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2025 ; 24
(1
): 287
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Progress and inequalities in financial risk protection toward universal health
coverage: insights from Vietnam
#MMPMID41131564
Nguyen PT
; Le PM
Int J Equity Health
2025[Oct]; 24
(1
): 287
PMID41131564
show ga
BACKGROUND: Financial risk protection (FRP) is central to Universal Health
Coverage (UHC), aiming to shield individuals from financial hardship when
accessing essential healthcare services. This study estimates trends and
projections for FRP indicators in Vietnam from 2010 to 2030 at both national and
sub-national levels, assesses the probability of achieving UHC targets, and
analyses demographic-, geographic-, and socioeconomic-related inequalities.
METHODS: Data from 168,812 households collected in six nationally representative
surveys (2010-2020) were analysed. FRP coverage was evaluated using indicators
including catastrophic health expenditure (CHE), impoverishing health expenditure
(IHE), further impoverishing health expenditure (FIE), financial hardship
expenditure (FHE), and the revised SDG 3.8.2 indicator, across multiple
thresholds (10%, 15%, 25%, 40%). Bayesian models projected trends and estimated
the probability of achieving the 2030 UHC targets. Inequality analyses using
relative, slope, and concentration indices were conducted across ethnicity,
dependency ratio, urban-rural residence, region, wealth quintile, and educational
level. FINDINGS: National FRP coverage was relatively high in 2020 (78.1%-94.9%),
with modest improvements projected for 2030 (81.4%-95.4%). However, probabilities
of achieving UHC targets remain low, with only protection from IHE showing
moderate prospects (83.6%). Ethnic minorities, rural households, and those with
high dependency ratios were consistently disadvantaged, especially regarding IHE
and FHE. Regional disparities were pronounced, with lower coverage in Central
highland and Central Coast regions, compared to the Southeast and Red River Delta
regions. Significant socioeconomic inequalities persisted, disproportionately
affecting the poorest and least educated groups. Inequality gaps widened over
time, particularly among regions and educational levels. INTERPRETATION: Our
findings suggest that Vietnam is unlikely to achieve full financial risk
protection by 2030, given modest projected improvements and low probabilities of
meeting UHC targets. Persistent and widening inequalities, particularly by region
and educational level, underscore the need for targeted health financing reforms
that prioritize disadvantaged groups such as ethnic minorities, rural households,
and those with high dependency ratios. Strengthening social health insurance,
expanding fiscal space for health, and integrating financial protection policies
with broader poverty reduction and social development programs will be critical
for advancing equity and moving closer to UHC in Vietnam.
|*Health Expenditures/statistics & numerical data
[MESH]
|*Healthcare Disparities/economics
[MESH]
|*Universal Health Insurance/economics/statistics & numerical data/trends
[MESH]