology, autoimmune diseases, palliative care, and mental health, are principally found inlarge urban areas. 97

Vietnam Investment Review, Rising inequality threatens to deny access to basic healthcare for some, 27 January2022, url
94
Vietnam, MOH, Tài liệu Hội nghị Y tế toàn quốc ngày 06/01/2021 [Documents of the National Medical Conference
on January 6, 2021], Executive Direction Information, 6 January 2021, url, p. 7, paragraph 5.
95
Wise Consulting Finland Oy, “My health emerging markets,” Wise Consulting Finland Oy, Vietnam, 2017, url, p. 9
96
Vietnam, GSO, Number of doctors by province, n.d., url; Vietnam, GSO, Average population by province, sex andresidence by Cities, provinces, Average population and Year, n.d., url
97
Krakauer, E.L., et al, Vietnam's palliative care initiative: successes and challenges in the first five years, 2010, url,
p. 29; Vuong, D.A., et al., Mental health in Vietnam: Burden of disease and availability of services, 2011, url, p. 1
93

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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

Table 5: Number of doctors by province per 10 000 population (2018-2020) 98
Economic Regions

2018

2019

2020

Red River Delta

9.89

10.37

7.42

North Midlands and Mountain areas

9.74

11.49

10.52

North and Central Coastal areas

8.76

9.52

9.42

Central Highlands

6.88

7.97

7.41

Southeast

8.78

10.08

9.31

Mekong River Delta

7.91

9.45

8.04

Average

8.66

9.81

8.69

Note: The proportions were calculated by dividing the number of ‘doctors by province’ by the ‘average population
per province.’

A 2017 review of Vietnam's healthcare reform found that the quantity and quality of healthcare
services is lower in rural areas compared to urban areas. 99 In its 2016-2020 plan, the MOH
stated that the health workforce is not evenly distributed across disciplines or across thecountry, 100 and that to develop the healthcare network at ‘grassroots level’ and to enhance
preventive medicine and health promotion, it was necessary to ‘invest in medical
infrastructure, equipment and essential drugs for district and commune health facilities’ and to
give priority to ‘communes in mountainous, remote, disadvantaged and extremely difficult
areas.’ 101 The overstretched capacity of Vietnam's health system is viewed as a threat to thecountry's ability to achieve the Sustainable Development Goals, as it impedes progress incombating noncommunicable diseases and consequently affects life expectancy and poverty
rates. 102

Vietnam, GSO, Number of doctors by province, n.d., url; Vietnam, GSO, Average population by province, sex andresidence by Cities, provinces, Average population and Year, n.d., url
99
Takashima, K., et al, A review of Vietnam's healthcare reform through the Direction of Healthcare Activities(DOHA), 30 October 2017, url, p. 1
100
Vietnam, MOH, Plan, For People’s Health Protection Care and Promotion, 2016-2020, 2016, url, p 10
101
Vietnam, MOH, Plan, For People’s Health Protection Care and Promotion, 2016-2020, 2016, url, p. 22
102
Vietnam, The Socialist Republic of Vietnam and the United Nations, One Strategic Framework for Sustainable
Development Cooperation between the Government of Viet Nam and the United Nations for the period 2022–
2026, n.d., url, p. 27
98

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EUROPEAN UNION AGENCY FOR ASYLUM

2.3.

Pharmaceutical sector

At the time of writing, the current version of Vietnam’s essential medicines list was publishedin 2018. 103 The list helps to ensure access to safe, effective, and affordable medicines of goodquality and provides guidance to healthcare professionals. It covers 510 allopathic medicines,
and 737 herbal and traditional medicines. 104
The MOH states that ‘the pharmaceutical market is controlled and provides enough drugs for
medical examination and treatment, it ensures enough drugs for the prevention of epidemics,
natural disasters and floods and that there is no shortage of medicine.’105
Official data on the availability of essential drugs in Vietnam is scarce. A study into theavailability of 30 paediatric essential medicines reported that the availability of original
patented pharmaceutical products was low in both the public and private sectors. The prices
for original patented pharmaceutical products were high in private medicine outlets, making
them unaffordable. In both sectors, generic medicines were readily available and lowestpriced generic medicines were sold to patients at reasonable prices. 106
Official documents mention that ‘the drug distribution system spans the entire nation, with anaverage density of one pharmacy per 1 600 people. Inspection and supervision of the qualityof drugs circulating on the market are conducted regularly and in an organised manner fromthe central to the local levels, and the rate of substandard drugs has been maintained at lessthan 2 % over the years. Under the Expanded Programme of Immunisation, domestic vaccine
manufacturers have supplied 10 of 11 vaccines.’ 107
Vietnam's pharmaceutical industry is at an early stage of development, characterised by thepresence of small, low-competitive domestic firms, low investment, lax price management andintellectual property protection. Its pharmaceutical industry has been excessively reliant on
imported material inputs and pharmaceuticals, and foreign companies have dominated thepatent and specialty drug segments. Therefore, pharmaceutical enterprises have primarily
produced low-priced and limited-product-type generic drugs. In recent years, nearly 60 % of
the total domestic consumption of pharmaceuticals in Vietnam has been met by imported
drugs. The European Union (EU) has traditionally been the largest market for Vietnamese
pharmaceutical imports. 108

Vietnam, MOH, Số: 19/2018/TT-BYT, Ban hành danh mục thuốc thiết yếu [No: 19/2018/TT-BYT, Issuance of a listof essential drugs], Hanoi, 30 August 2018, url
104
Nguyen, H.T.T., et al., Availability, prices and affordability of essential medicines: A cross-sectional survey in
Hanam province, Vietnam, 2021, url, p. 3
105
Vietnam, MOH, Tài liệu Hội nghị Y tế toàn quốc ngày 06/01/2021 [Documents of the National Medical
Conference on January 6, 2021], Executive Direction Information, 6 January 2021, url, p. 26
106
Nguyen, H.T.T., et al., Availability, prices and affordability of essential medicines: A cross-sectional survey in
Hanam province, Vietnam, 2021, url, p. 13
107
Vietnam, MOH, Tài liệu Hội nghị Y tế toàn quốc ngày 06/01/2021 [Documents of the National Medical
Conference on January 6, 2021], Executive Direction Information, 6 January 2021, url, p. 5
108Angelino, A., et al., Pharmaceutical Industry in Vietnam: Sluggish Sector in a Growing Market, 29 August 2017,
url, p. 6
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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

Product registration is overseen by the Drug Administration of Vietnam and is conducted on
an individual basis, necessitating lengthy local trials. 109 In general, ‘fully meeting domestic
demand’ is the ultimate objective for the development of the pharmaceutical industry in
Vietnam, hence it is not a profit-seeking sector. 110 An analysis of significant obstacles facing
the Vietnamese pharmaceutical industry listed: no long-term strategy, low value-added
production, dependence of external material inputs, distorted distribution network, pricedistortion, and ineffective quality control and supervision. 111 Despite this, the British BusinessGroup Vietnam reports that, in 2018, Vietnam was the second largest medicine market inSouth East Asia and that the value of per capita spend per annum on pharmaceuticals is
expected to increase from 170 USD [152 EUR] in 2017 to 400 USD [360 EUR] in 2027. 112

2.4.

