Publication:
Trends and Differentials in Household Out-of-Pocket Spending for Health in Viet Nam, 2010–2022

Loading...
Thumbnail Image
Files in English
English PDF (1.32 MB)
74 downloads
English Text (134.45 KB)
17 downloads
Published
2025-06-30
ISSN
Date
2025-09-30
Editor(s)
Abstract
This report examines household out-of-pocket (OOP) health spending in Viet Nam from 2010 to 2022. Despite high health insurance coverage (91percent in 2022) and reduced catastrophic health expenditure, OOP spending remains high, about 40 percent of current health expenditure, well above WHO’s recommended 15–20 percent. Per capita OOP spending has risen, especially for inpatient care, and the COVID-19 pandemic shifted spending toward retail pharmaceuticals. Large disparities exist by income, age, ethnicity, and region, with wealthier groups spending much more and vulnerable populations facing higher burdens. Pharmaceutical OOP spending is especially high (75 percent in 2022), indicating a need for better prescription enforcement and medication quality. The report recommends policy reforms to improve financial protection and service access for vulnerable groups, strengthen primary care, and enhance monitoring of OOP spending.
Link to Data Set
Citation
Bales, Sarah; Huong, Dao Lan. 2025. Trends and Differentials in Household Out-of-Pocket Spending for Health in Viet Nam, 2010–2022. © World Bank. http://hdl.handle.net/10986/43785 License: CC BY-NC 3.0 IGO.
Digital Object Identifier
Associated URLs
Associated content
Report Series
Other publications in this report series
Journal
Journal Volume
Journal Issue

Related items

Showing items related by metadata.

