Speech of Dr Shin Young-soo, WHO Regional Director for the Western Pacific Reforming health insurance policy and implementation to achieve universal health coverage in Viet Nam

Viet Nam
9 March 2012

Honourable Minister of Health, Dr Nguyen Thi Kim Tien Ladies and Gentlemen:

Good morning and thank you for investing time and effort to participate in this forum.

This is a unique meeting.

It's unique in its working methods and its range of participants, and especially unique in its expected outcomes.

Assembled here are all the major parties involved in shaping policy and managing Viet Nam National Health Insurance.

We have representatives from key legislative and policy-making agencies, including the Party Commission,
the National Assembly, the Prime Minister's office,
Viet Nam Social Security, the Ministries of Finance,
Health, Labour, Invalids and Social Affairs,
as well as central and provincial government authorities.

We also have representatives from health providers, professional associations and academia.

This forum started with dialogue between WHO and the Ministry of Health and now includes many international partners and technical experts.
We have representatives from multilateral institutions, such as the World Bank, UNICEF, the Asian Development Bank, the International Labour Organization, the European Commission and bilateral development partners.

To share their experiences, experts from China, the Republic of Korea, Thailand and the United States of America are also here.

When we first met in October at the Regional Committee Meeting in Manila, Minister Tien strongly urged WHO to support the development of Viet Nam's National Health Insurance.

I took this request quite seriously and made it a high priority to support the Government of Viet Nam.

A month later, I visited Viet Nam and learned more about the health care challenges here first-hand.

At that time, we agreed to hold this forum to bring together experts for strategic discussions.

Viet Nam provides a strong example of how basic health coverage can be expanded successfully.

The country has made impressive progress in all health-related Millennium Development Goals.

Life expectancy, immunization coverage and other indicators are far better than many other countries with similar economic situations.

Over the past two decades, Viet Nam's economic development has been impressive.

Along with encouraging rapid economic growth, the Government emphasized social development, with health as a high priority.

Since the economic reforms of the 1980s, the Government has made efforts to improve access to health services and social health protection.

A series of policy decisions has led to significant increases in Government spending on health in recent years.

In my view, Viet Nam has many advantages compared with countries at similar levels of development.

Viet Nam already has good primary level health infrastructure, even in remote areas.

And during my visit, I was reassured of the Government’s strong commitment to universal health coverage through National Health Insurance development.

Certainly, there will be many challenges ahead, but Viet Nam is well-positioned to make strong strides down the road to universal health coverage.

That is why this forum is especially timely.

It will be an opportunity to review the programme, to assess the situation, to explore the most appropriate direction with earnest and frank discussions among different national stakeholders and international experts.

In particular, I believe these discussions will be of tremendous benefit in the revision of the social health insurance law, which is planned for 2013.

Universal health coverage is a shared vision globally and is seen as making a significant contribution to the fabric of a society.

It enables every person, no matter how rich or poor, to be free from the fear of financial ruin if they or a family member becomes ill.

The impact of universal coverage goes beyond health.

It is a vehicle to reduce poverty and to build social solidarity, national pride and trust in the Government.

In many ways, universal coverage contributes to the development of a secure society with sustainable economic growth. National health insurance is much more than a mechanism for collecting and disbursing funds.

It has three main functions:
1. collecting money from different sources
2. pooling the money
3. paying for health care services.

Once fully operational, national health insurance shapes, guides and leverages all elements of the health system.

The design of the national insurance system will also determine the roles and responsibilities of government agencies and other stakeholders.

It will also influence economic efficiency and social equity.
It will even affect major international trade issues.

For these reasons and many others, development of a properly functioning national health insurance system needs to be a long-term project — which is why getting the basics right from the beginning is so important.

Once the system is established, it will endure for generations.
And modifications of the structure can be costly, both politically and financially.

Clearly, shaping the system is in the hands of Viet Nam's policy-makers.
The purpose of this forum is to shed light on the dynamics and linkages among the main functions of the system.

The list of issues to address seems never-ending
… how to collect funds efficiently and equitably
… to what extent different sources of funds are pooled and cross-subsidized
… what services will be covered and how to pay for them
… how to develop and deploy human resources and facilities to ensure quality and accessibility
… how to generate reliable information at all levels of
the system to make managing with maximum
transparency and efficiency easier

… how to cultivate and maintain a "think tank" atmosphere that will allow the system to respond strategically to change and proactively to future challenges…
…The list goes on and on…

In the end, there is no perfect model.

We will have the opportunity in this forum to learn from China, Thailand and the Republic of Korea — not just their successes, but also the challenges they faced and continue to face.

National health insurance is a sub-system of the overall social system.

Culture, history, politics and socio-economic development must be reflected in its design and implementation.

At the same time, universal coverage could also be a catalyst for overall social development.

With my experience of nearly three decades of involvement in the development of national health insurance in the Republic of Korea, I grasp the great challenges you are facing.

I share your concerns and frustrations, whether you are a doctor, a hospital administrator, an Insurance fund manager or a policy-maker.

National health insurance is an evolving process.
Every change requires a new balance to be reached.

Every function must be managed efficiently to maximize the impact of resources.
Conflicts of interest are unavoidable.

We simply have to work through them.

We must stay focused on our all-important, long-term mission: improving people's lives, especially the most vulnerable in our society.

As long as we honour our shared mission, we will find the solidarity to make universal health coverage a reality and pave the road to a better future for all the people of Viet Nam.

Thank you.