Patient pathways

Patient referral is the transfer of a patient from lower to higher level healthcare facilities and is
the key component of DOHA. DOHA departments from health facilities manage this process,which is covered by Circular 14/TT-BYT. 113 Referral between healthcare facilities is determinedby several factors: the technical capacity of the respective facilities, the availability of medical
specialities and the respective standard lists of medical technologies. One of the aims is areduction in the number of patients referred to central (higher-level) hospitals while improving
treatment outcomes at all levels. 114
Outpatients often go to private sector facilities or engage in self-treatment to avoid lengthy
wait times and subsequent out-of-pocket expenses, and due to the perception that staff inprivate facilities display a better attitude towards patients. 115
Different groups have different patterns of usage of health facilities. This leads to inequalities
in the quality of care between rural and urban areas, the wealthy and the poor, and different
ethnic groups. For example, poor households of ethnic minorities are more likely to visit a
Commune Health Station than a provincial hospital (67 % vs 2 %). Commune Health Stations
are not well-resourced, and they are staffed by providers who expend less effort on eachpatient. Richer households visit hospitals that are staffed by physicians and compared with
Commune Health Stations, are better supplied with medicines, staff and facilities. Somnathan

World Bank (The), Ministry of Planning and Investment of Vietnam, Vietnam 2035: Toward Prosperity, Creativity,
Equity, and Democracy, 2016, url, p. 57
110
Vietnam, Government of Vietnam. Resolution No. 37-CP of the Government on Strategic Orientations for Public
Health Care and Protection in the 1996–2000 Period and National Drug Policy, 1996, url
111Angelino, A., et al., Pharmaceutical Industry in Vietnam: Sluggish Sector in a Growing Market, 29 August 2017, url,
pp. 12-13
112
British Business Group Vietnam, Vietnam 2019. Healthcare, 2019, url, p. 3
113
Vietnam, MOH, Thông tư số 14/2014/TT-BYT của Bộ Y tế: Quy định việc chuyển tuyến giữa các cơ sở khám bệnh,chữa bệnh [Circular No. 14/2014/TT-BYT of the Ministry of Health: Regulations on the transfer between medical
examination and treatment establishments], 14 April 2014, url
114
Takashima, K., et al, A review of Vietnam's healthcare reform through the Direction of Healthcare Activities(DOHA), 30 October 2017, url, p. 5
115
Lê, N., et al., Health insurance and patient satisfaction: evidence from the poorest regions of Vietnam, 5November 2018, url, p. 13
109

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EUROPEAN UNION AGENCY FOR ASYLUM

et al. state that this gap in the quality of care is as significant as differences in the quantity ofcare.116
A 2021 study found that patients with noncommunicable diseases had to visit multiple healthfacilities before obtaining a definitive diagnosis at a provincial or central level hospital. Accessto healthcare was affected by participants' often limited knowledge of their condition, lack ofsupport, costs of healthcare and other factors such as public health insurance coverage,
distance to health facilities, and the attitude of healthcare providers. 117

116
117

Somanathan, A., et al., Master Plan Goal (2): Improving Financial Protection and Equity, 2014, url, p. 41
Nguyen, T.A., et al., Factors affecting healthcare pathways for chronic lung disease management in Vietnam: aqualitative study on patients' perspectives, 2021, url, p. 1
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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

3.

Economic Factors

3.1.

Risk pooling mechanisms

3.1.1.

Public health insurance, national or state coverage

The government introduced a formal social health insurance scheme in 1993 to improveaccess to healthcare services and to protect the population against the financial burden of
illness. 118 The MOH defines social health insurance as ‘a form of mandatory health insurance
policy, of which the premium rate depends on the financial capability [of theindividual/household], and the benefits do not depend on the premium rate but the healthstatus’ of the individual/household. 119 The MOH states that in 2020, approximately 91 % of the
population had health insurance. 120 Social health insurance is managed by the Vietnam Social
Insurance, a single fund that is directly under the Government and 63 social agencies inprovinces. 121
Social health insurance started as a compulsory scheme and Vu et al. describe how at first, ‘itcovered state officials and civil servants, state enterprise employees, medium and large nonstate enterprise employees, and those receiving social security allowance.’ 122 The scheme was
expanded between 1993 and 2013 to include children under 6 years of age, ‘the poor andnear-poor, ethnic minority households living in remote mountainous areas and residents ofcommunes with very difficult socio-economic circumstances.’ 123 A voluntary scheme wasstarted for those not eligible for the compulsory scheme. 124 The website Pháp Luật DoanhNghiệp (Corporate Law) explains that employers are required to contribute to the social healthinsurance scheme. The premium is quoted as being 4.5 % of the employee’s monthly salary.
Employees are required to contribute 1.5 % of their salary.125
Figure 5 shows that in 2015 approximately 75 million people were covered under the social
health insurance scheme. Approximately 40 % of the population are categorised as vulnerable
and poor and they have their premium payments covered by the government. Approximately
30 % were partially subsidised. 126
Vu, P.H., et al., Trends in out-of-pocket expenditure on facility-based delivery and financial protection of healthinsurance: findings from Vietnam’s Household Living Standard Survey 2006–2018, 2023, url, p. 239
119
WHO and Vietnam MOH, Health financing strategy of Vietnam (2016–2025), 2016, url, p. 5
120
Vietnam, MOH, Tài liệu Hội nghị Y tế toàn quốc ngày 06/01/2021 [Documents of the National Medical
Conference on January 6, 2021], Executive Direction Information, 6 January 2021, url, p. 8
121
WHO and Vietnam MOH, Health financing strategy of Vietnam (2016–2025), 2016, url, p. 21
122
Vu, P.H., et al., Trends in out-of-pocket expenditure on facility-based delivery and financial protection of healthinsurance: findings from Vietnam’s Household Living Standard Survey 2006–2018, 2023, url, p. 239
123Vu, P.H., et al., Trends in out-of-pocket expenditure on facility-based delivery and financial protection of healthinsurance: findings from Vietnam’s Household Living Standard Survey 2006–2018, 2023, url, p. 239
124Vu, P.H., et al., Trends in out-of-pocket expenditure on facility-based delivery and financial protection of healthinsurance: findings from Vietnam’s Household Living Standard Survey 2006–2018, 2023, url, p. 239
125Pháp Luật Doanh Nghiệp, Những điều cần biết về Bảo hiểm y tế [What you need to know about Health
Insurance], 6 January 2022, url
126
Teo, H.S., and Huong, D.L., Improving Efficiency in the Health Sector: An Assessment of Vietnam's Readiness for
Integration of Care, April 2020, url, p. 34
118

