The health care system in Vietnam has long been cited as an example of primary health care that has worked well. The achievements of the system during the past decades have indeed been impressive, but the changing economic situation in Vietnam has consequences for all public sector activities, including health care. Liberalization of economic policies has encouraged private medical practice and free trade in medicines and drugs, while financial support for the state health system is decreasing. Equity has always been an important goal for the vietnamese health system, but it becomes harder and harder to realize under the new conditions of financing. The restrictions in centralized planning and funding brought about by recent changes also reveal weak points in the system, from planning to training to management at the different levels. This situation is discussed and issues concerning policy, legislation and human resources are highlighted in terms of their effect on equity.