  • Publication
    Who Pays? Out-of-Pocket Health Spending and Equity Implications in the Middle East and North Africa
    (World Bank, Washington, DC, 2010-11) Elgazzar, Heba; Raad, Firas; Arfa, Chokri; Mataria, Awad; Salti, Nisreen; Chaaban, Jad; Salehi-Isfahani, Djavad; Fesharaki, Sanaz; Majbouri, Mehdi
    Ensuring affordable, effective health care and financial protection against the adverse effects of household out-of-pocket (OOP) health expenditures represents an important policy objective in most countries, yet relatively little evidence exists regarding patterns and implications of household health expenditures in the Middle East and North Africa (MENA) region. This paper examines the scope of out-of-pocket expenditures and their implications on living standards and policy reforms in six MENA countries including Yemen, the West Bank and Gaza, Egypt, Iran, Tunisia, and Lebanon. Results show that OOP payments represent a relatively high share of total national health care financing at 49 percent on average in the MENA region as of 2006. Households pay an average of 6 percent of their total household expenditure on health. Most of this OOP is spent on medications, doctor visits and diagnostic services. Lower-income and rural households generally face greater financial risk; yet this is reversed where private health services are utilized and paid for more frequently by higher-income groups. 7 to 13 percent of households face particularly high OOP payments, or catastrophic expenditures equal to at least 10 percent of household spending. Poverty rates tend to increase by up to 20 percent after health care spending is accounted for. Results are discussed in light of ongoing policy efforts to strengthen social protection for health care.
  • Publication
    Albania - Out-of-Pocket Payments in Albania’s Health System : Trends in Household Perceptions and Experiences 2002-2008
    (World Bank, 2011-03-28) World Bank
    In many countries absent or poorly functioning prepayment mechanisms for health care expose families to the financial risks associated with accidents and sickness. The report exploits a specially designed health governance and accountability module that was added to the 2008 wave of the Albania LSMS to gain additional insight into the determinants of informal payments and household perceptions and experiences of governance in the health sector more generally. This report is structured in four parts. Following the motivation, introduction and summary of the report's findings in part one, part two sets the institutional context for readers not already familiar with Albania's health system, and presents data showing public perceptions of health care and answers to subjective questions included in the health governance and accountability module of the 2008 Albania LSMS. These data have been combined with prior waves of the LSMS to show how the incidence of informal payments has changed in recent years. Part three shows the impact out-of-pocket payments -both formal and informal- have on household consumption and the incidence of poverty. Part fourth presents the results of statistical analysis, using techniques to match like-households over time, in order to identify significant factors at the household level that are associated with informal payments and how these have changed during a period of structural changes in the health system.
  • Publication
    How to Reduce Out-of-Pocket Payments in the Health Sector in Moldova?
    (World Bank, Washington, DC, 2015-05-20) World Bank
    Out-of-pocket payments (OOPs) are direct (at the point of service) financial contributions or co-payments by patients and their families associated with consumption of medical products (such as medicines) and/or services. They can be formal as well as informal payments. Together with taxation, social and private health insurance contributions, they constitute the main sources of financing for medical products and services in all countries of the world. This policy note looks at prevalence and trends of OOPs in Moldova during 2007-2013, evaluates their impact on the population’s economic well-being (section two), identifies key drivers of the current OOPs (section three), and, based on the analysis, suggests several policy options for government’s consideration (section four).
  • Publication
    Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Vietnam
    (World Bank Group, Washington, DC, 2014-09) Barroy, Helene; Jarawan, Eva; Bales, Sarah
    Vietnam is regarded as a development success story. Political and economic reforms ( Doi Moi ) launched at the end of the 1980s have transformed the country from one of the poorest in the world to a lower middle-income country in a quarter century, with per capita income of $1,130 (World Bank, 2013). Over the past 10 years, Vietnam has seen average annual economic growth of nearly 8 percent. Poverty tumbled from 58 percent in 1993 to 12 percent in 2009. Economic development and innovative policy interventions led to steep gains in health outcomes and access to health care, although large disparities persist between the rich and poor, and between poorer and better-off regions (Vietnam General Statistics Office 2011b). Infant mortality declined from 30 to 16 per 100,000 live births, and under-five mortality rates from 42 to 25 per 100,000 live births, between 2001 and 2009 (Vietnam General Statistics Office 2011a, 2011c). Vietnam has shown strong political commitment toward universal health coverage (UHC), making it a national goal for 2014. A major challenge lies now in expanding coverage to the non-covered population (64 percent had coverage in 2012) while addressing the model s financial sustainability.
  • Publication
    Moving toward Universal Coverage of Social Health Insurance in Vietnam : Assessment and Options
    (Washington, DC: World Bank, 2014-06-26) Tandon, Ajay; Somanathan, Aparnaa; Dao, Huong Lan; Hurt, Kari L.; Fuenzalida-Puelma, Hernan L.
    To address the growth in resultant out-of-pocket (OOP) payments and associated problems of financial barriers to access, the government issued several policies aimed at expanding coverage throughout the 1990s and 2000s, particularly for the poor and other vulnerable groups. Universal coverage (UC) can be an elusive concept and is about three objectives: (a) equity (linking care to need, and not to ability to pay); (b) financial protection (ensuring that health care use does not lead to impoverishment); (c) effective access to a comprehensive set of quality services (ensuring that providers make the right diagnosis and prescribe a treatment that is appropriate and affordable; and (d) to ensure that the financing needed to achieve UC is mobilized in a fiscally sustainable manner, and is used efficiently and equitably. The objective of this report is to assess the implementation of Vietnam social health insurance (SHI) and provide options for moving toward UC, with a view to contributing to the law revision process. It analyzes progress to date on the two major goals of the master plan. The report assesses Vietnam's readiness to meet these goals, the challenges it will face in achieving UC, and key reforms needed to overcome those challenges. It does so through a health financing lens, focusing on how resources are mobilized, pooled, and allocated, and how services are purchased. The report also examines the stewardship of financing that is, the organization, management, and governance of SHI as it has direct implications for achieving UC. The report ends by pulling together the recommendations in the form of an implementation road map.

