Vietnam is aging at a speed few countries can match, and the people carrying that demographic weight are rendering a quiet verdict on the health system that serves them. According to a new study published in the journal Ageing International, roughly 83.2 percent of older Vietnamese patients report being satisfied with the healthcare services they receive — a figure that sounds reassuring until the map is consulted. Behind the national average lies a pronounced split between the country’s northern and southern regions, a divide that persists even after accounting for income, education and where people live. The study, led by Nguyen Anh Tuyet of Osaka University’s Osaka School of International Public Policy together with Dung D. Le of the Institute of Social and Medical Studies in Hanoi and Tuan Anh Nguyen of the Vietnam Academy of Social Sciences, tackles a question that has remained largely unexplored in Vietnamese research: how do older adults actually judge the care they receive, and what explains the differences in their judgments?
Patient satisfaction occupies a curious place in health research. It is not a clinical measure — no stethoscope is involved — yet decades of evidence link it to whether patients take their medication, return for follow-up, trust their physicians and ultimately benefit from treatment. The World Health Organization has repeatedly emphasized that health systems responding to population aging must be judged not only by survival statistics but by the quality of experience they deliver to older users, who typically consume more services, manage multiple chronic conditions and navigate more administrative hurdles than younger patients. For Vietnam, where rapid economic growth has been accompanied by one of the world’s fastest demographic transitions, the question is pressing. The share of the population aged 60 and over — the country’s official threshold for old age — is climbing steadily, noncommunicable diseases now dominate the disease burden, and demand for services is expanding faster than the system’s capacity to refine it. Satisfaction, in this context, functions as a barometer of whether the system’s growth is being felt by its oldest customers.
The evidence base for the new analysis is the Vietnam Aging Survey, or VNAS, a national survey conducted in 2011 by the Institute of Social and Medical Studies. The survey was approved by the Institutional Review Board in Biomedical Research of ISMS under Decision No. 308/HDDD-ISMS dated 9 May 2011, and its procedures followed the ethical standards laid out in the 1964 Helsinki Declaration and its later amendments. Interviewers obtained written informed consent from participants, who were told they could withdraw at any time. The VNAS remains a restricted-access dataset, with researchers required to request permission from ISMS for replication purposes — a detail that matters in an era when survey microdata are increasingly treated as public goods. Crucially, the survey collected, alongside socio-demographic characteristics, exactly the information the study needed: whether respondents held social insurance, which type of healthcare facility they used, and how satisfied they were with the services they had received.
The statistical machinery behind the paper rewards a closer look, because it illustrates how a seemingly technical decision can reshape a study’s conclusions. Patient satisfaction is usually recorded on an ordinal scale — categories with a natural order, such as dissatisfied, neutral and satisfied. The standard toolkit for such outcomes is ordered logistic or probit regression, which estimates the effect of each predictor on the odds of falling into a higher category. But these models rest on the proportional odds assumption: the idea that each predictor has the same effect across every possible cut of the outcome scale. When Tuyet and colleagues tested that assumption, the likelihood ratio chi-square statistic returned a p-value below 0.001, decisively rejecting it. Imposing the assumption would have distorted the estimates. The team therefore dichotomized satisfaction — satisfied versus not satisfied — and estimated binary logistic regression models, a framework drawn from the health econometrics tradition and implemented in Stata. The resulting odds ratios describe how each characteristic multiplies the odds of an older patient reporting satisfaction with care.
The headline number is straightforward: 83.2 percent of older patients were satisfied with healthcare services, a level the authors characterize as high but unevenly distributed. The regional contrast between Northern and Southern Vietnam emerged as statistically significant, meaning the difference was too large to be attributed to sampling noise. Satisfaction also varied with education — patients at different educational levels rated the system differently — and with social insurance holding status. The insurance finding carries a plausible mechanism: coverage in Vietnam reduces out-of-pocket expenditure at the point of care and widens the range of facilities a patient can afford to visit, so insured older adults may experience both fewer financial shocks and more choice. Education, meanwhile, can operate in either direction — shaping both what patients expect from providers and how confidently they navigate the system — which is precisely why the researchers treated it as a variable demanding explicit control rather than an afterthought.
