Financing Long-Term Care for Older People in Viet Nam: Linking Affordability, Service Coverage and Quality Accountability
LONG-TERM CARE QUALITYMEASUREMENT, IMPLEMENTATION & LEARNING
LONG-TERM CARE QUALITY & AGING IN PLACE · MEASUREMENT & IMPLEMENTATION
Last reviewed: October 2026
An older woman in Viet Nam needs increasing assistance with everyday activities. Her daughter begins exploring residential long-term care and finds a facility with an apparently manageable monthly fee. The price includes accommodation, meals and basic personal assistance, but several services are charged separately. If her mother's needs increase, the family may have to pay substantially more.
Another older person has similar care needs but far fewer financial resources. He receives public assistance and has health insurance, yet his family remains uncertain about which services are covered, where he can receive them and what expenses they would still need to pay.
These situations illustrate different aspects of the same challenge. Older people and their families need care they can afford, while providers need sufficient and predictable resources to deliver appropriate services. Public authorities must determine who qualifies for financial support, what that support should cover and how limited resources can be used responsibly.
Reducing the price of care may improve affordability, but not if providers respond by reducing essential assistance or staffing. Increasing public expenditure may expand access, but it does not necessarily improve quality if the services being financed are poorly defined or their delivery is not monitored.
The central question is: How can Viet Nam develop more affordable and sustainable long-term care financing arrangements while linking service coverage and provider payment to safety, equity and quality accountability?
This question is becoming increasingly important as population aging changes the demand for care in Viet Nam. Families continue to provide much of the assistance older relatives need, while formal home-based, community-based and residential services are developing to support people with different levels of dependency.
Financing arrangements influence more than the amount paid by an individual or the government. They affect which services become available, where providers operate, which older people can obtain assistance and whether care remains reliable when needs change.
A public subsidy that does not cover the assistance a person actually needs may provide limited financial protection. A payment rate that ignores essential staffing costs may undermine safe service delivery. A financing mechanism that increases provider participation without appropriate oversight may create additional quality concerns.
These are questions of service design and accountability as much as financial policy.
This article examines a proposed Long-Term Care Financing and Quality Accountability Framework for Viet Nam, addressing responsibilities at both the system and provider levels.
At the system level, the framework considers financing sources, eligibility for public support, service coverage, subsidies, purchasing arrangements and the quality requirements associated with funding.
At the provider level, it examines pricing, services included in agreed fees, additional charges, changes in care costs, financial transparency and accountability for the services older people and families purchase.
The article does not assume that Viet Nam already operates a comprehensive long-term care insurance system or a unified national payment mechanism tied to quality outcomes. Instead, it considers how existing policies and future financing arrangements could support more affordable, sustainable and accountable care.
Financing Long-Term Care Means Defining What People Can Actually Access
Long-term care includes assistance that people may require when illness, disability or declining functional ability makes everyday activities difficult to manage independently.
Depending on individual circumstances, this may involve personal assistance, supervision, nursing-related services, rehabilitation support, social care and other activities that help people maintain daily functioning and well-being.
Care can be delivered at home, through community-based services or in residential settings. Each arrangement has different costs, workforce requirements and practical limitations.
The World Health Organization's 2024 Long-Term Care for Older People: Package for Universal Health Coverage identifies interventions that countries can consider when developing formal, integrated long-term care systems. It emphasizes that priorities should reflect population needs, available resources and national circumstances.
The financing challenge is to translate appropriate services into access that people can realistically obtain and sustain.
Someone who needs assistance a few times each week may face very different costs from a person requiring support throughout the day. Duration also matters. A family may afford additional assistance for several months but become financially vulnerable when the need continues for years.
The OECD's 2024 report Is Care Affordable for Older People? demonstrates that long-term care can place substantial financial pressure on older people, even in countries with established public financing systems. Its findings should not be treated as direct estimates for Viet Nam, but they illustrate why affordability cannot be judged by advertised service prices alone.
A credible financing framework must connect several decisions: where resources come from, who qualifies for support, which services are covered, how providers receive payment and how the quality of funded services is verified.
These decisions cannot be considered independently.
A payment arrangement may appear financially manageable for the government but provide insufficient resources for safe service delivery. A generous individual subsidy may still leave people without care when no suitable provider is available. A provider may offer a low monthly price while charging separately for assistance that the person cannot safely go without.
The objective is therefore not simply to increase funding or reduce prices. It is to organize resources so that appropriate care can be accessed and sustained without creating avoidable financial hardship or compromising quality.
What Viet Nam's Current Financing Framework Provides
Viet Nam already has several mechanisms that provide financial assistance or support access to services for eligible older people. However, these mechanisms have different legal purposes and should not be described as a single comprehensive long-term care financing system.