Users also downloaded

Showing related downloaded files

  • Publication
    Jobs in a Changing Climate: Insights from World Bank Group Country Climate and Development Reports Covering 93 Economies
    (Washington, DC: World Bank, 2025-11-05) World Bank
    The World Bank Group’s Country Climate and Development Reports (CCDRs) provide a crosscutting look at how countries’ development prospects, and the job opportunities they offer to their people, can be threatened by climate impacts and supported by climate policies. Climate change and policies affect jobs through impacts on productivity, energy and material efficiency, and physical, human, and natural capital. They can also transform employment opportunities, especially through complementary measures that help workers and firms adapt to and benefit from new technologies and production practices. Prepared by the World Bank, the International Finance Corporation (IFC), and the Multilateral Investment Guarantee Agency (MIGA), CCDRs integrate country perspectives, climate science and economic modeling, private sector information, and policy analysis to assess how countries can successfully grow and develop their economies and create jobs despite increasing climate risks and while achieving their climate objectives and commitments. Each CCDR starts from the country’s development priorities, opportunities, and challenges, and is developed in close consultation with governments, businesses, and civil society, ensuring the recommendations reflect national priorities. By combining evidence on adaptation, resilience, and emissions pathways, CCDRs highlight where climate action can reinforce development and job creation, and where targeted policies are needed to manage risks and smooth labor market transitions. Taken together, these elements can help create local jobs, ensure economic transitions are just and inclusive, and equip workers and firms to navigate the disruptions and opportunities of a changing climate and changing technologies.
  • Publication
    Kyrgyz Republic Country Climate and Development Report
    (Washington, DC: World Bank, 2025-11-03) World Bank Group
    This Country Climate and Development Report (CCDR) on the Kyrgyz Republic aims to support the country’s development goals amid a changing climate. The CCDR considers two policy scenarios up to 2050: the business-as-usual (BAU) and high-growth scenarios. As it quantifies the likely impacts of climate change on the Kyrgyz economy between now and 2050, the report highlights key government actions to best prepare for and adapt to climate impacts (referred to as “with adaptation” measures), with a particular focus on the time horizon up to 2030. The CCDR also outlines a path to net zero emissions by 2050 (referred to as “with mitigation” measures, “decarbonization,” or, simply, “net zero 2050”), highlighting associated development co-benefits.
  • Publication
    Gabon Country Climate and Development Report
    (Washington, DC: World Bank, 2025-11-01) World Bank
    Gabon has a unique opportunity to drive inclusive growth, reduce poverty, and build a resilient post-oil economy, with climate action accelerating progress toward these goals. The country’s main development challenge is achieving higher growth and poverty reduction, as stronger growth is needed regardless of projected climate shocks to create jobs, raise living standards, and enable a viable post-oil economy. While pursuing growth-promoting economic reforms, climate action that prioritizes people must remain central to its development pathway. However, climate change risks exacerbating poverty and regional inequalities in a country already facing long-term challenges in expanding economic opportunities and basic public services, especially in rural areas. Climate shifts compound these challenges, making stronger private sector-led growth driven by reforms essential for resilience, diversification, job creation, and poverty reduction, though targeted investments in adaptation will still be required to mitigate climate shocks. Using a whole-of-economy approach, the Gabon Country Climate Development Report (CCDR) estimates that climate change impacts could result in GDP losses of 3.5 to 5.3 percent per year through 2050 compared to a business-as-usual baseline trajectory.
  • Publication
    Comoros Country Climate and Development Report
    (Washington, DC: World Bank, 2025-06-18) World Bank Group
    The Union of the Comoros (The Comoros) has significant vulnerability to climate change-related risks but has considerable opportunities to strengthen preparedness and resilience against these challenges. According to the Notre Dame Global Adaptation Index, the Comoros is the 29th-most vulnerable country to climate change and the 163rd most ready to adapt (out of 191). The Comoros archipelago is exposed to many natural hazards that adversely affect the country’s natural capital, people, and physical infrastructure. In 2014, the economic cost of climate-related disasters was estimated at 5.7 million dollars annually, equivalent to 9.2 percent of Gross Domestic Product (GDP). Between 2018 and 2023, as many as 11 tropical depressions or cyclones impacted the country, with Cyclone Kenneth causing the greatest damage, equivalent to 14 percent of GDP, resulting in total