Three areas need improvement: sustainable financing, a balanced healthcare system, and effective healthcare prevention.

As the country enters an aging population phase, people are no longer only concerned with “how long we live” but also “how we live in our later years.” Living longer without good health is a burden for the elderly and a major challenge for healthcare and social security systems.

Vietnam’s average life expectancy stands at about 74.7 years and is expected to reach 75.5 by 2030. The major challenge is that the additional years added to people's lives need to be truly healthy, with fewer illnesses, and an improved quality of life.

Nguyen Huy Hoang, a member of the Vietnam Association of Hyperbaric and Undersea Medicine, said the most difficult problem for the current healthcare system is not only expertise or facilities, but financial sustainability.

Amid rapid population aging, chronic diseases, higher treatment costs, and longer treatment times, dual pressure is created: ensuring resources for the system and protecting people from the risk of "impoverishment due to illness”.

Although health insurance coverage has reached over 93-94 percent of the population, out-of-pocket spending by citizens remains high, especially for medicines and services outside the coverage list. This shows that the "financial shield" still has significant gaps, particularly for the poor, the near-poor, elderly people living alone, and people in remote areas.

Besides financial pressure, the healthcare system has to deal with balancing hospital autonomy and equity in access to services. 

When medical facilities must be partially self-financed, prioritizing revenue-generating services is inevitable, while preventive medicine and primary care, which bring long-term benefits, have not received adequate investment.

The gap in access to services between regions is also a distinct bottleneck. In urban areas, people easily access upper-level hospitals, while in remote areas, travel for medical examination and treatment can last all day, incurring additional costs for travel and accommodation. There are many cases where mild illnesses turn severe simply because of late arrival at the hospital, leading to higher treatment costs and a greater risk of complications.

According to Hoang, the overload at the upper level is only the "tip of the iceberg" of a systemic issue. The ideal healthcare model is a pyramid, on which the grassroots level handles the majority of common illnesses, while the upper level focuses on severe cases. However, in reality, even common diseases like hypertension and diabetes are crowding into central hospitals.

To reach the "old but healthy" goal, Hoang believes it is necessary to address: sustainable financing, a balanced health system, and effective prevention. Among these, policy implementation plays a key role because, even with investment in human resources or facilities, there are situations where some places lack doctors and others lack medicine and supplies.

Meanwhile, digital transformation is expected to become an important tool to help bridge the access gap, allowing remote consultations and local disease management, reducing pressure on the upper level. 

In particular, the protection of vulnerable groups must be placed at the center, with better health insurance policies, because even a small portion of the cost can become a huge burden for them.

Prevention is better than cure

Associate Professor Dr Tran Dac Phu said the biggest "bottleneck" is the approach. Although the policy of "prevention is key" has been established for a long time, the system is still heavily focused on treatment. This leads to high costs, hospital overload, and difficulty in achieving sustainability.

The issuance of Resolution 72 and the Law on Disease Prevention is considered an important turning point, shifting the focus from treatment to prevention - early, remote, and comprehensive. For the first time, preventive activities such as periodic health check-ups and screening for non-communicable diseases have been included in the scope of health insurance payments, creating a foundation for health management throughout the life cycle.

Amid rapid population aging, the approach is also changing, from family planning to "population and development," associated with healthcare from the womb to old age. When each citizen receives periodic health check-ups, early risk detection, and timely intervention, the goal of living long and living healthy will become more feasible.

Vo Thu