The Law on the Elderly No. 39/2009/QH12 provides an important foundation for older people's rights, care and social support. Decree No. 06/2011/NĐ-CP further addresses older-person care services and relevant arrangements between providers and service users.
The National Strategy on Older Persons to 2035, with a Vision to 2045, approved under Decision No. 383/QĐ-TTg on February 21, 2025, provides a broader policy direction for improving older people's welfare, participation and access to appropriate services.
More specific financing provisions are found in social assistance legislation.
Decree No. 335/2026/NĐ-CP, issued on August 21, 2026 and effective October 5, 2026, establishes an updated framework for social assistance in the community, care and maintenance support, emergency assistance and care at social assistance establishments.
Article 4 sets the national social assistance reference amount at VND 540,000 per month. This amount is used as the basis for calculating specified social assistance benefits and care-related support under the decree.
It is not a universal monthly payment available to every older person, nor does it represent the full cost or regulated market price of residential long-term care.
The decree permits provincial authorities, through the applicable decision-making process, to establish higher social assistance reference amounts or additional assistance for certain disadvantaged groups when local conditions and resources allow.
The amount applicable to an individual may therefore depend on eligibility, the relevant benefit coefficient, local provisions and other statutory conditions.
Article 22 addresses financing for care and maintenance at social assistance establishments.
For eligible individuals covered by Clauses 1, 2 and 3 of Article 21, the State provides funding to the establishment according to the decree's provisions. The minimum monthly maintenance allowance is calculated using the social assistance reference amount and a coefficient determined by the beneficiary category.
For eligible beneficiaries aged four years and older, including qualifying older residents, the coefficient is 4.0.
At the national reference amount of VND 540,000, this produces a minimum monthly maintenance allowance component of VND 2,160,000 per eligible person.
This figure must be interpreted carefully. It is a statutory funding component within a defined social assistance arrangement. It is not a cash allowance automatically paid to every older resident, the complete operating cost of institutional care or a general price ceiling for residential providers.
Article 22 also provides for other eligible expenditures associated with care and maintenance, subject to the conditions and limits established by the decree. These may include specified personal necessities, certain healthcare-related expenses, equipment and facility operating costs.
Institutional financing may therefore involve several expenditure categories rather than one payment intended to cover every aspect of accommodation, personal support and healthcare.
The decree also contains transitional provisions.
Although it took effect on October 5, 2026, the revised corresponding benefit levels apply from July 1, 2026 to existing recipients covered by the specified transitional arrangements. Relevant authorities and social assistance establishments are responsible for implementing those provisions.
The date on which a regulation takes effect should therefore be distinguished from the date from which particular benefits are calculated or adjusted.
Social pension benefits provide another form of financial protection.
The Law on Social Insurance No. 41/2024/QH15 introduced the social pension benefit framework. Decree No. 176/2025/NĐ-CP provides detailed implementation provisions, subsequently amended by Decree No. 335/2026/NĐ-CP.
Under the amendment to Article 3 of Decree No. 176/2025/NĐ-CP, the national monthly social pension benefit is VND 540,000 for eligible recipients.
The framework generally covers qualifying Vietnamese citizens aged 75 and older who meet the relevant pension-related and application conditions. It also covers specified individuals aged 70 to under 75 in poor or near-poor households.
Higher local support may be available where approved under the applicable arrangements.
An important legal distinction concerns people who qualify for more than one benefit.
Article 31 of Decree No. 335/2026/NĐ-CP provides that individuals who simultaneously qualify for the social pension and a monthly social assistance benefit receive the higher applicable benefit.
The two payments should therefore not automatically be added together when estimating an individual's monthly income.
Social pension benefits may contribute to an older person's financial resources, but they do not constitute a dedicated entitlement to a comprehensive long-term care service package.
Health insurance provides another important form of protection.
Under Viet Nam's health insurance legislation, including amendments introduced by Law No. 51/2024/QH15, eligible medical examination and treatment services may be covered according to the applicable benefit package, payment conditions and authorized healthcare providers.
However, health insurance coverage for medical treatment does not automatically include residential accommodation, everyday personal assistance, social activities or the full range of nonmedical long-term care services.
An older person may therefore have health insurance and still face substantial expenses for continuing support.
Social assistance, social pension benefits and health insurance are important but distinct forms of financial protection. None should be presented as automatically financing a complete long-term care package for every older person in Viet Nam.
These mechanisms provide foundations for future coordination, but they do not amount to a nationally unified long-term care insurance and reimbursement system covering the full continuum of home, community and residential care.
Distinguishing Where Funding Comes From and How It Is Used
A practical financing framework should distinguish the source of money from the mechanism through which that money reaches individuals or providers.
Relevant resources in Viet Nam may include state budget allocations, social assistance funding, pensions and other personal income, household savings, family contributions, private service payments, charitable support and other lawful sources.
