Foreword

Summary

Health policy and health insurance systems have come under scrutiny all around the globe. From the debate of the U.S. American health care system and global health initiatives such as the Millennium Development Goals to that of privatization and reform of health services in post-socialist countries, discussions on health care provision and financing have been ongoing and heated.

This book is the first macro-study systematically analysing the evolution of the Vietnamese health care system since the beginning of the reform process in the mid-1980s. The book is a valuable contribution to the welfare regime debate since it extends theorizing on welfare systems from a basically OECD-perspective to the domain of developing countries. It thereby examines changing state-society relations in an erstwhile socialist country. It supplements the bulk of literature on industrialized countries with an empirically rich and theoretically reflected study of an important developing country.

The theoretical framework is based on the concept of informal security, network analysis and belief systems to explain the welfare outcomes in Vietnam. The book departs from two central questions: Why are attempts of the Communist Party of Vietnam and the Vietnamese government for more equitable health services so easily diluted? And under what conditions can positive welfare outcomes nevertheless be achieved?

Kerstin Priwitzer argues here that Esping-Anderson's famous welfare regime concept provides an excellent starting point, but does not fit well the conditions of developing countries where social security systems are highly informal and non-state based. For analysing Vietnam's informal security regime, she develops an analytical framework which distinguishes several analytical categories. One is the socio-economic setting in which Vietnam's health system is embedded, the second is the provider network (public and private) and the third the so-called regulatory network which captures the interactions among actors in the health sector. Change in health policies is brought about by policy learning.

The research questions reflect a key problem of Vietnam's transition from a centrally planned state economy into a market economy with socialist orientation: the tensions that emerge between equity, on the one hand, and growth and efficiency, on the other.