Progress and inequality in financial risk protection in Vietnam

Abstract Background This study estimates trends and projections for Financial risk protection indicators in Vietnam from 2010 to 2030 at both national and sub-national levels, assesses the probability of achieving UHC targets, and analyzes inequalities. Methods Data from 168,812 households collected in six nationally representative surveys (2010-2020) were analyzed. FRP coverage was evaluated using indicators including catastrophic health expenditure (CHE), impoverishing health expenditure (IHE), further impoverishing health expenditure (FIE), and financial hardship expenditure (FHE), 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 demographic, geographic, and socioeconomic groups. Results National FRP coverage was relatively high in 2020 (78.1%-97.6%), with modest improvements projected for 2030 (81.9%-99.1%). However, probabilities of achieving UHC targets remain low (0%-57.8%), with only higher-threshold CHE indicators showing moderate prospects. Ethnic minorities, rural households, and those with high dependency ratios were consistently disadvantaged. Regional disparities were pronounced, with lower coverage in Northern mountainous and Central highland 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 ethnic groups and regions. Discussion Our findings highlight the need for ongoing healthcare financing reforms that target inequalities among ethnic groups and regions, integrated with broader economic and poverty reduction programs. With sustained commitment to strengthening healthcare systems, Vietnam can achieve its UHC targets by 2030, advancing health equity nationwide. Key messages • This study highlights a low probability of meeting UHC targets, alongside persistent and widening disparities affecting ethnic minorities, rural households, and socioeconomically disadvantaged groups. • Findings emphasize the need for targeted health financing policies and interventions that address inequalities, support timely, informed policymaking, and accelerate Vietnam’s progress toward UHC.