Health insurance may finance eligible medical services, while other arrangements are needed for personal assistance and social care.
These sources differ in their reliability, purpose and conditions of use.
Public funding can help protect eligible disadvantaged groups and maintain services that might otherwise be unaffordable. However, public budgets face competing priorities, and long-term care commitments must be sustainable beyond a single fiscal year.
Household payments provide flexibility where people have sufficient resources. Yet heavy reliance on private payment can create substantial inequalities because the need for care does not necessarily correspond to income.
People requiring the most intensive assistance may face the highest expenses precisely when their ability to earn income has declined.
Charitable contributions and corporate support may help particular facilities, projects or disadvantaged groups. Such funding can be valuable, but unpredictable donations are not a dependable foundation for essential services requiring continuity over several years.
Private insurance and other prepayment arrangements may also have potential roles, depending on their design, affordability, regulation and actual benefits. They should not be assumed to provide comprehensive protection against increasing dependency.
WHO's 2024 long-term care financing series examines international approaches based on general taxation, mandatory insurance contributions and combinations of public and private resources.
Tax-financed arrangements can support people outside formal employment, although they depend on fiscal capacity and budgetary priorities. Contribution-based insurance can provide more predictable revenue in some settings, but systems heavily dependent on employment-related contributions face challenges where informal employment is substantial.
These international experiences provide possible financing options, not models that can be transferred to Viet Nam without adaptation.
A new mandatory long-term care insurance contribution or dedicated national financing scheme would require explicit policy decisions, administrative capacity and an appropriate legal framework.
In the nearer term, greater coordination of existing funding streams, clearer service coverage and carefully designed arrangements within existing legal authority may provide practical opportunities for improvement.
Connecting Financial Eligibility With Actual Care Needs
A central policy decision is determining which older people should receive publicly financed or subsidized long-term care.
Age alone is not a sufficient indicator of care needs. Two people of the same age may differ substantially in functional ability, health conditions, family support and financial resources.
A financing framework should therefore distinguish eligibility for financial assistance from assessment of the services an individual requires.
Financial eligibility concerns whether the person meets the criteria of a particular public program. Needs assessment concerns the type, frequency and intensity of assistance required.
These decisions are related but not interchangeable.
Someone may qualify for financial assistance because of low income or other statutory circumstances while requiring relatively limited daily support. Another person may have substantial dependency and high care expenses without meeting the criteria of a narrowly targeted program.
WHO's 2024 brief on population coverage describes universal, selective and mixed approaches to long-term care financing.
Selective arrangements can direct limited resources toward people facing particular disadvantages. However, narrowly defined eligibility may leave others with significant unmet needs, while income assessments and verification procedures can create administrative costs.
Broader coverage can provide more consistent financial protection, but it requires a sustainable financing base and decisions about the level of benefits offered.
A mixed approach may allow some services to be available more broadly while reserving additional support for people with greater dependency or fewer financial resources.
For Viet Nam, one possible direction would be to strengthen the effective coverage of groups already eligible under social assistance policies while examining how defined long-term care services might become accessible to other groups through future reforms.
Such an approach would require clear eligibility criteria, appropriate needs assessment and safeguards against arbitrary exclusion.
Attention should also be given to older people living alone, people with disabilities, residents of underserved areas and households whose income is slightly above existing eligibility thresholds but insufficient to sustain substantial care expenses.
The purpose of targeting should be to allocate resources fairly, not create unnecessary barriers to essential support.
Defining What a Publicly Financed Service Package Would Cover
Once a funding source and eligible population are established, the next question is what the financing arrangement will actually provide.
A public program may offer a cash benefit, finance care at an eligible establishment or, where lawfully authorized, purchase specified services from a provider.
These mechanisms are not equivalent.
A cash benefit contributes to the recipient's financial resources according to the rules governing that benefit. A service subsidy reduces the cost of defined assistance. A provider payment finances activities delivered under a particular public program or agreement.
Each mechanism should explain what is covered and what responsibilities remain with the individual or family.
A future long-term care service package could potentially include personal assistance, selected supervision, specified nursing-related support within lawful professional arrangements, community day services or defined residential care components.
These are possible areas for future benefit design, not a claim that all such services already form part of a unified Vietnamese public long-term care package.
The coverage rules should explain how the intensity of assistance is determined and how support changes when an individual's needs change.
Someone needing limited assistance several times a week may require a different allocation from a person depending on support throughout the day and night.
Providing an identical service allocation to everyone regardless of dependency may leave people with substantial needs inadequately supported. Conversely, poorly defined or overly generous coverage may create financial commitments that cannot be sustained.
WHO's 2024 brief on long-term care benefit packages emphasizes the importance of linking eligibility thresholds, individual needs assessment and covered services with available financing and delivery capacity.
