Vietnam is growing old before its health system is paid for

In 2015, people aged 65 and over made up 6.5 percent of Vietnam’s population. By 2025 the share had reached 9.5 percent, on World Bank data.¹ That is still younger than Thailand or China, but the gap is closing quickly, and it is closing from a lower level of income than either country had when it reached the same point.

Vietnam is expected to move from an ageing to an aged population between 2036 and 2038, a transition of 17 to 20 years that ranks among the fastest anywhere.² Vietnam will have to build the health system of an older country within a single investment cycle.

Hospital capacity has grown steadily. The World Bank series shows beds per 1,000 people rising from 1.6 in 2006 to 2.5 in 2017,³ and the Ministry of Health reported 34 beds per 10,000 people, or 3.4 per 1,000, at the end of 2024, slightly above the global average. The country now has 1,665 hospitals, of which 384 are non-public.⁴

The constraint has moved from buildings to people. Vietnam had 1.1 physicians per 1,000 people in 2021, against 2.3 in Malaysia and 3.1 in China on the most recent World Bank figures.⁵ An older population needs more chronic and specialist care, which is more intensive in doctors and nurses than in beds. Without a matching increase in clinical staff, additional capacity will sit underused in some places while patients continue to travel to Hanoi and Ho Chi Minh City for treatment.

Vietnam spends about 4.6 percent of GDP on health, a share that has barely moved in a decade and is close to Thailand’s.⁶ The difference lies in who pays. Out-of-pocket payments account for about 39 percent of current health spending in Vietnam, against less than 10 percent in Thailand, where universal coverage has long been established.⁷

High out-of-pocket spending has two consequences that matter for investors. It makes demand for care sensitive to household income, and it means that any move to shift costs onto insurance will require either higher premiums, more public money or both.

Vietnam spends about as much on health as Thailand. The difference is that its households pay four times as large a share directly.

The Politburo’s Resolution 72, adopted in September 2025, sets the direction. It targets life expectancy of 75.5 years by 2030 and a waiver of basic hospital fees within the health insurance package by the same year.⁸ From 2026, every citizen is entitled to a free periodic health check at least once a year and an electronic health record.⁹ Commune health stations are to have four to five doctors each by 2027.⁸

The resolution also opens the door to private providers, with incentives on land, tax and legal procedure, including corporate income tax exemption for non-profit health facilities, whether public or private.¹⁰ Read together, the targets imply a large transfer of cost from households to the insurance fund and the state, and a corresponding need for providers outside the public system.

2030

Target year for waiving basic hospital fees within health insurance

75.5

Life expectancy target for 2030, in years

384

Non-public hospitals among 1,665 nationwide

Three areas stand out in our view. The first is specialist and chronic care outside the two largest cities, where an ageing population will need cardiology, oncology and rehabilitation close to home. The second is the training and retention of clinical staff, without which new facilities cannot operate at capacity. The third is the financing structure itself: as basic fees move into the insurance package, hospital revenue will depend more on insurance reimbursement rates and less on household payments, and investors will need to underwrite that shift explicitly.

Vietnam has shown that it can build hospitals. The test of the next decade is whether it can staff them and pay for them before the demographic curve steepens further.