Adaptive social health insurance strategy and policy to aging population in Vietnam

Background
 

According to Resolution No.20/NQ-TW dated on 25 October 2017, by 2025, 95% of the population would be covered by social health insurance (SHI) and the out-of-pocket (OOP) payments in healthcare should be reduced to 35% of the total health expenditure. To do so, the Ministry of Health (MOH) is now in process to review and revise SHI Law, and this amended Law is planned to be approved by end of 2020. Various issues will be considered in promoting the role of SHI as a tool to increase access to and financial protection in healthcare services for all citizens, particularly vulnerable groups which include older people.

Along with expected swiftly aging population as projected by GSO (2016), increasing burden of multiple diseases, declining traditional care, and low income are key factors influencing long-term care (LTC) needs and demand of the Vietnamese older people, especially at community level (MOH and Health Partnership Group, 2018). Up to date, however, aging-related government policies provided inadequate regulatory guidance and concrete list of scope of LTC services to meet the needs of older people. 

Up to date, there have been few studies discussing these critical issues for Vietnam, and the main weaknesses of these studies was that they used not-updated national data or non-nationally representative data on older people, so that they could not cover all important issues for aging-related adaptive policies. As such, there has been a great need for having a nationally representative data on older people in Vietnam.

Currently, the government is encouraging innovation and social mobilization to create different models of LTC for older people, including the centralized care model and the model to support families to care for older people in the community. The current SHI Law does not present adaptive policies to aging, particularly comprehensive healthcare needs of older people (such as primary healthcare for older people, and early diagnoses of non-communicable diseases (NCDs), and LTC services). To follow this, MOH is now developing LTC strategy for older people in the next ten years.

In response to the request of the Government of Viet Nam through the Ministry of Health (MOH), the Asian Development Bank (ADB) approved a policy and advisory technical assistance for Strengthening the Policy and Institutional Framework of Social Health Insurance (in short, TA9221-VIE). This TA aims to support the government to strengthen the implementation of universal SHI coverage, especially for the poor and vulnerable people. The TA outputs are: (i) priority legislative and regulatory measures identified and endorsed to appropriate authorities for decision, (ii) long-term health care (LTHC) model for the elderly designed and pilot tested, and (iii) staff capacity and stakeholders’ knowledge of social health insurance improved. 

This study was led by Dr Nam Truong Nguyen and Asst. Professor Long Thanh Giang and ISMS researchers and research assistants. 

Goals/Objectives
 

The general objective of the Survey is to collect nationally representative data on ageing and health situation of the Vietnamese near-elderly and elderly population (those aged 50 and over).

The specific objectives of the Survey are:

1. To investigate health issues of older people and to analyze gaps between healthcare service demand and supply for older people with results from a new national survey on older people;
2. To explore the role of SHI in improving access to and financially protecting older people in healthcare services; and
3. To provide recommendations for adaptive policies on healthcare and SHI in the coming decades when Vietnam will be facing rapidly aging population.

Study design
 

The survey sample was distributed proportionately to population (aged 50+) size in six (06) ecological regions of Viet Nam, including both urban and rural areas. The study employed a cross-sectional survey with a multiple stage sampling method.

A multiple-stage sampling method was applied: selected 12 provinces/cities using PPS (population proportionate to size) method; selected 3 districts per provinces using PPS; selected 4 communes per district using PPS; selected 3 villages (clusters) per commune using a systematic random sampling, and selected 10 people per village using  a systematic random sampling.

Sample size for this study was 4,320

Study setting and Time
The study was conducted in 12 provinces/cities including: Ha Noi, Hung Yen, Hoa Binh, Bac Giang, Ninh Binh, Thua Thien Hue, Dak Lak, Binh Thuan, TP. Ho Chi Minh, Ba Ria – Vung Tau, Đong Thap, Ca Mau in 2019.