For Viet Nam, service definitions should also clarify the boundary between long-term care and healthcare.
When a healthcare service is covered by health insurance, the applicable medical benefit and payment rules must be followed. Providers should not inappropriately charge another publicly funded program for the same service.
Conversely, personal assistance does not automatically become an insured medical service because the recipient has a chronic condition.
Clear definitions reduce funding gaps, inappropriate duplication and disputes about payment responsibility.
They also help older people and families understand what public support will actually provide, rather than assuming that eligibility for one benefit means all care expenses are covered.
How Public Resources Reach Providers
Governments can finance long-term care through different arrangements.
Publicly operated facilities may receive budget allocations under applicable financial and administrative rules. Eligible individuals may receive benefits contributing to their expenses. Competent authorities may also commission or purchase specified services where the law authorizes those arrangements.
Each mechanism creates different responsibilities.
Direct budget financing can maintain essential capacity, particularly where services must be provided to people who cannot pay. However, allocations need to reflect the actual resources required by the population served.
A fixed budget that does not account for increasing dependency or essential staffing costs may place pressure on service quality.
Individual service subsidies or vouchers, if introduced through an appropriate legal and policy framework, could allow eligible people to obtain defined services from participating providers.
Such mechanisms may increase choice where suitable providers exist. They would also require clear rules governing eligible expenditure, provider participation, beneficiary protection and payment verification.
Public purchasing provides another possible approach.
Under a lawfully established program, a competent authority could define eligible beneficiaries, specify the services to be financed, select appropriate providers, determine payment arrangements and monitor performance.
Depending on the applicable framework, providers could include public, nonprofit or private organizations.
WHO's 2024 brief Aligning Financing and Delivery in Long-Term Care emphasizes that when governments purchase services from external organizations, they retain responsibilities for provider selection, reimbursement rates, service standards and quality oversight.
For Viet Nam, a proposal to purchase long-term care services should be distinguished from existing administrative arrangements for distributing social assistance benefits.
Selecting an organization to disburse a cash benefit does not automatically authorize a public authority to purchase any type of long-term care service from a private provider.
These arrangements have different legal and operational purposes.
Any new purchasing mechanism would require confirmation of the relevant authority, budget provisions, procurement or contracting procedures, provider requirements and oversight responsibilities.
The purchaser should also consider what happens when a provider ceases operations, loses essential staff or can no longer deliver the contracted services.
Public financing should support continuity of care rather than create dependence on organizations without appropriate contingency arrangements.
Setting Payment Rates That Support Safe Service Delivery
How providers are paid influences how they organize care.
A fixed payment per resident may be simple to administer, but it may not reflect differences in dependency. Payment based on service hours may correspond more closely to the amount of assistance delivered, although it can encourage unnecessary activity if the services are not properly verified.
A fixed monthly amount can improve revenue predictability, but inadequate rates may encourage providers to reduce staffing or limit assistance.
Payments adjusted according to assessed care needs may better reflect differences in dependency, but they require reliable assessment methods and safeguards against overstating those needs.
No single payment method automatically produces better quality.
The appropriate arrangement depends on the service being financed, the population served, available information and administrative capacity.
For Viet Nam, a reasonable starting point would be to understand the actual costs of delivering defined services before selecting a payment mechanism.
Residential long-term care involves more than accommodation and meals. Essential costs may include direct care workers, night staffing, supervision, training, equipment, utilities, maintenance, administration and coordination with healthcare providers.
Home-based services have different cost structures, including travel, professional visits, equipment and service coordination.
Costs may also change with the intensity of assistance required.
A payment rate that ignores essential staffing and operating requirements may appear financially efficient while making safe delivery difficult to sustain.
Geographical differences may matter as well. Providers operating in remote areas can face higher transport costs or greater difficulties recruiting qualified employees. Any adjustments should be based on documented service requirements and costs rather than assumptions.
At the same time, higher prices do not necessarily indicate better care.
A residential facility may charge more because it offers additional amenities without providing stronger personal assistance or better safety arrangements.
Payment design should therefore support appropriate services at sustainable rates while discouraging unnecessary billing, underprovision and avoidance of people with greater needs.
Quality-Accountable Purchasing: Connecting Funding With Service Responsibilities
One opportunity for future development is to connect publicly financed long-term care with explicit quality responsibilities.
This approach can be described as quality-accountable purchasing.
It should be distinguished from a fully established performance-based payment system.
Quality-accountable purchasing means that provider eligibility, the services financed, payment conditions and the mechanisms for monitoring performance are connected within a transparent arrangement.
The starting point is to establish what the provider is authorized and capable of delivering.
An organization receiving public funds for specified care services should have the necessary legal authorization, qualified workforce, suitable environment and operational resources.
