The average Vietnamese person spends more than 7 million VND a year on healthcare

“Medical spending in Vietnam is increasingly high with an average growth rate of about 7-8% per year,” Dr. Ong The Due, Institute of Health Strategy and Policy, Ministry of Health, said at the policy dialogue workshop on Risk sharing solutions in healthcare to increase access to medicine for patientsorganized by the Ministry of Health in collaboration with AstraZeneca Vietnam on December 24 in Hanoi.

Specifically, the country’s total health spending increases from 17.4 billion USD in 2019 to 27.5 billion USD in 2025. It is forecast that by 2028, this number will increase to 34.1 billion USD. This cost leads to an increasingly high level of spending per capita on health care, from 270 USD a year currently to 328 USD in the next three years. In 2019, on average, each Vietnamese person spent more than 150 USD on healthcare.

In total medical spending, drug costs still account for the largest proportion. In the period 2019-2025, total drug spending increases from 4.7 billion USD to 6.9 billion USD, equivalent to an average growth rate of about 6-7%/year. It is forecast that by 2028, the pharmaceutical market size will reach about 8.6 billion USD, reflecting people’s growing demand for medicine. Currently, drug costs account for more than 30% of health insurance spending groups.

Vietnam is currently the second largest pharmaceutical market in Southeast Asia, only behind Indonesia and surpassing Thailand, the Philippines, and Malaysia.

Dr. Due said the trend of spending on health, especially medicine, is increasing due to the impact of many factors. In particular, population aging and increasing non-communicable diseases (cardiovascular disease, diabetes, cancer…) increase the need for long-term treatment and regular use of drugs. In addition, living standards and expectations for treatment quality are improving, leading to demand for brand-name drugs, new generation drugs and intensive treatment drugs with higher costs.

Rapidly increasing drug costs create significant pressure on patients and the health insurance system, especially for long-term treatment and high-priced drugs. Dr. Due analyzed that new drugs often have high prices. If the traditional payment mechanism is applied, it may lead to not being able to add drugs to health insurance, but if added, it will put great pressure on the health insurance fund. Some new drugs, especially rare drugs, often do not have complete clinical data at the time of approval. Waiting for enough evidence to use the drug will lose the patient’s opportunity to access the drug, but immediately supplementing it without accompanying conditions will put the health insurance budget at risk.

In this context, experts believe that Vietnam needs a risk sharing mechanism (Risk Sharing Scheme – RSS) in accessing drugs. The risk-sharing solution is a multi-party agreement mechanism between regulators, payers and drug manufacturers. This can be a financial-based, results-based, or service-based agreement mechanism to increase access to medicine for patients, limit budget risks, and aim to maintain the sustainability of the health insurance fund.

“Risk sharing solutions help the health insurance system control financial risks while ensuring increased early access for patients to new drugs,” Dr. Nguyen Khanh Phuong, Director of the Institute of Health Strategy and Policy, said.

Many countries have adopted Risk Sharing Solutions as an important policy tool. In the UK, the Cancer Drugs Fund (CDF) was established in 2011 with a fixed budget of 340 million pounds per year, to allow patients to access cancer drugs early when there is not enough evidence, and to collect more real-world data. CDF combines both financial and outcomes-based mechanisms to reduce the risk to the health system if drugs do not perform as expected. After up to two years, the National Institute for Health and Care Excellence (NICE) reviews the medicine again based on the data collected and decides whether to include it in routine coverage or refuse to cover it. During the period 2016-2023, the program benefited 88,300 patients with 102 drugs and 241 indications.

Ms. Luong Thi Mai Anh, Department of Legal Affairs, Ministry of Health, said that Vietnam can consider building a pilot – evaluation – expansion roadmap, combining legal frameworks, data standards and transparent monitoring mechanisms for successful implementation.

“RSS is effective when choosing a model that suits capacity, setting dual goals of cost and quality, standardizing data and monitoring, being transparent through audits, collaborating between parties and having a mechanism for periodic evaluation and improvement,” she said.