economic growth falling from 3.6 percent in 2018 to 1.9 percent in 2019. More than 345,000 people (40 percent of the population) were affected by the cyclone, with 185,000 people experiencing severe impacts and 12,000 people displaced. However, there is an opportunity for the country to grow more robust and shock-responsive, and to establish pre-positioned funding mechanisms to enhance future crisis response efforts. For the Comoros, adaptation and climate-resilient development are the key climate change focus areas, with the country projected to face 836 million dollars 2050 in additional costs due to climate-related impacts. Current plans to adapt to the impacts of climate change in the Comoros include efforts to improve water management, strengthen coastal protection, and develop climate-smart agriculture practices. Given the country’s reliance on its natural resource base for economic growth and mobility, protection of these resources from climate change will be essential for promoting resilient growth and development. In addition to growing the adaptive capacity of the country’s natural resource sectors, strategic economic diversification will be important to help minimize future climate impacts, and development activities will need to be undertaken in such a way as to attract low-carbon co-benefits. The Union of the Comoros is committed to addressing climate change through its Nationally Determined Contribution (NDC) and national priorities. The country’s NDC (which was revised in 2021 for a ten-year horizon) sets ambitious targets, with a goal of reducing greenhouse gas emissions by 23 percent by 2030. The country also plans to significantly increase the share of renewable energy in its energy portfolio, reaching 33 MW by 2030. This will not only promote low-carbon development but also reduce the country’s dependency on imported oil and coal, which currently make up 95 percent of the energy mix. Additionally, the Comoros has declared its intention to increase CO2 removals by 47 percent by 2030, compared to BAU.
  • Publication
    Guinea-Bissau Country Climate and Development Report
    (Washington, DC: World Bank, 2024-10-23) World Bank Group
    Guinea-Bissau is endowed with a wealth of natural resources, with the highest natural capital per capita in West Africa (US3,874 dollars per capita), which could be leveraged for sustainable and resilient growth. However, Guinea-Bissau faces significant development hurdles, such as high poverty rates, political instability, and economic challenges, including an over-reliance on cashew nuts. Rural poverty has increased, and the nation's infrastructure, education, and health care systems are underdeveloped. Climate change poses a severe threat, potentially impacting agriculture, fisheries, and infrastructure. Without adaptation, it could lead to a significant cut in real GDP per capita (minus 7.3 percent by 2050) and increase in poverty (with up to over 200,000 additional poor by 2050, that is, 5 percent of the expected population, in the worst scenario). The country's low greenhouse gas emissions are expected to rise, mainly due to agriculture and land-use changes, with deforestation being a major contributing factor. Although Guinea-Bissau is a low emitter, it has high mitigation ambitions, targeting a 30 percent reduction in greenhouse gas emissions by 2030. The Nationally Determined Contribution outlines significant climate actions, with initiatives focused on forest conservation, sustainable agriculture, and community development. However, the country's political instability, institutional weaknesses, and limited financial resources pose challenges to implementing these climate commitments, which depend heavily on external funding. The financial sector's underdevelopment and vulnerability to external shocks limit its ability to support green investments, though reforms could enhance resilience. Guinea-Bissau must consider its climate financing as development financing and vice-versa, engage the private sector, and integrate climate goals with national development plans to ensure a sustainable future. Concessional climate financing is vital due to the underdeveloped financial sector and the government’s limited borrowing capacity. Addressing Guinea-Bissau's vulnerability to climate change and its structural issues requires a cohesive approach that integrates development and climate strategies. This could involve improving governance, diversifying the economy, protecting natural capital, developing human capital, and investing in sustainable agriculture and infrastructure. The transition to a more sustainable and inclusive development pathway that supports economic growth is possible, but requires focusing on key strategic sectors, enhancing institutional capacity, and creating the conditions to mobilize finance. As a highly vulnerable country, there are myriad needs in the different sectors; however, to be more efficient and effective, Guinea-Bissau should prioritize actions in a few sectors, especially actions on biodiversity, agriculture, and social protection. Low carbon development, especially in energy and forestry sectors, could provide cost-efficient solutions and attract climate finance, including from the private sector, which will support the overall development agenda.