The purchasing arrangement should then define the services being financed and the responsibilities associated with payment.
A funding agreement should not merely specify the number of residents or service hours. It should explain what services are expected, how delivery will be documented, which information must be reported and how concerns will be addressed.
Accountability requires verification.
The purchaser should have a lawful and practical way to determine whether services were delivered, whether significant problems occurred and whether appropriate corrective action was taken.
Depending on the type of service, monitoring may examine staffing arrangements, delivery records, complaints, serious incidents, continuity of assistance and the experiences of older people and caregivers.
When obligations are not met, the response should be proportionate and consistent with applicable law and contractual provisions.
It may involve requiring corrective action, increasing monitoring, reviewing provider eligibility or taking other authorized measures.
The purpose is to protect beneficiaries and improve service reliability rather than simply impose penalties after harm occurs.
Quality-accountable purchasing does not necessarily mean paying providers according to a numerical quality score.
Quality requirements can be incorporated into provider eligibility, service agreements, monitoring and improvement processes without creating a complex pay-for-performance formula.
As of October 2026, Viet Nam has relevant social assistance, older-person care and regulatory provisions. However, those instruments should not be presented as evidence that a single nationwide long-term care purchasing system with standardized outcome-based quality payments is already operating.
Such a system would require further decisions concerning service coverage, payment methods, quality measurement, legal authority and oversight.
Quality-accountable purchasing is therefore best understood as a possible approach to designing or improving specific financing arrangements, not an existing uniform Vietnamese reimbursement model.
Why Paying for Quality Outcomes Requires Caution
Linking financial incentives directly to measured quality may appear attractive, but poorly designed indicators can produce unintended consequences.
Long-term care providers serve people with very different levels of dependency, health conditions and social circumstances.
A facility supporting residents with substantial functional impairment may experience more hospital transfers than one serving relatively independent older people. That difference does not automatically indicate poorer quality.
A payment formula that rewards providers mainly for low hospitalization rates could encourage them to avoid accepting people with complex needs or delay clinically appropriate transfers.
Similarly, rewarding low expenditure without assessing service adequacy may create incentives to reduce necessary assistance.
Outcome measurement must therefore consider differences in case mix, dependency, service scope and circumstances beyond the provider's control.
Appropriate decisions also need to be distinguished from preventable failures.
A timely hospital transfer may demonstrate good care. A planned move to another facility may reflect responsible recognition that a resident's needs now exceed the provider's capabilities.
Neither should automatically be classified as poor performance.
WHO's 2024 brief Promoting Quality and Value in Long-Term Care emphasizes the importance of quality principles, regulatory arrangements and reliable assurance systems when financing long-term care.
For Viet Nam, establishing clear service definitions, provider requirements and trustworthy monitoring would be a more practical initial priority than introducing sophisticated outcome-based payment formulas.
Where financial incentives are eventually considered, they should be tested carefully and evaluated for unintended effects, particularly whether they discourage providers from serving people with greater needs.
The objective should remain appropriate and reliable care, not maximizing a performance score.
Financial Transparency at the Provider Level
While system-level financing reform requires policy development, residential and community care providers can improve financial transparency within their existing services.
A facility may advertise a monthly fee covering accommodation, meals and basic personal assistance. However, the total amount paid by a family may increase because of additional care worker time, equipment, medications, medical consultations or transportation.
A quoted price is meaningful only when the services included are clearly explained.
Providers should distinguish the base fee from additional charges and identify the circumstances in which those charges apply.
They should also explain which services are delivered directly by employees and which are arranged through external organizations.
Home-based services require similar transparency. An hourly rate may exclude travel, minimum booking periods, night visits, equipment or additional professional activities.
Comparing providers should therefore involve the full expected cost of obtaining the necessary services, not simply the advertised monthly or hourly price.
The legal framework is relevant.
Where long-term care services are supplied through transactions within its scope, the Law on Consumer Rights Protection No. 19/2023/QH15 provides requirements concerning consumer information, provider responsibilities, service quality and complaint handling.
The Law on Prices No. 16/2023/QH15 and other applicable provisions may also be relevant to pricing and disclosure, depending on the service and legal circumstances.
These laws should not be interpreted as establishing one nationally standardized fee schedule for all residential or home-based long-term care providers.
Organizations must determine which disclosure, pricing and contractual requirements apply to their particular services.
Written agreements should explain payment frequency, deposits, refunds, additional charges, fee changes and termination conditions.
They should also identify what is not included in the agreed price.
A statement that a facility offers healthcare support should not lead families to assume that all medical consultations, investigations, medications or hospital expenses are covered.
Likewise, an older person's health insurance status does not automatically remove every healthcare-related or long-term care expense.
Financial information should be understandable to the older person and relevant family members. The individual paying the fees should not automatically be treated as having unrestricted authority over the resident's personal decisions.