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EUROPEAN UNION AGENCY FOR ASYLUM

Figure 5: Social health insurance coverage by financing source, 1993–2015 127

The insurance scheme provides similar benefits covering most outpatient and inpatient carereceived at government health facilities, and at private facilities that hold contracts with VSS,
the insurer. 128 Article 21 of the Law on Health Insurance 2008129 (amended by the Law on
Amendments to Law on Health Insurance 2014) 130 sets out the scope of health insurance
benefits as being that the insured has the following costs covered: costs of medical
examination and treatment, function rehabilitation, regular pregnancy check-ups and birthgiving, and, subject to conditions, the costs of the transfer of the patients from district hospitals
to superior hospitals in case of medical emergency or inpatients needing such transfer. 131
Various co-insurance schemes have been tried and Vu et al. state that the co-insurance rate is
5 % for pensioners, social security/unemployment insurance recipients and near-poorhouseholds. Co-insurance is waived for children under six years old, social protection pension
recipients, police officers and public security officers, poor households, and other groups insocio-economic difficulties. 132 Those who self-refer to hospitals face higher co-insurance rates:
40 % at provincial hospitals and 60 % at central and tertiary hospitals. 133

Teo, H.S., and Huong, D.L., Improving Efficiency in the Health Sector: An Assessment of Vietnam's Readiness for
Integration of Care, April 2020, url, p. 34
128
Vu, P.H., et al., Trends in out-of-pocket expenditure on facility-based delivery and financial protection of healthinsurance: findings from Vietnam’s Household Living Standard Survey 2006–2018, 2023, url, p. 239
129
Vietnam, National Assembly, Socialist Republic of Viet Nam, Luật Bảo Hiểm Y Tế Căn cứ Hiến pháp nước Cộnghòa xã hội chủ nghĩa Việt Nam năm 1992 đã được sửa đổi, bổ sung theo Nghị quyết số 51/2001/QH10 [Law on
Health Insurance Pursuant to the 1992 Constitution of the Socialist Republic of Vietnam, which was amended
and supplemented under Resolution No. 51/2001/QH10], No. 25/2008/QH12, 14 November 2008, url
130
Vietnam, National Assembly, Socialist Republic of Viet Nam, Sửa Đổi, Bổ Sung Một Số Điều Của Luật Bảo Hiểm Y
Tế [Amendments to the Law on Health Insurance No: 46/2014/QH13], Hanoi, 13 June 2014, url
131
Thoa, K., Scope and levels of health insurance benefits in Vietnam, 26 November 2022, url
132
Vu, P.H., et al., Trends in out-of-pocket expenditure on facility-based delivery and financial protection of healthinsurance: findings from Vietnam’s Household Living Standard Survey 2006–2018, 2023, url, p. 239
133Vu, P.H., et al., Trends in out-of-pocket expenditure on facility-based delivery and financial protection of healthinsurance: findings from Vietnam’s Household Living Standard Survey 2006–2018, 2023, url, p. 239
127

34

PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

Restrictions on the use of facilities are gradually being lifted for those who are referredappropriately. Since 1 January 2016, those who do not go to their registered hospital arereimbursed for examination and treatment at the commune hospitals or the inpatient treatment
costs at the provincial and central hospitals. 134 The benefit levels are set out in Clause 1 Article
22 of the Law on Health Insurance 2008. 135 This applies to poor household members or ethnic
groups living in regions facing socio-economic difficulties, to regions facing extreme socioeconomic difficulties, and to the insured living in island communes or islands districts.136
The 2020 Vietnam Household Living Standards Survey reports that 95 % of people who had
health treatment were covered by health insurance. 137 WHO and MOH note that patients withhealth insurance can still find themselves being required to pay for their healthcare services
because of many factors; for example, insured patients not using their health insurance cards,
bypassing (skipping a level in the system), or self-referral.138 A 2013 study reported that healthinsurance provided limited protection against catastrophic payment and impoverishment. 139 A
2017 survey of patients in a northern area of Vietnam found that approximately 60 % of
Vietnamese held universal cover. However, the majority of these insured patients were found
not to be adequately covered and to receive less than 50 % of their actual expenditures. 140
WHO and MOH considered barriers to equity in health insurance and the rates of service
access and usage and noted the following challenges:•

the percentage of the population that remains without health insurance and thus
makes direct payment for healthcare services;•

inequality in the ability to access and use healthcare services between
geographical areas and population groups;•

barriers to many low-income households created by health facilities seeking toincrease revenue by charging in addition to health insurance revenue and any copayments for patients with health insurance.141

The MOH works with Vietnam Social Insurance and localities to reach out to health insurance
participants, to encourage prompt payment of insurance premiums by units and enterprises,
and to identify groups who do not participate in health insurance with a view to increasing
uptake. 142 For example, VSS provides various ways by which people can monitor their
participation history and the usage value of their health insurance card, such as the App

