The political economy of healthcare commercialization in Vietnam

Three million people are pushed down to poverty in Vietnam each year as direct and indirect consequences of ill-health and medical costs. The current economic situation with extremely high inflation and an absence of a functional social safety net may set many more households on the road to poverty. Vietnam is at a crossroads. The basic systems put in place now in terms of public services and development-financing solutions will fundamentally shape the development and economic structure for decades to come. Against this backdrop, the Vietnamese health sector is facing fundamental challenges in terms of access, quality, financing and effectiveness of healthcare services. Rapid commercialization in healthcare services has shifted a large part of fiscal burden of healthcare from the state onto individuals. While some health indicators are improving and public investment in healthcare services is increased, Vietnam meets serious problems in making healthcare equitably accessible and affordable to a large segment of the population. This paper aims at addressing the impacts of commercialization in healthcare services and its policy challenges to healthcare in Vietnam. Drawing on existing analyses and outcomes of field studies in the health sector, the author suggests that changes in health financing and institutions governing access to healthcare services are needed to reduce individual financial burdens, increase access to services and improve quality and effectiveness of healthcare. These changes are associated with the Vietnamese political economy at large, notably with the role of the state and its relations to social welfare services and market institutions. Structural changes may require a central political and economic reconsideration of the health sector in the development, in which healthcare can be considered a welfare investment in growth, rather than economic burdens.