Key Development
Ho Chi Minh City has approved a 2026–2030 elderly healthcare strategy, with a 2045 vision, built around a five-tier care model ranging from self-care to hospital treatment. The strategic shift is not simply the creation of more services. It is an attempt to route older adults according to health status, functional dependency and care needs rather than defaulting to hospital-based care.
The five tiers are: self-care and health promotion; community support; home-based care; residential care; and hospital care. Home and community services are positioned as the foundation, while geriatric medicine provides the specialist clinical backbone.
The demographic pressure is significant. Following administrative restructuring, Ho Chi Minh City has approximately 1.57–1.7 million residents aged 60 or older, representing more than 11–12% of the population depending on the reporting date. Decision 6655/QD-UBND projects that the city could enter a formal “aged population” stage around 2038 if current trends continue.
Why It Matters
- Hospitals are structurally unsuitable as the default response to every elderly-care need. Multimorbidity, frailty and functional decline require longitudinal care rather than repeated acute episodes.
- Chronic disease burden is already substantial. A 2024 city screening program found hypertension in 61.6% of participating older adults and diabetes or suspected diabetes in 25.68%.
- Functional dependency may matter more than diagnosis alone. Approximately 2.2% required assistance with basic daily activities, while 7.9% needed help with broader daily living tasks.
- National policy is moving in the same direction. From 2026, older adults are targeted for at least one free annual health examination or screening and ongoing health-record management.
Healthcare Insight Analysis
Healthcare Insight believes the five-tier model addresses a common structural weakness in elderly care:
services are often organized around institutions rather than around the intensity of patient need.
The traditional pathway frequently looks like:
living at home → deterioration → hospital admission → discharge → return home.
The problem is everything that happens between those episodes.
Who monitors medication adherence?
Who recognizes worsening frailty?
Who identifies early cognitive decline?
Who supports nutrition, mobility and rehabilitation?
The five-tier architecture attempts to create a continuum:
independent aging → community support → home care → residential care → hospital.
Its most important innovation may be making functional status and frailty part of the routing logic, rather than relying only on disease labels.
That distinction matters.
Two older adults may both have hypertension, but one may be fully independent while the other lives alone, has memory impairment and is at high risk of falls.
Their diagnoses may be identical.
Their care needs are not.
The economic implications could also be substantial.
If tiers 1–3 absorb appropriate demand, community and home-based services can function as a capacity-management layer for the entire healthcare system.
Better medication management, earlier detection of deterioration and timely rehabilitation can potentially reduce emergency visits, hospitalizations and prolonged inpatient stays.
In that sense, home care is not merely a social service.
It can become part of health-system infrastructure.
The largest execution risk, however, is coordination.
A five-tier diagram does not create continuity if each tier uses separate records, assessments and referral processes.
The model therefore needs a common operating backbone:
shared assessment → shared electronic record → standardized referral criteria → care coordination → closed-loop follow-up.
Ho Chi Minh City has already built part of that foundation: previous elderly-health programs created health databases for more than 526,000 older residents.
The next challenge is turning those records into active care management.
This also changes the role of hospitals.
In a mature five-tier system, hospitals do not need to retain every patient relationship directly.
Their highest-value role becomes handling complex acute care, supporting specialist decision-making and enabling lower tiers to manage stable disease safely.
That is a more scalable model than continuously adding beds.
Market Implications
Hospitals: could shift toward complex-care hubs rather than acting as the default site for routine chronic management.
Primary and home care: demand should expand for community nursing, rehabilitation, medication management, nutrition and family support.
Digital health: remote monitoring, shared health records and care-coordination platforms could become core infrastructure.
Private healthcare: assisted living, day care, home nursing and geriatric rehabilitation may become larger service categories if standards and payment models mature.
ANALYTICAL MATRIX
| Tier | Primary Role | System Value | KPI to Watch |
| 1. Self-care | Prevention | Maintain independence | Healthy years |
| 2. Community | Screening/support | Earlier detection | Risk identification |
| 3. Home care | Long-term management | Avoid hospitalization | Avoidable admissions |
| 4. Residential | Dependency support | Reduce family burden | Functional stability |
| 5. Hospital | Acute/complex care | Manage high-acuity cases | LOS/readmission |
The ultimate measure of success should therefore not be how many eldercare facilities are opened.
It should be:
how much longer older adults remain independent, how many preventable hospitalizations are avoided, and how reliably people move to the right level of care at the right time.
If Ho Chi Minh City can demonstrate those outcomes, the five-tier model could become more than a local elderly-care program.
It could become a prototype for how Vietnam reorganizes healthcare delivery for an aging society.