Study on the current situation of organization of registering for HI-covered PHC, preconditions and the balance between the capacity of HFs and the number, the subject of the insured registering for health insurance-covered PHC

Over many years, Vietnam has made substantial efforts to ensure access to healthcare services, of gradually increasing quality, for the entire population through programs of upgrading the health system, expanding health insurance coverage and increasing state budget spending on health. Up to 2013, the coverage rate of health insurance was more than 70 percent of the total population, of which almost 100 percent of the vulnerable and poor groups of people were covered. In addition, greater availability of the health facilities at all levels and provided by both public and private sectors have increased accessibility of citizens to health insurance-paid health care services. Thanks to social health insurance, out of pocket (OOP) payments of the patients and their families – though still high - have reduced over the past decades, from more than 80 percent in the early 1990s to less than 40 percent in the early 2010s.

Up to date, however, the Ministry of Health has not issued the regulations on the specialty scale in primary health care, specific guidelines on the infrastructure, equipment, human recourse, specialty scale for a health facilities (public and private) which are allowed to implement SHI-paid primary care as well as principles or criteria in determination of the quantity, structure of the insured registering for primary health care in each health facility. As such, many health facilities have encountered certain difficulties in providing SHI-paid primary health care, which in turn affect rights of patients and operational activities of health facilities. In term of the insured, it is necessary to evaluate the current status of selection of health facility for primary health care, accessibility to the health facilities, difficulties in using health care services and equity in implementation the right of the insured. Understanding these issues will be the basis for information and orientation of the right to choose the health facility satisfying the accessibility of quality health services when needed.

Overall objective

The study is to give necessary recommendations for the development of the Circular guiding Provincial Health Department and Social Security at the localities on the implementation of registering for health insurance-covered primary health care, ensuring the right of the insured, quality of health care services and strengthening the effectiveness of the health care facilities.