The study’s most intriguing result concerns how the explanatory variables behave across the North-South divide. When the researchers accounted for insurance coverage and socio-demographic factors, these characteristics worked to narrow the gap between the two regions — in other words, part of the raw regional difference dissolves once one recognizes that the northern and southern older populations differ in who holds insurance, how educated they are and other measurable attributes. Equalizing those endowments would pull the two regions’ satisfaction levels closer together. Facility type moved in the opposite direction: it widened the regional difference. Older adults in the two halves of the country use different mixes of healthcare facilities, and because satisfaction varies by facility type, those patterns of use amplify rather than erase the divide. The implication is uncomfortable but clear — where older Vietnamese patients go for care matters as much as who they are, and the geography of facility choice is itself feeding the satisfaction gap.
The finding lands within a well-documented international conversation about place and patient experience. Studies from Scotland to Ghana to Poland have found that urban and rural patients, and patients in different regions, report systematically different levels of satisfaction with comparable services, and Vietnamese scholarship has repeatedly flagged spatial inequality — from the health status of remote and mountainous communities to regional disparities in service utilization among older people. Vietnam’s internal geography gives the pattern particular texture: the Red River Delta in the north and the Mekong Delta in the south anchor two historically distinct economic zones, and the market-oriented Doi Moi reforms of the late 1980s unfolded unevenly across the country. Health infrastructure, workforce density and private-sector development have not converged at the same pace everywhere. A satisfaction gap between North and South is therefore less a curiosity than a signature of deeper structural asymmetries — one that perception-based measures can detect even when access statistics look broadly comparable.
The authors distill the results into two policy priorities. The first is to strengthen Vietnam’s social insurance mechanisms. The country has spent more than a decade pushing toward universal health coverage, with the World Bank and other analysts cataloguing both the expansion of compulsory insurance and the persistent protection gaps that leave some older adults exposed to out-of-pocket costs. The new results suggest that closing those gaps is not merely a financing exercise — it is also a lever for equalizing how the system is experienced across regions. The second priority is to improve the quality of healthcare services at the district level in rural areas. District facilities are the practical backbone of care for aging rural populations, who face the highest travel costs and the thinnest alternatives; if satisfaction is systematically shaped by facility type, then upgrading the district tier is the most direct route to geographic equity in patient experience. Neither measure, the study implies, is optional if equity is the goal.
The study’s limitations are worth stating plainly. The VNAS data date from 2011, so the snapshot predates more recent insurance expansions and infrastructure investments; the picture today may differ, though the methodological template the study provides remains fully applicable. The design is cross-sectional, which means the associations reported — insurance with satisfaction, facility type with satisfaction, region with satisfaction — cannot be read as causal effects. And satisfaction itself is a subjective construct, sensitive to patient expectations that vary with education and lived experience, a caveat researchers in the patient-experience field have long emphasized when contrasting satisfaction ratings with more granular measures of what actually happened during a visit. None of this undermines the central contribution: a nationally grounded demonstration that the geography of satisfaction in Vietnam’s older population is real, patterned and partly explicable. It does, however, argue for repeating the analysis as fresher survey waves become available, ideally with instruments that separate what patients received from how they felt about it.
The broader stakes extend well beyond Vietnam. Almost every middle-income country is now negotiating the same compound challenge: populations aging quickly, chronic disease rising, insurance systems expanding, and quality lagging unevenly across territory. In such settings, satisfaction surveys of older adults are among the cheapest instruments available for detecting where the system is fraying — provided analysts take the measurement seriously, test their models’ assumptions, and resist the temptation to average away regional variation. The Vietnamese case shows what that discipline can reveal: a health system in which most older patients are satisfied, yet in which the north and south of the country are, in effect, being served by experiences that are not equivalent. Achieving geographic equity in patient satisfaction, the authors conclude, will require both better financial protection and better care in the places where older people actually seek it. For the world’s fastest-aging developing societies, it is a lesson arriving none too soon.
Subject of Research: Geographical differences in patient satisfaction with healthcare services among older adults in Vietnam, analyzed using national data from the Vietnam Aging Survey (VNAS)
Article Title: Geographical Difference in Patient Satisfaction With Healthcare Services for Older Adults in Vietnam
Article References: Tuyet, N. A., Le, D. D., & Nguyen, T. A. (2026). Geographical Difference in Patient Satisfaction With Healthcare Services for Older Adults in Vietnam. Ageing International, 51(1), Article 12. https://doi.org/10.1007/s12126-025-09647-3
Image Credits: AI Generated
DOI: 10.1007/s12126-025-09647-3
Keywords: Patient satisfaction, Healthcare services, Older adults, Vietnam, Geographical difference, Social insurance, Regional disparity, Health equity, Aging population, District-level healthcare
