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Vietnam's agrarian transition is reviewed and, against the World Bank view that land markets in Vietnam have been pro‐poor, it is suggested that access to land has become stratified within specific provinces, districts and communes. Aggregate data and field research both demonstrate that the technical coefficients of production differ between farms when grouped according to a proxy for wealth, and that this is correlated with productivity per unit of land. It is therefore argued that there are emerging differences between farms that reflect divergence in the scale of production. At the same time, when grouped according to wealth there are differences between farms in terms of crop mix, the degree of market integration, and the extent of rural diversification. Holistic examination of the evidence suggests that Vietnam has an emergent group of rich peasants with relatively larger landholdings, amounts of capital stock, and use of hired labour‐power; and higher yields per unit of land, a greater degree of market integration, and more marked productive diversification. This class can be set beside a numerically preponderant class of relatively small peasants, with smaller landholdings and amounts of capital, a heavier reliance on family labour, lower yields per unit of land, and less market integration and diversification. The evidence further demonstrates the rapid growth of a class of rural landless who are largely separated from the means of production, who survive by intermittently selling their labour, and who are the poorest segment of rural society.

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The transition from a centrally planned economy in the 1980s and the implementation of a series of neoliberal health policy reform measures in 1989 affected the delivery and financing of Vietnam's health care services. More specifically, legalization of private medical practice, liberalization of the pharmaceutical industry, and introduction of user charges at public health facilities have effectively transformed Vietnam's near universal, publicly funded and provided health services into a highly unregulated private-public mix system, with serious consequences for Vietnam's health system. Using Vietnam's most recent household survey data and published facility-based data, this article examines some of the problems faced by Vietnam's health sector, with particular reference to efficiency, access, and equity. The data reveal four important findings: self-treatment is the dominant mode of treatment for both the poor and nonpoor; there is little or no regulation to protect patients from financial abuse by private medical providers, pharmacies, and drug vendors; in the face of a dwindling share of the state health budget in public hospital revenues and low salaries, hospitals increasingly rely on user charges and insurance premiums to finance services, including generous staff bonuses; and health care costs, especially hospital costs, are substantial for many low- and middle-income households.