Transparent pricing connects the financial agreement with the services the provider is responsible for delivering.
When Increasing Care Needs Lead to Higher Costs
Long-term care expenses often change because the person's needs change.
An older resident may initially require limited assistance with bathing and dressing but later need more frequent help with transfers, eating, continence or mobility.
Delivering this additional support may require more staff time, equipment or professional services.
These changes can affect fees according to the agreement and applicable legal requirements. However, higher charges should not arise through an unclear process that leaves the resident and family unable to understand what has changed.
The provider should reassess the person's needs, explain the additional assistance proposed and identify the financial implications.
If a new level of care requires more resources, the organization should confirm that it can actually provide them.
Increasing the fee does not resolve a lack of service capability.
If the provider lacks the workforce, equipment or professional authority required for the additional care, the appropriate response is to address that limitation or consider another arrangement.
The agreement should also distinguish temporary from continuing changes.
A person recovering from an acute illness may require extra assistance for a limited period. Another may develop long-term support needs.
The review process should consider whether additional charges remain appropriate when the level of assistance changes again.
Residents and relevant parties should receive clear information about proposed service and fee adjustments, including the reasons, services involved, amounts and effective dates, subject to applicable legal and contractual requirements.
Where care needs exceed the provider's capabilities or the available financial resources, the organization should discuss realistic options and support appropriate planning.
Financial disagreements should not become a reason for unsafe or abrupt withdrawal of essential assistance.
Measuring Affordability Beyond the Monthly Fee
A service is not necessarily affordable because its advertised price is lower than that of another provider.
Affordability depends on whether the total cost can be sustained using the older person's and household's available resources while allowing other essential needs to be met.
Relevant resources may include pensions, social assistance, savings, other income and contributions from relatives.
The assessment must also consider housing, food, healthcare and other household expenses.
A family may manage residential care costs for several months but become financially vulnerable if the arrangement continues for years or the person's dependency increases.
Similarly, home-based care may appear inexpensive until travel, equipment, lost employment income and family caregiving time are considered.
A relative who reduces working hours to support an older parent may experience a substantial economic burden even when direct service payments are relatively limited.
These indirect costs matter in Viet Nam, where unpaid family caregiving remains a central part of long-term care.
WHO's 2024 brief Ensuring Financial Protection in Long-Term Care highlights the difficulty many people face in accumulating sufficient resources to cover long periods of care, particularly when dependency is substantial.
The European Observatory on Health Systems and Policies' 2025 publication The Care Dividend also examines the broader economic value of investment in long-term care, including implications for households, workforce participation and society.
For Viet Nam, an affordability assessment could consider expected care expenditure, available public benefits, personal resources, realistic family contributions and the risk of future cost increases.
At the system level, such information can help identify groups facing inadequate financial protection.
At the provider level, it can support more informed discussions about whether a proposed arrangement is financially sustainable.
These assessments must respect privacy and should not assume that relatives are legally obliged or financially able to pay every additional cost.
The purpose is to understand financial sustainability, not pressure families into commitments they have not undertaken.
Equity Requires Services to Be Available Where People Need Them
Financial support does not automatically create access.
An older person living in a major urban area may have several formal care options. Someone living in a remote community may have very few, even when financial assistance is available.
A subsidy has limited practical value if no suitable provider serves the area.
This creates a connection between financing and service development.
Public investment may need to support workforce training, local service availability, equipment and infrastructure in addition to individual benefits.
Different locations may also involve different delivery costs.
Providers serving geographically dispersed communities may face higher transportation expenses. Smaller services may have higher fixed costs per beneficiary because they cannot operate at the same scale as larger organizations.
Where relevant, payment arrangements should consider these differences based on documented costs and service needs.
Equity also requires attention to people who do not qualify for narrowly targeted public assistance but face substantial care expenses.
Future policies could examine appropriately designed service subsidies, cost-sharing protections or other lawful mechanisms to reduce financial barriers for such groups.
The balance between broader coverage and targeted support will depend on fiscal capacity, service availability and national priorities.
What matters is that financial eligibility, geographical access and the person's actual ability to obtain appropriate care are considered together.
Measuring Financial Performance and Care Quality Together
A long-term care financing framework should assess whether expenditure reaches the intended beneficiaries and supports the services they require.
Relevant financial measures may include expenditure per beneficiary, administrative costs, payment delays, service utilization and the proportion of costs borne by older people and families.
However, financial information alone cannot establish whether care is appropriate.
A program may appear efficient because expenditure is low, while important assistance remains unavailable.
Quality measures should therefore be examined alongside financing.
Depending on the service, monitoring may consider whether funded assistance was delivered, whether essential staffing arrangements were maintained, whether significant concerns were addressed and whether beneficiaries experienced continuity of support.