Thoa, K., Scope and levels of health insurance benefits in Vietnam, 26 November 2022, url
Vietnam, National Assembly, Socialist Republic of Viet Nam, Luật Bảo Hiểm Y Tế Căn cứ Hiến pháp nước Cộnghòa xã hội chủ nghĩa Việt Nam năm 1992 đã được sửa đổi, bổ sung theo Nghị quyết số 51/2001/QH10 [Law on
Health Insurance Pursuant to the 1992 Constitution of the Socialist Republic of Vietnam, which was amended
and supplemented under Resolution No. 51/2001/QH10], No. 25/2008/QH12, 14 November 2008, url
136
WHO and Vietnam MOH, Health financing strategy of Vietnam (2016–2025), 2016, url, p. 29
137
Vietnam (GSO), Kết quả Khảo sát mức sống hộ gia đình Việt Nam 2020 [Result of the Viet Nam Household Living
Standards Survey 2020], 2021, url, p. 14
138
WHO and Vietnam MOH, Health financing strategy of Vietnam (2016–2025), 2016, url, p. 16
139
Van Minh, H., et al., Financial burden of household out-of pocket health expenditure in Viet Nam: Findings fromthe National Living Standard Survey 2002–2010, November 2013, url, pp. 263
140
Pekerti, A., et al., Health Care Payments in Vietnam: Patients’ Quagmire of Caring for Health versus Economic
Destitution, 2017, url, p. 19
141
WHO and Vietnam MOH, Health financing strategy of Vietnam (2016–2025), 2016, url, p. 37
142
Vietnam, MOH, Tài liệu Hội nghị Y tế toàn quốc ngày 06/01/2021 [Documents of the National Medical
Conference on January 6, 2021], Executive Direction Information, 6 January 2021, url, p. 28
134

135

35

EUROPEAN UNION AGENCY FOR ASYLUM"VssID - Digital Social Insurance" for smartphones, a portal,143 support hotline, and healthinsurance payment receipt. 144
VSS states that this helps people to renew their health insurance cards in a timely manner
after the old one expires, ensuring continuous health insurance benefits, while also avoiding
fraudulent activities and misappropriation of the health insurance fund (if any). 145

3.1.2.

Private health insurance schemes

Private healthcare is paid directly by the patients or by their social or private health insurance
scheme. In Vietnam, numerous insurers provide comprehensive private health insurance andinternational providers are entering the market, typically in partnership with a general insurer.
Insurance from local providers is usually for Vietnamese nationals but can also be available toforeigners. 146
The monthly premium can range from 1 173 725 VND [45 EUR] to 11 737 250 VND [453 EUR]
depending on the benefits package, which can include for example the following services:
inpatient, outpatient, health checks, maternity, dental and medical evacuation. 147
Tenzing Pacific Services, an insurance provider, states that with regard to pre-existing
conditions, the provider will typically:1.

accept pre-existing conditions under standard terms;

2. accept it with a surcharge ("loading");
3. exclude this condition and all related expenses from coverage; or
4. reject the application if the pre-existing condition is extremely grave. 148
Tenzing Pacific Services also states that those who can afford private insurance may face
problems related to direct billing. A common issue is the delay between insurance providers
and medical facilities. Other issues are:•variations in whether a treatment is available for direct billing;•

variations in ability of providers to cope with direct billing;•

request from hospital to provide credit card details;•

the insured needing to check that preferred hospital or clinic is in the direct billing
network; and•variation in whether service providers provide direct billing for outpatient
services. 149

VSS, Bảo Hiểm Xã Hội Việt Nam [Vietnam Social Security], 2016-2017, url
VSS, 4 ways to check participation history and usage value of health insurance card, 5 March 2023, url
145
VSS, 4 ways to check participation history and usage value of health insurance card, 5 March 2023, url
146
Tenzing Pacific Services, The Ultimate Guide to Health Insurance in Vietnam 2023, 2023, url
147
Tenzing Pacific Services, The Ultimate Guide to Health Insurance in Vietnam 2023, 2023, url
148
Tenzing Pacific Services, The Ultimate Guide to Health Insurance in Vietnam 2023, 2023, url
149
Tenzing Pacific Services, The Ultimate Guide to Health Insurance in Vietnam 2023, 2023, url
143

144

36

PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

3.2.

Out-of-pocket health expenditure

Direct out-of-pocket payments for health care refer to the payments households make when
they use services. These include the purchase of medication, the payment of hospital user
fees, payment for diagnostic services and other indirect expenses related to seeking medicalcare at public or private facilities (including self-medication). 150
WHO advises that a health system reliance on out-of-pocket health expenditures increases
when the proportion of government health expenditure to GDP is less than 5 %. 151 In 2019,
Vietnam’s Current Health Expenditure as a proportion of its GDP was 5.03 %. Figure 6 shows
how from 2000 to 2020, this proportion has remained close to the average for Low- andMiddle-Income countries in the World Bank’s East Asia and Pacific Region. 152
Figure 6: Current health expenditure (% of GDP) - Vietnam, East Asia & Pacific (excluding
high income), 2000-2020 153

Note: Data from the WHO Global Health Expenditure database, url, License : CC BY-4.0

According to the Household Living Standard Survey 2020, in 2020, the average annual healthexpenditure per person was 3 033 200 VND [approx. 120 EUR]. This represents approximately
5.8 % of household expenditure. 154 Sephiri et al. looked at Vietnam's Household Living
Standard Survey between 2006 and 2018. They found that the use of inpatient departments in
Van Minh, H., et al., Financial burden of household out-of pocket health expenditure in Viet Nam: Findings fromthe National Living Standard Survey 2002–2010, November 2013, url, p. 259
151
Jowett, M, et al., Spending targets for health: no magic number, 2016, url, p. 4.
152
World Bank (The), Current health expenditure (% of GDP) - Vietnam, East Asia & Pacific (excluding high income), 7
April 2023, url
153
World Bank (The), Current health expenditure (% of GDP) - Vietnam, East Asia & Pacific (excluding high income), 7
April 2023, url
154
Vietnam (GSO), Kết quả Khảo sát mức sống hộ gia đình Việt Nam 2020 [Result of the Viet Nam Household Living
Standards Survey 2020], 2021, url, p. 14
150

