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Abstract
Availability of affordable medicines is one precondition to realizing the fundamental human right of access to essential healthcare. Although Vietnam is progressing well with several health-related targets of the Millennium Development Goals being achieved ahead of time, attaining equitable access to affordable medicines remains problematic.
In this thesis, a mixed-method approach was adopted in the analysis of medicine prices and polices. The literature was reviewed, followed by an analysis of Vietnam’s pharmaceutical market and legislation. A quantitative study of medicine prices, and a qualitative study on how and why high, unaffordable prices occurred, were conducted. The findings were synthesized to form policy recommendations.
The studies demonstrated that medicine prices in Vietnam were unreasonably high. Adjusted for Purchasing Power Parity in 2005, prices in the public sector were 46.58 times the international reference price for innovator-brand medicines and 11.41 times for the lowest-priced generic equivalents. Monopoly of supply was an important cause of high innovator-brand prices. More complex, intrinsic features of Vietnam’s healthcare system were also reported by key stakeholders as driving up prices. Economic survival pressures, in an imperfectly competitive market, were said to force both pharmaceutical companies and prescribers to be inextricably linked financially. Ethics and personal values however did influence prescribers’ behaviour and their response to corrupt procedures. Overall, intractable, systemic features contributing to high prices included unrealistic low salaries for prescribers, poor economies of scale in domestic production, inefficiencies in the local distribution network, malfunctioning pricing policies and a general lack of transparency and accountability in administrative procedures.
A range of policy measures and changes are required to improve access to medicines in Vietnam. Short-term recommendations include amendments to pharmaceutical policies, with better enforcement of current regulations. Medium-term measures include the public health insurance system taking an active role in price setting, pooling procurement through a national tendering procurement system and reform of the domestic market through rationalization with appropriate capital and technological investment to achieve improved efficiencies and economies of scale. Longer-term goals include health system improvements to address poor governance, low remuneration of prescribers, with additional measures to limit the scope for corrupt practices.