Older people and caregivers should also have opportunities to describe their experiences.
Complaints about unexpected charges, unavailable assistance or difficulties accessing services may reveal weaknesses that financial reports do not capture.
Comparisons require careful interpretation.
Providers serve different populations and offer services with different levels of intensity. Comparing expenditure or outcomes without considering these differences can produce misleading conclusions.
The purpose is not to collect the largest possible number of indicators.
It is to establish a limited, reliable set of measures capable of showing whether eligible people received the intended support, whether funding purchased the agreed services and whether acceptable quality was maintained.
Information collection must also comply with applicable privacy requirements.
Viet Nam's Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/NĐ-CP are relevant where financial and quality monitoring involves identifiable personal information, including health-related data.
Public reporting should support transparency without unnecessarily disclosing sensitive information about individual beneficiaries.
A Practical Long-Term Care Financing and Quality Accountability Framework
A useful framework for Viet Nam should make the relationships among funding, service coverage, provider capability and accountability explicit.
It can begin with a Financing Source and Coverage Map identifying the funding streams relevant to a particular population or service.
The map should distinguish social assistance, social pension benefits, health insurance payments, private expenditure and other lawful resources. It should explain the purpose of each source and identify potential gaps or inappropriate overlaps.
An Eligibility and Service Coverage Assessment can then establish who qualifies for support, how needs are assessed, which services are covered and what financial conditions apply.
A Service Cost and Affordability Assessment should examine the actual resources needed for safe delivery and the likely financial contributions expected from older people and households.
At the provider level, a Fee Disclosure and Change Protocol can explain included services, additional charges, circumstances requiring fee reviews and how proposed changes will be communicated.
Where public purchasing is legally authorized, a Provider Selection and Quality Accountability Arrangement can define the capabilities required, the services being financed, monitoring responsibilities and appropriate responses when obligations are not fulfilled.
Finally, a Joint Financing and Quality Monitoring Process can examine access, expenditure, service delivery, complaints and significant quality concerns together.
These components are proposed implementation tools. They do not represent a newly established national Vietnamese financing or accreditation system.
Their value lies in connecting decisions that are often addressed separately.
A funding program should not set payment rates without understanding service costs. A purchaser should not select providers without verifying their capabilities. A provider should not quote an attractive price without explaining what can actually be delivered.
The framework can be adapted to different services, organizations and financing arrangements rather than requiring every locality or provider to follow an identical model.
Beginning With Carefully Bounded Applications in Viet Nam
Developing stronger financing and quality accountability does not necessarily require immediately creating a new national long-term care insurance scheme.
A more practical approach may be to begin with defined populations and services under existing legal and administrative arrangements.
An appropriately authorized public authority or participating organization could examine one group of beneficiaries and one type of long-term care service.
The initial assessment should establish the legal basis for financing, existing funding sources, eligible beneficiaries and service requirements.
For example, a local initiative might examine the adequacy of financial support for a defined group of older people receiving care through an eligible social assistance establishment.
Another initiative could study service costs and affordability barriers within a specific community-based care model.
These are possible areas for development, not claims that new public purchasing powers or benefit entitlements already exist.
Before implementation, the relevant authority must confirm that the proposed financing arrangement is lawful and that the necessary budget, approval and contracting requirements can be satisfied.
Participating providers should demonstrate that they can deliver the intended services.
A baseline assessment could establish current service availability, workforce capacity, beneficiary expenditure and important quality concerns.
The program should then define payment arrangements, reporting responsibilities and procedures for reviewing financial irregularities or service failures.
During implementation, expenditure must be considered alongside service delivery.
Lower spending should not automatically be interpreted as success if beneficiaries are receiving less assistance than they need.
Higher expenditure may be justified when previously unmet needs are appropriately addressed, but the resulting improvements in access and quality should be examined.
A program that expands coverage while depending on unsustainable staffing or unreliable providers should not be considered ready for rapid expansion.
Findings should inform adjustments to eligibility, service design, payment rates and provider requirements.
More sophisticated performance-related financial incentives should be considered only when sufficiently reliable information and quality oversight arrangements are available.
Building Financial Sustainability Without Sacrificing Quality
Long-term care creates continuing financial obligations.
Buildings, equipment and digital systems may strengthen service capacity, but they do not replace the recurring costs of competent workers, supervision, daily assistance and operational support.
A residential facility may receive investment funding for its premises yet struggle to maintain adequate staffing if operating revenue is insufficient.
Similarly, a subsidized program may initially improve access but become unreliable if payment rates do not reflect the actual cost of safe service delivery.
Financial sustainability therefore requires realistic costing, predictable funding, periodic review and responsible management of available resources.
Workforce expenditure deserves particular attention because direct human assistance is central to long-term care.