37

EUROPEAN UNION AGENCY FOR ASYLUM

higher level government hospitals and private facilities increased over this period while theuse of Commune Health Centres fell. Sephiri et al. report an upward trend in out-of-pocket
expenditure, reaching as high as 155.5 % extra per patient in 2018. This price increase wasmost notable at higher level government hospitals and private hospitals. 155
Catastrophic health expenditure can be defined in different ways: the Vietnamese MOH 156
accepts the WHO definition which is when health expenses exceed 40 % of a household’s
ability to pay. 157 Vietnam relies heavily on out-of-pocket payments for healthcare, which is aburden for low-income households. Household out-of-pocket payments represented 37 % ofCurrent Health Expenditure in 2000 and rose to 45 % in 2019. 158 As noted above, healthfacilities charge additional costs to patients which creates barriers to low-income
households. 159
This report has noted various factors that lead to increased costs for health services, some ofwhich are borne by the state and some of which are passed on to patients: for example, therecognition that the reimbursement system creates incentives for over treatment (see section
2.1.2), 160 and the tendency for healthcare providers to hold positions in both the public andprivate sectors (see section 2.1.3).161
Corruption in the health sector is also an important issue. The Vietnamese not-for-profit
company Towards Transparency reports that Vietnamese urban citizens in 2010 ranked thehealth sector as being the third most corrupt institution. Of people who had had contact withmedical services in the previous 12 months, 29 % reported paying a bribe. 162 Towards
Transparency and the National Contact for Transparency International interviewed 170 medical
staff in Ha Noi, Son La, Dak Lak and Can Tho and discovered that the most common mode of
informal payment was a direct offer of cash. The amounts varied according to the level andlocation of the hospital, whether urban or rural. Payments ranged from 50 000 VND [1.93 EUR]
to 5 000 000 [193.90 EUR]. 163 Service providers saw the payments as being offered informallyand they were accepted to supplement official salary and to avoid embarrassment. In contrast,
patients reported social pressure to offer payment, explaining that it is seen as common
behaviour and that it must be offered to avoid the embarrassment of knowing that others have

Sepehri, A., et al., Challenges in moving toward universal health coverage: rising cost of outpatient care among
Vietnam's insured rural residents, 2006-2018, February 2023, url, p. 1
156
Vietnam, MOH, Tài liệu Hội nghị Y tế toàn quốc ngày 06/01/2021 [Documents of the National Medical
Conference on January 6, 2021], Executive Direction Information, 6 January 2021, url, p. 5
157
Xu, K., Evans, D.B., et al., Household catastrophic health expenditure: a multicountry analysis, 12 July 2003, url,
p. 112
158
WHO, Household out-of-pocket payments (OOPS) as % Current health expenditure (CHE), n.d., url, select: year
2000 to 2020, countries: Viet Nam, indicators: out-of-pocket payments (OOPS) as % Current healthexpenditure (CHE), relations: % of Current health expenditure159
WHO and Vietnam MOH, Health financing strategy of Vietnam (2016–2025), 2016, url, p. 37
160
Teo, H.S., and Huong, D.L., Improving Efficiency in the Health Sector: An Assessment of Vietnam's Readiness for
Integration of Care, April 2020, url, p. 11
161
Medical Practitioner Society of Ho Chi Minh City, Bộ Y tế: Đầu tư bệnh viện tư nhân sẽ tăng cao [Ministry of
Health: Private hospital investment will increase], n.d., url
162
Towards Transparency, Informal Payments in the Health Sector, n.d., url
163
Towards Transparency, Informal Payments in the Health Sector, n.d., url [conversion rate as at May 2023]
155

38

PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

paid. Payment was seen as being necessary to get access to care and to enhance its quality,
to get medical supplies and to ensure transfer to a higher-level hospital. 164
Despite the availability of social health insurance, out-of-pocket expenditure and informal
payments to service providers continue to be integral to healthcare in Vietnam. In addition,
there is a paucity of data on health expenditure in the private sector and Teo et al. emphasise
the need for a greater understanding of the levels of private spending on health byhouseholds, including on investments, recurrent spending, and health insurance. 165
The changing age structure and the epidemiological transition, whereby communicable andnoncommunicable diseases are prevalent, are both noteworthy. Vietnam is an aging society(see section 1.2) which has been described as one of the fastest-aging countries in Asia. 166
Older people have higher needs for health services, indeed, the presence of a chronic illness
among rural elderly in Vietnam was shown to be a predictor of the need for care with a higher
likelihood of catastrophic payment. 167 Communicable diseases remain a cause of catastrophic
healthcare expenditures. A study examined the total hospital bills and insurance contributionsfor 100 adults treated for the two most common infectious shock causes in southern Vietnam,
septic shock, and dengue shock, as well as the proportion of patients/families who faced
catastrophic healthcare costs. The median hospital bills for septic shock and dengue shock
are 617 USD and 57 USD, respectively. The authors estimated that 47 % and 13 % of patientswith septic shock and dengue shock, respectively, incurred catastrophic payments, as did
56 % and 84 % of fatal cases of septic shock and dengue shock, respectively. 168 The WHO andMOH state that in 2011, out-of-pocket expenditure was 55.8 % for inpatient services and 43.7 %for medication with a small amount being spent on outpatient services (0.5 %). 169

3.2.1.

Cost of consultations

In 2017, Viet Nam News reported that the government was increasing the medical examination
fee in a bid to encourage people to enrol in the state-sponsored health insurance programme.
The fees for people without national health insurance increased as follows:•in special-class and Level I hospitals (under the management of the MOH orprovincial/municipal people's committees) the fee per consultation rose from
20 000 VND [0.80 EUR] to 39 000 VND [1.56 EUR];•in Level II hospitals, under the management of provincial/municipal departments ofhealth, the fee per consultation rose from 15 000 VND [0.60 EUR] to 35 000 VND[1.40 EUR];

Towards Transparency, Informal Payments in the Health Sector, n.d., urlTeo, H.S., and Huong, D.L., Improving Efficiency in the Health Sector: An Assessment of Vietnam's Readiness for
Integration of Care, April 2020, url, p. 47
166
Teo, H.S., and Huong, D.L., Improving Efficiency in the Health Sector: An Assessment of Vietnam's Readiness for
Integration of Care, April 2020, url, p. 1
167
Van Minh, H., Xuan Tran, B., Assessing the household financial burden associated with the chronic noncommunicable diseases in a rural district of Vietnam, 2012, url, p. 5
168
McBride, A., et al., Catastrophic health care expenditure due to septic shock and dengue shock in Vietnam, 24
July 2019, url, p. 2
169
WHO and Vietnam MOH, Health financing strategy of Vietnam (2016–2025), 2016, url, p. 16
164

165

39

EUROPEAN UNION AGENCY FOR ASYLUM•

in Level III hospitals, under the management of provincial/municipal departments ofhealth, serving residents of a district or a certain number of districts, the fee per
consultation rose from 10 000 VND [0.40 EUR] to 31 000 VND [1.24 EUR];•

the cost of certain medical procedures and surgeries increased by 20 % to 30 %. 170

