Progress and inequalities in financial risk protection toward universal health coverage: insights from Vietnam.

backgroundFinancial 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.

methodsData 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.

findingsNational 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.

interpretationOur 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.