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Moving toward Universal Coverage of Social Health Insurance in Vietnam of Social in Health Insurance Coverage Universal toward Moving Public Disclosure Authorized Public Disclosure Authorized DIRECTIONS IN DEVELOPMENT Somanathan, Tandon, Dao, Hurt, and Fuenzalida-Puelma Dao, Tandon, Somanathan, Human Development Moving toward Universal Coverage Public Disclosure Authorized of Social Health Insurance in Vietnam Assessment and Options Aparnaa Somanathan, Ajay Tandon, Huong Lan Dao, THE WORLD BANK Kari L. Hurt, and Hernan L. Fuenzalida-Puelma Public Disclosure Authorized Moving toward Universal Coverage of Social Health Insurance in Vietnam DIRECTIONS IN DEVELOPMENT Human Development Moving toward Universal Coverage of Social Health Insurance in Vietnam Assessment and Options Aparnaa Somanathan, Ajay Tandon, Huong Lan Dao, Kari L. Hurt, and Hernan L. Fuenzalida-Puelma © 2014 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW, Washington DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org Some rights reserved 1 2 3 4 17 16 15 14 This work is a product of the staff of The World Bank with external contributions. The findings, interpreta- tions, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. 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Cover design: Debra Naylor, Naylor Design Library of Congress Cataloging-in-Publication Data has been requested. Moving toward Universal Coverage of Social Health Insurance in Vietnam http://dx.doi.org/10.1596/978-1-4648-0261-4 Contents Foreword xi Acknowledgments xiii Abbreviations xvii Overview 1 Chapter 1 Moving toward Universal Coverage? Assessing the Way Forward 11 Major Achievements and Shortcomings on the Path to Universal Coverage 12 Government of Vietnam’s Agenda for Moving toward Universal Coverage 18 A Guide to This Report 18 Methodology and Consultation Process 20 Notes 21 References 22 Chapter 2 Master Plan Goal 1: Increasing Enrollment Rates 23 Understanding Where the Gaps in Coverage Are 23 Global Experiences with Increasing Enrollment Rates and Coverage 27 Recommendations 33 Notes 35 References 35 Chapter 3 Master Plan Goal 2: Improving Financial Protection and Equity 37 Implications of High Out-of-Pocket Payments for Financial Protection and Equity 38 Understanding Why Out-of-Pocket Payments Are Persistently High 42 Regional Patterns in Out-of-Pocket Spending and Coverage 43 Recommendations 45 Moving toward Universal Coverage of Social Health Insurance in Vietnam v http://dx.doi.org/10.1596/978-1-4648-0261-4 vi Contents Notes 47 References 47 Chapter 4 Estimating the Cost of Moving toward Universal Coverage 49 Costing Universal Coverage: Revenue Projections Based on the Master Plan 49 Costing Universal Coverage: Expenditure Projections Using the Lieberman-Wagstaff Model 50 Summary: Estimates of the Costs of Achieving Universal Coverage 54 Notes 54 References 55 Chapter 5 Mobilizing Resources for Universal Coverage: The Macro-Fiscal Context 57 Macro-Fiscal Environment 58 Reprioritizing Health 63 Health Sector–Specific Resources 65 External Resources 67 Recommendation 69 Notes 69 References 70 Chapter 6 Reducing Fragmentation in the Pooling of Funds 73 Fragmentation in the Pooling of Funds and Its Implications 73 Global Experiences with Reducing the Fragmentation of Funds 75 Recommendations 79 Notes 80 References 80 Chapter 7 Strengthening Resource Allocation and Purchasing 81 Sources of Inefficiency 82 Global Experiences with Strengthening Resource Allocation and Purchasing 90 Recommendations 94 Notes 100 References 100 Chapter 8 Strengthening the Organization, Management, and Governance of Social Health Insurance 103 Problem Diagnosis 104 Brief Overview of the Social Health Insurance Law of 2008 106 Organization of SHI 109 Moving toward Universal Coverage of Social Health Insurance in Vietnam http://dx.doi.org/10.1596/978-1-4648-0261-4 Contents vii Management of SHI 114 SHI Governance 118 The Social Health Insurance Agency 123 Road Map for Institutional Reform 125 Recommendations 128 Notes 131 References 132 Chapter 9 An Implementation Road Map for Moving toward Universal Coverage in Vietnam 133 Legislative and Regulatory Measures 134 Health System Strengthening Measures 138 Data and Information Gaps That Need to Be Addressed 139 Note 139 Reference 139 Appendix A Health System Overview 141 Appendix B The Consultation Process for the Health Insurance Review 147 Appendix C Details of Universal Coverage Costing Simulations 149 Appendix D Inefficiencies in Pharmaceutical Spending 153 Boxes 2.1 Survey of the Knowledge, Attitudes, and Behavior of Parents Related to the Use of SHI for Children Under Six Years of Age in Vietnam 26 2.2 The Role of General Revenues in Subsidizing Enrollment: The Global Experience 29 2.3 Challenges of Voluntary, Contributory-Based Enrollment in the Philippines and Thailand 30 2.4 Evidence That Tax Financing for the Informal Sector Increases Informality 31 2.5 Experience with Family-Based Enrollment from the EAP Region 31 2.6 The Role of Information, Education, and Communication in Expanding Coverage 32 6.1 The Evolution of Fund Pooling in Japan, the Republic of Korea, and Taiwan, China 77 6.2 Consolidation of Funding through Public Financing Reforms in Chile 78 6.3 Harmonizing National and Subnational Efforts under the NCMS in China 79 7.1 The Benefits Package Decision Process under the UCS in Thailand 91 Moving toward Universal Coverage of Social Health Insurance in Vietnam http://dx.doi.org/10.1596/978-1-4648-0261-4 viii Contents 7.2 The Benefits Package Decision-Making Process: Republic of Korea National Health Insurance 92 7.3 Cost Containment through Provider Payment and Purchasing Reforms in Thailand and Turkey 93 7.4 Effective Containment of Pharmaceutical Costs in Selected Countries 95 8.1 Allocating Resources to Benefits Packages: Questions to Answer 116 A.1 Calculation Formula for Capitation Rate 144 Figures 1.1 Evolution of Social Health Insurance in Vietnam (1989–2020) 13 1.2 Health Expenditure Trends and Composition (2000–11) 14 1.3 Sources of Financing for SHI Revenues 15 1.4 Physicians and Nurses to Population Ratios by Geographical Region (2002–11) 16 1.5 Distribution of Health Professionals at the Commune Level 16 1.6 Share of Population Aged 65+ in Selected Countries (1950–2070) 17 1.7 Functions of Health Financing 19 2.1 Enrollment Rates as a Share of the Population 24 2.2 Health Insurance Coverage by Economic Decile (2010) 25 2.3 Informal Employment and GDP Per Capita in 41 Countries

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