In the private sector, prices are higher, see, for example, Table 6 which shows the price list for
consultation in a private clinic. 171
Table 6: Price list for consultation with different medical specialists in a specific private
sector hospital 172
General Practitioner

Resident doctor

Expatriate doctor

Standard Medical Consultation (up to 30 mins)

2 009 000 VND[80.36 EUR]

2 210 000 VND[88.40 EUR]

Extended Medical Consultation (1 hour)

2 678 000 VND[107.12 EUR]

2 880 000 VND[115.20 EUR]

After-Hour Consultation

2 612 000 VND[104.48 EUR]

4 017 000 VND[160.68 EUR]

Vietnamese

ForeignerStandard Medical Consultation

2 009 000 VND[80.36 EUR]

3 107 000 VND[124.28 EUR]

Obstetrician and Gynaecologist

Business Hours

After Hours

Standard Medical Consultation

3 107 000 VND[124.28 EUR]

4 486 000 VND[179.44 EUR]

Business Hours

After Hours

Paediatrician

Other Specialist

Viet Nam News, Medical fees to rise for people without insurance, 20 April 2017, url
Raffles Medical, Raffles Medical International Clinics in Viet Nam, Price List, n.d, url
172
Raffles Medical, Raffles Medical International Clinics in Viet Nam, Price List, n.d., url
170
171

40

PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORTStandard Medical Consultation

3 107 000 VND[124.28 EUR]

Vaccination

4 486 000 VND[179.44 EUR]

Business Hours

Vaccination Consultation

1 687 000 VND[67.48 EUR]

Vaccination Administration

803 000 VND[32.12 EUR]

Consultation fees exclude medical charges such as medication, laboratory tests, x-rays, etc. 173

3.2.2.

Cost of medication

The Drug Administration of Vietnam regulates the price of medication. 174 It operates under the
Law on Pharmacy, which prioritises the purchase of generic medications that are on the List of
National Products and that are produced locally. 175 The Law on Pharmacy provides for the saleof medication when the foreign manufacturer of the medicine meets conditions outlined in thelaw. 176 Importers of medication and local manufacturers of medication are required to declarea price for the medication which is then approved by authorities and everyone must keep tothe declared price, which can only be changed after approval by the authorities. 177
Medicines on the national Essential Medicine List are available at different co-payment rates of
0 %, 0.5 % and 20 % respectively, dependent on the population group to which an individual
belongs. Employees and employers pay at the 20 % rate, pensioners and people in nearpoverty pay at the 5 % rate. For people living below the poverty line and for children under six
years of age, medicines on the national Essential Medicine List are not subject to co-payment
rates, if the patient receives care from the hospital listed on their health insurance card. 178
Three qualified pharmacists in Ho Chi Minh City, from a hospital, a chain pharmacy and an
individually owned pharmacy, were interviewed to provide a qualitative assessment for thisreport on the availability and the affordability of essential medicines. 179 The pharmacists fromRaffles Medical, Raffles Medical International Clinics in Viet Nam, Price List, n.d., url
Vietnam, Drug Administration of Vietnam, n.d., url
175
Vietnam, National Assembly, Socialist Republic of Viet Nam, Số: 105/2016/QH13, Luật Dược [Number:
105/2016/QH13, Law On Pharmacy], 6 April 2016, url, Article 7, paragraphs 4a and 4c176
Vietnam, National Assembly, Socialist Republic of Viet Nam, Số: 105/2016/QH13, Luật Dược [Number:
105/2016/QH13, Law On Pharmacy], 6 April 2016, url, Article 54, paragraph 4
177
Lexology, Q&A: the promotion and sale of pharmaceuticals and medical devices in Vietnam, 8 October 2022, url
178
Oanh, T.T.M. et al., Sustainability and Resilience in the Vietnamese Health System, March 2021, url, p. 11
179
VN001, interview April 2023. VN001 is a pharmacist in a hospital pharmacy in Ho Chi Minh City. The person
wishes to remain anonymous; VN002, interview April 2023. VN002 is a pharmacist in a commercial chain
pharmacy in Ho Chi Minh City. The person wishes to remain anonymous; VN003, interview, April 2023. VN003
173

174

41

EUROPEAN UNION AGENCY FOR ASYLUM

the hospital and the chain stated that drugs that required a prescription were never soldwithout it. 180 The pharmacist at the individually owned pharmacy stated that they would sellprescription drugs, such as antibiotics, without a prescription. This practice is reportedly
common in rural areas, where most pharmacies are individually owned. In rural pharmacies,
pharmacists also commonly listen to clients’ symptoms and sell medication directly. 181 The
pharmacist at the individually owned pharmacy stated that they would often give a patient the
medication even when that patient was too poor to pay for it. 182 This generosity is possible
because the pharmacist owns the business. In the hospital and the chain pharmacies, patientswere reported to always have the means to pay for the drugs as they are aware that payment
is required to obtain the drugs. 183
Prices for medication in public hospitals (paid via insurance) and medication from pharmacistsin public hospitals are controlled by the MOH. The newspaper, Hànộimới (New Hanoi), reportsthat pharmacists sell at a range of prices. Hànộimới surveyed four pharmacies in Hanoi, close
to the Duc Giang General Hospital, and found that each pharmacy was selling medications at
higher prices than the official retail price. Retail pharmacies can set their own prices andHànộimới observes that the prices are set by the rules of the market. 184
Nguyen et al. looked at the availability and affordability of generic and original branded
medicines. They found that generic medicine is mostly available and affordable, while original
branded medication is not widely available and is also more expensive. 185 Table 7 below
shows that generic drugs for common conditions are available at less than one day’s worth ofwages for the lowest level government employee. 186

is a pharmacist in an individually owned pharmacy in Ho Chi Minh City. The person wishes to remain
anonymous.
180
VN001, interview, April 2023. VN001 is a pharmacist in a hospital pharmacy in Ho Chi Minh City. The person
wishes to remain anonymous; VN002, interview, April 2023. VN002 is a pharmacist in a commercial chain
pharmacy in Ho Chi Minh City. The person wishes to remain anonymous.
181
VN003, interview, April 2023. VN003 is a pharmacist in an individually owned pharmacy in Ho Chi Minh City..
The person wishes to remain anonymous.
182
VN003, interview, April 2023. VN003 is a pharmacist in an individually owned pharmacy in Ho Chi Minh City. The
person wishes to remain anonymous.
183
VN001, interview, April 2023. VN001 is a pharmacist in a hospital pharmacy in Ho Chi Minh City. The person
wishes to remain anonymous; VN002, interview, April 2023. VN002 is a pharmacist in a commercial chain
pharmacy in Ho Chi Minh City. The person wishes to remain anonymous.
184Hànộimới, Bao giờ “dẹp loạn” giá thuốc? [When will drug prices be "quieted"?], 26 July 2017, url
185
Nguyen, H.T.T., et al., Availability, prices and affordability of essential medicines: A cross-sectional survey in
Hanam province, Vietnam, 2021, url, p. 12
186
Nguyen, H.T.T., et al., Availability, prices and affordability of essential medicines: A cross-sectional survey in
Hanam province, Vietnam, 2021, url, p. 842

PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

Table 7: Number of days’ wages of the lowest-paid government worker needed to purchasestandard treatments 187
Disease condition and standard treatment

Day’s wages to pay fortreatment

Condition

Medicine name, strength,
dosage form

Treatmentschedule

LPG —publicsectorLPG –privatesectorOB –privatesectorAsthmaSalbutamol 100 mcg/dose
inhaler

1 inhaler of
200 doses

0.5

0.7

0.9

Diabetes

Metformin 500 mg cap/tab

1 cap/tab x 3 x
30 days = 90
cap/tab

0.5

-

1.6

Hypertension

Bisoprolol 5 mg cap/tab

1 cap/tab x 2 x
30 days = 60
cap/tab

0.4

0.9

2.7

Hypertension

Captopril 25 mg cap/tab

1 cap/tab x 2 x
30 days = 60
cap/tab

0.3

0.4

-

Hypercholesterolaemia

Simvastatin 20 mg cap/tab

1 cap/tab x 30
days = 30
cap/tab

0.2

0.7

-

Depression

Amitriptyline 25 mg
cap/tab

1 cap/tab x 3 x
30 days = 90
cap/tab-

0.3-

Paediatricrespiratory
infection

Co-trimoxazole 8+40
mg/ml suspension

5 ml twice a
day x 7 days =
70 ml

0.1

0.5

-

187

Nguyen, H.T.T., et al., Availability, prices and affordability of essential medicines: A cross-sectional survey in
Hanam province, Vietnam, 2021, url, p. 8
43

EUROPEAN UNION AGENCY FOR ASYLUM

Disease condition and standard treatment

Day’s wages to pay fortreatment

Condition

Medicine name, strength,
dosage form

Treatmentschedule

LPG —publicsectorLPG –privatesectorOB –privatesectorAdult
respiratory
infection

Ciprofloxacin 500 mg
cap/tab

1 cap/tab x 2 x
7 days = 14
cap/tab

0.5

0.1

-

Adult
respiratory
infection

Amoxicillin 500 mg cap/tab

1 cap/tab x 3 x
7 days = 21
cap/tab

0.1

0.2

-

Adult
respiratory
infection

Ceftriaxone 1 g/vial
injection

1 vial-0.2-

AnxietyDiazepam 5 mg cap/tab

1 cap/tab x 7days = 7
cap/tab

0.04

-

-

Arthritis

Diclofenac 50 mg cap/tab

1 cap/tab x 2 x
30 days = 60
cap/tab

-

0.1

2.3

Pain/
inflammation

Paracetamol 24 mg/ml
suspension

Child oneyear: 120 mg(= 5ml) x 3 for
3 days = 45 ml

-

0.3

-

Ulcer

Omeprazole 20 mg cap/tab

1 cap/tab x 30
days = 30
cap/tab

0.04

0.1

-

Note: OB: originator brand, LPG: lowest-priced generic, cap/tab: capsule/tablet, mcg: microgram.
“-”means “Medicines were not found in 4 facilities or more”
All above treatment schedules were taken from documents of the WHO/HAI.

44

PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORT

4.

List of Useful Links

Organisation

Web addressCountry informationWHO

https://www.who.int/vietnam/health-topics/hospitals

WHO

https://www.who.int/countries/vnm

World Bank

https://www.worldbank.org/en/news/feature/2021/03/
01/vietnams-rural-populace-enjoys-better-healthcareservices

Information about healthcare
providers
Family Medical Practicehttps://www.vietnammedicalpractice.com/

FV Hospital

https://www.fvhospital.com/

Raffles Medical Vietnam

https://rafflesmedical.vn/en/

UK Government

https://www.gov.uk/government/publications/list-ofmedical-facilities-in-vietnam/list-of-medical-facilities-inhanoi-and-northern-provinces

US Government

https://vn.usembassy.gov/wpcontent/uploads/sites/40/List-of-Clinics-andHospitals.pdf

45EUROPEAN UNION AGENCY FOR ASYLUM

Annex 1: Bibliography
Oral sources, including anonymous sources
VN001, interview, April 2023. VN001 is a pharmacist in a hospital pharmacy in Ho Chi Minh
City. The person wishes to remain anonymous.
VN002, interview, April 2023. VN002 is a pharmacist in a commercial chain pharmacy in Ho
Chi Minh City. The person wishes to remain anonymous.
VN003, interview, April 2023. VN003 is a pharmacist in an individually owned pharmacy in Ho
Chi Minh City. The person wishes to remain anonymous.

Public sources
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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORTWorld Bank (The), Life expectancy at birth, male (years) – Vietnam, 2022,
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Annex 2: Terms of Reference
General information
Avoid general Country of Origin Information (COI), focus on aspects that have an impact on
healthcare.
This section is devoted to the geographic, demographic, political and/or economic contexts
which are relevant to analyse the health system in the country in question. If possible, explain
the impact of these factors on the accessibility of healthcare. Ensure that in this section are
included all particular aspects that can have an impact on the provision of healthcare in the
country. (e.g., security situation, internally displaced people (IDPs) / refugees, ethnic tensions,etc.).