Payment arrangements that consistently undervalue care work can make it difficult to recruit, train and retain competent employees.
However, increasing funding without appropriate monitoring does not guarantee better staffing or service quality.
The challenge is to provide sufficient resources while maintaining accountability for how those resources are used.
WHO's 2024 brief Ensuring Financial Sustainability in Long-Term Care emphasizes the importance of balancing revenue and expenditure over time while protecting equitable access and considering broader economic effects.
At the system level, financing decisions should also consider whether appropriate home and community services can meet some needs without unnecessary reliance on more intensive residential arrangements.
This should not be based on the assumption that home-based care is always cheaper or more suitable.
Service costs, safety and suitability depend on the individual's needs, the available workforce and actual delivery arrangements.
Financial policy should support access to the appropriate form of care rather than create incentives to select a setting primarily because it appears less expensive.
Connecting Affordability, Coverage and Quality in Future Reform
Viet Nam's long-term care financing challenge cannot be resolved through a single subsidy, insurance product or payment formula.
Existing social assistance, social pension and health insurance arrangements already provide important forms of financial protection, but they serve different purposes.
Their combined existence should not be mistaken for comprehensive coverage of long-term care needs.
Future development requires a clearer connection among funding sources, eligible populations, covered services and provider responsibilities.
At the system level, this means identifying who needs financial support, defining what assistance can be financed, establishing how resources reach eligible individuals or providers and determining how quality will be monitored.
At the provider level, it means explaining fees transparently, distinguishing included from additional services, managing cost changes appropriately and ensuring that financial commitments correspond to actual service capabilities.
Quality-accountable purchasing may offer one useful direction where public service purchasing is lawfully established. However, it should begin with clear service requirements, appropriate provider selection and dependable monitoring rather than assume that a nationwide pay-for-performance system already exists.
Affordability and quality should not be treated as competing objectives.
Poorly financed care can undermine essential staffing and service reliability. Poorly monitored spending can fail to produce appropriate care even when resources are available.
The financing challenge is to manage both risks.
Affordable long-term care is not simply care with a lower price. It is care that people can realistically access and sustain, supported by transparent financing and providers accountable for the services they deliver.
For Viet Nam, a Long-Term Care Financing and Quality Accountability Framework could provide a practical foundation for connecting existing financial protections with clearer service coverage, realistic costing, appropriate provider payment and proportionate quality oversight.
The ultimate objective is not merely to increase public expenditure or reduce individual bills. It is to ensure that available resources translate into accessible, appropriate and reliable long-term care for older people, while keeping financial responsibility and service quality visible throughout the care relationship.
References
National Assembly of Viet Nam. Law on the Elderly No. 39/2009/QH12. Adopted November 23, 2009; effective July 1, 2010, as amended.
Government of Viet Nam. Decree No. 06/2011/NĐ-CP Detailing and Guiding the Implementation of Certain Provisions of the Law on the Elderly. January 14, 2011, as applicable and amended.
Government of Viet Nam. Decree No. 103/2017/NĐ-CP on the Establishment, Organization, Operation, Dissolution and Management of Social Assistance Establishments. September 12, 2017, as amended.
National Assembly of Viet Nam. Law on Prices No. 16/2023/QH15. Adopted June 19, 2023; effective July 1, 2024, as amended.
National Assembly of Viet Nam. Law on Consumer Rights Protection No. 19/2023/QH15. Adopted June 20, 2023; effective July 1, 2024, as amended.
National Assembly of Viet Nam. Law on Social Insurance No. 41/2024/QH15. Adopted June 29, 2024; effective July 1, 2025.
National Assembly of Viet Nam. Law No. 51/2024/QH15 Amending and Supplementing Certain Provisions of the Law on Health Insurance. Adopted November 27, 2024; principally effective July 1, 2025.
Prime Minister of Viet Nam. Decision No. 383/QĐ-TTg Approving the National Strategy on Older Persons to 2035, with a Vision to 2045. February 21, 2025.
Government of Viet Nam. Decree No. 176/2025/NĐ-CP Detailing and Guiding Provisions of the Law on Social Insurance Concerning Social Pension Benefits. June 30, 2025, as amended.
Government of Viet Nam. Decree No. 335/2026/NĐ-CP on Social Assistance Policies. August 21, 2026; effective October 5, 2026.
National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. Adopted June 26, 2025; effective January 1, 2026.
Government of Viet Nam. Decree No. 356/2025/NĐ-CP Detailing Certain Provisions and Measures for Implementing the Law on Personal Data Protection. December 31, 2025; effective January 1, 2026.
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United Nations Population Fund in Viet Nam. Applying Foresight to Curate a Care Economy for Older Persons in Viet Nam. Hanoi: UNFPA Viet Nam; 2025.