In an article on its website Wednesday, a group of researchers from Duke University in the U.S., Duke Kunshan University in China and the Health Strategy and Policy Institute in Vietnam said Vietnam has made sizable gains towards providing equitable, universal healthcare by focusing on the most disadvantaged when growing its health insurance scheme.

Citing their own study published on BioMed Central, a U.K.-based open access scientific journal, last November, the researchers said Vietnam incrementally increased enrollment in compulsory health insurance, and provides comprehensive and universal service packages for all of them with priority given to poor and vulnerable populations.

Such an approach means the most vulnerable populations are stabilized first while the uninsured are assumed to already have some form of financial capacity, making the approach much more equitable for all, they added.

As a result, the country has reduced catastrophic health expenditure, defined as when health spending exceeds 40 percent of non-subsistence spending for a household, and the gap between urban and rural populations, the study said.

The study, which collected data through interviews with policy makers, bureaucrats and health insurance scholars and statistics from national reports between June 2017 and January 2018, also said Vietnam's health service delivery, while it includes both public and private systems, mainly relies on a vast network of public healthcare providers from the commune to central levels to deliver health services to everyone but especially those with insurance.

The country is among the highest scorers in essential health services coverage in WHO's Universal Health Coverage Index, the study said.

But a significant increase in health expenditure driven by a rapidly aging population and an increased burden of noncommunicable diseases poses a challenge.

The country also needs to ensure the sustainability of health insurance schemes and design an effective cross-subsidization mechanism, according to the study.

To tackle some of these problems, Vietnam has been working to increase coverage, thereby increasing the financial pooled funding and hopefully decreasing the government’s total health expenditure, it said.