Healthcare system
Health system organisationa) Overview
How is the healthcare system organised (e.g., organised as primary, secondary and tertiary
healthcare)? If so, could you explain who provides care at each level and what type of care isprovided at each level? Does a system of referrals and counter referrals exist?
Is the healthcare system centralised, decentralised or federal? How are the healthcare
jurisdictions distributed between the levels of power? How is the health sector financing
distributed between the levels of power? In the cases of states with federal / confederal
structure, if the care is not available in the state / region/republic of residence of the patient,
but is however available in another federated state (region / republic) of the same country, isthere a possibility for the patient to be transferred there? Is there a mandatory referral system?
What are the conditions?
Is there recent data on the geographical distribution of the health structures? If so, could you
give an overview? Is there a difference in the care supply, in respect to the different
healthcare levels, in the urban and rural regions? Do the patients in the urban and rural zones
have equal access to healthcare? Are there regions / provinces particularly affected by a lackof hospitals or health centres? Ensure that there is Information on the number of healthcare
facilities at each level of healthcare.
Use links to existing documents online for more detailed information.
b) Public sector
How is the public sector structured? What are the strengths? What are the weaknesses?

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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORTc) Private sector
Does a private health sector exist? How is it structured? Is there a difference (quantitatively
and qualitatively) between hospitals and health structures in the public and private sector?
What are the main differences, for the patient looking for medical care, between the statefinanced healthcare system and the private sector?

Healthcare resources
Is there recent data on the number of healthcare personnel in the country (e.g., cardiologists,
psychologists, etc. per number of inhabitants)? If so, provide a brief overview (context /comparison with other similar countries or Europe)?
How is the distribution of human resources in health care in the country? Are there regions /provinces particularly affected by a shortage of healthcare professionals? Is the distribution of
the healthcare personnel equal between the public and private sectors?
Are there any specific needs with regards to human resources for health? Are there any
under-represented professional categories? Could you specify?
Is there an emergency healthcare service, e.g., ambulances? How is it organised?
Health expenditure / GDP.

Pharmaceutical sector
Is there a national essential drugs list for the country? What does it mean in terms of access to
drugs for patients? How often is the list updated? If generic drugs are not widely available, dopatients have access to generic drugs? Are they accessible to patients and how?
Is there a supply system for drugs? Does the country experience regular stock shortages? If
so, does it affect the patients’ access to medication? What drugs and diseases are mainly
affected by these stock shortages? What organisations regulate / control the market? Are
there many illegal medications in circulation?
Are the drugs accessible both in urban and rural areas? Are the drugs accessible
geographically in all the country's regions?
Are any medications only available in hospitals, not pharmacies? If so which ones?
Can non-registered medication be imported (parallel import)? How?

Patient’s pathways
In general: when in need of medical treatments and/or medicines, where and how can patientsfind information? What is the ‘typical route’ of a patient who needs healthcare; treatments
and/or medicines? What does he/she do and where does he/she go primarily and what

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happens next? What are the main obstacles in general to access medical treatments /medicines in the country?

Economic factors
Risk-pooling mechanisms
Include only the mechanisms which are relevant to the country in question. Remove section if
there are none.

Health services provided by the State / Public authorities
Is there a national health and social insurance system / certain state coverage in the country?
How is the Public Health / Social Insurance system organised?
How is health insurance financed? Is it financed by the employer and/or employee
contribution or by taxation or by OOP (out of pocket payments)? What is the patient's financial
contribution?
What does it consist of? Who is entitled to public health insurance (or other form of public /state coverage)? Is the entire population entitled to this insurance? If not, what are theadministrative procedures that should be undertaken and/or the conditions that are necessary
in order to be registered with health insurance? Are the procedures identical for the entire
population? Is being employed one of the conditions to qualify for health insurance? Does thehealth coverage target certain groups of the population (pregnant women, children, seniors,etc.)? What are the criteria in order to be covered by public health insurance? Is a patient’s
financial participation necessary for the registration? If so, how much should they pay? What
percentage of the population is covered by public health insurance?
Does the country have a complementary system to protect the most vulnerable and those
who cannot contribute or be enrolled in the National Health insurance?
Are returning migrants / citizens covered by public health insurance?

Public health insurance, national or state coverage
Note for drafters: the aim of this section is to make clear to the reader what is covered bypublic health insurance and to what extent it is covered. Below are guiding aspects to take
into account.
What type of healthcare / what diseases does health insurance cover? Is maternity carecovered by health insurance? Where is the healthcare provided (in which healthcare facility orat what level of the health pyramid structure)?

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PROVISION OF HEALTHCARE IN VIETNAM – MEDCOI REPORTAre medicines covered by health insurance? Does it cover all medicines or only some of themor only a percentage of the cost? What are the conditions to benefit from drug coverage?
Are there cash benefits in case of illness for employees? If so, in which cases and conditions
and what is the amount of these benefits?
In case a patient needs medical care and does not have the means to pay, are there any
governmental measures allowing them access to healthcare? Is there a difference between
emergency care and non-emergency care? What are the solutions for patients without
financial resources?

Private health insurance schemes
Are there private health insurance systems? What are the main health insurances in the
country? What are the conditions necessary to benefit from them?
What do these health insurances cover? What type of healthcare, which diseases arecovered? Where is the healthcare provided (in which healthcare facility or at which level of thehealth pyramid structure)?
How much must a person / family pay to obtain a private insurance on average?
What is the percentage of the population’s coverage by private health insurances? Who hasaccess to this type of insurance?

Out-of-pocket health expenditure
Average total of out-of-pocket payment on total health expenditure.
Information on the frequency of health expenditure events that may bankrupt a person /family.
a) Cost of consultations
Provide a range of prices for consultations with a general practitioner and different specialists
as well as for a hospital stay. What is the price of a consultation / hospitalisation in an
emergency department? What is the share of financial participation by patients?
Is there a difference in respect to prices between the private and public facilities? Are there
any geographical disparities?
Is there a practice of overcharging medical fees? Is it common? If so, could you explain thecontext? How much does it amount to?
b) Cost of medication
General information about the prices of medication: Are the prices regulated? Is there an
inflation problem, price variation, etc.?

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Are there medications provided for free (e.g., are certain medicines covered by the state)? If
so, could you specify which ones and in what facilities or at what health level?
In general, what share of the health budget per person / family goes to the purchase of drugs?
Does the price of medication vary between pharmacies? Is there a difference in respect toprices between the private and public facilities? Are there any geographical disparities?

List of useful links
Include links that provide long-term value and are likely to be kept updated, such as websites
detailing epidemiologic data, national disease programmes, Ministry of Health website, certain
large hospitals, online pharmacies, etc. Not e.g., individual research articles or other ‘static’material.

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