Improving Efficiency in the Health Sector : An Assessment of Vietnam's Readiness for Integration of Care

Vietnam has achieved impressive improvements in its health outcomes over the last few decades. Life expectancy has increased significantly over the years, and mortality rates have declined substantially. The prevalence of chronic, noncommunicable diseases (NCDs) in Vietnam has also risen sharply. These trends imply a shift in the health needs of Vietnam’s population away from acute episodic care, towards disease management for NCDs. Ensuring that care is appropriate for the changing needs of the population, including older persons, will require a paradigm shift in the way services are delivered. Today, Vietnam’s health service delivery system is hospital-centric, which is both expensive and not well-suited to the management of chronic conditions and NCDs. An important contributor to the persistence of the hospital-centric model of service delivery and hospital overcrowding is a weak primary health care (PHC) system, especially for NCD management. In theory, most patients with NCDs and chronic conditions can be managed in the community, where care is closer to home, more appropriate, and cheaper. Putting this into practice in Vietnam will entail a new orientation in health service delivery - one which focuses on shifting the delivery of low complexity care out of hospitals to PHC and other intermediate units. Globally, there has been a push towards service delivery models which are more responsive to individual health needs and can deliver the right care in appropriate settings. Such service models typically promote a person-centered approach and involve integration of care.