Vietnam's health care system, explained by its Minister of Health, Nguyen Thi Kim Tien




This interview was conducted in August, released as a Web First, and appears in the November issue of Health Affairs.


Health Affairs has previously published Cheng's interviews with other world health ministers, including Thomas Zeltner of Switzerland (2010) and Chen Zhu of China (2012).


In this interview, Minister Nguyen noted that the Vietnamese parliament has voted to spend about 30 percent of the country's state fund for public health. However, that goal has yet to be reached. She also confirmed that Vietnam's 2008 Law of Health Insurance requires patients use the communal health facility they have registered for through their social health insurance, except in cases of an emergency. If a patient insists on visiting a different facility, the insurance will not cover the service and the patient will need to pay out of pocket for that care.


While the goal of the 2008 law was universal coverage by 2014, Minister Nguyen acknowledged that the goal has not yet been reached, although she noted that about 70 percent of Vietnam's population has enrolled. Participation in social health insurance is mandatory, but the minister also allowed that enforcement has been weak. She said that Vietnam's "master plan" aims for 80 percent by 2020.


Nguyen stated that Vietnam is the first country to successfully control SARS, and the incidence of other infectious diseases such as HIV/AIDS and TB has declined in the past ten to twenty years. The exception is malaria, which Vietnam had conquered five years ago but is now witnessing a return among migrant workers along the borders with Cambodia and Laos. Minister Nguyen said that drugs for treatment are available and costs for epidemic outbreaks are borne by the government.


When asked about medical training in Vietnam, Minister Nguyen said that it is comparable to that of other nations, with many countries supporting the postgraduate training of new Vietnamese physicians. She said that graduates are free to choose positions in either the public or private sector. While many prefer to work in cities, one training model accepts students with substandard entrance exams into government medical schools in exchange for future service in their native provinces for a minimum of five years. She also noted when asked that over 90 percent of Vietnamese babies are delivered by trained midwives.


Looking ahead at achieving Millennium Development Goals, Minister Nguyen called the greatest difficulty "overcoming the disparities between residents in mountainous areas and members of the minority groups, on the one hand, and the residents of urban areas on the other hand....Infant mortality, maternal and child mortality, and the incidence of malnutrition are still high in some very remote areas, while they are all very low in cities. But on average, for the country as a whole we achieved the goals."

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