Abstract
The article examines changes which have taken place in the health system in Vietnam as a result of the economic reform process dating back to the late 1980s. With the liberalization of the economy have come not only growth for many, and increased choice, but also increased income and regional disparities and the problem of access to social services for those households which are less successful in the market economy. While state official policy emphasizes equity and free access to services for the poor, health costs for patients have risen substantially in the form of official and unofficial payments to staff and payments for drugs. The public sector faces an unprecedented challenge in the form of dramatic decreases in the utilization of public facilities; a shift towards self-prescription and, to a lesser extent, private practice by public employees; and, increasing reliance on foreign donors for support to preventive programmes. The article makes some recommendations on priorities for health policy in Vietnam to face these challenges.
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