Vietnam families can't afford children's cancer treatment

The 38-year-old couple from the southern Kien Giang Province has spent billions of dong (VND1 billion equals US$39,400) over two years on their child's medical care.

"This case is difficult," the doctor told Tuan after a grueling five-hour surgery that removed his 7-year-old daughter Thy Cat's two tumors and a kidney.

Diagnosed with cancer in 2022, the young girl was initially treated in Ho Chi Minh City before being transferred to Hue Central Hospital, renowned for its pediatric chemotherapy expertise.

By the end of 2023, after two years of continuous chemotherapy and surgery, cancer cells had invaded Cat's bone marrow. A stem cell transplant, one of the most promising but expensive cancer treatments, became the family's last hope.

The costs of treatment had already reached several hundred million dong. Many expenses fell outside their health insurance coverage, forcing the family to exhaust their savings and borrow more.

For many parents in Vietnam, the battle against their children's cancer has meant more than medical challenges, as catastrophic healthcare costs push them into financial ruin.

The average annual cost of cancer treatment in Vietnam is around VND176 million (US$6,930), but severe cases can incur much higher expenses. Even with partial health insurance support, many families face financial ruin due to out-of-pocket expenses for non-covered drugs, medical supplies, and the high cost of living in major cities where treatment is available.

A 2017 study by Hanoi University of Public Health revealed that families in Vietnam with a cancer patient are 2.3 times more likely to fall into poverty due to healthcare costs. A survey of nearly 2,000 patients across Vietnam's three largest cancer treatment centers found that 22.36% faced economic hardship a year after diagnosis. The cost for medicine, electricity, water, travel expenses, and food are the hardest to cover. To cope, nearly 80% had to borrow money.

"Debt"-end

"The doctor recommended a stem cell transplant for Cat. No matter how hard it is, we'll find a way," Tuan said.

Stem cell transplants can increase pediatric cancer patients' survival rates to 50%. However, the cost can range from VND100 million to VND1 billion, depending on various factors. The procedure involves two stages—cell retrieval and transplantation—costing a total of VND365 million in Cat's case. Initially, she received 80% insurance support for cell retrieval due to her age, but the family secured full insurance coverage for the transplant through local government support. Nonetheless, they still faced additional costs of VND145 million for non-covered medical supplies and drugs.

Despite these efforts, non-insurance expenses continued to accumulate. During chemotherapy, Thy Cat required 13 prescriptions instead of the expected 8, with the extra costs borne by her parents.

The family's finances were stretched to the breaking point.

Previously, Tuan earned an average of VND5 million per month as a motorbike taxi driver. The couple's combined salary is nearly VND10 million. Since his child got sick, he quit his job to care for her at the hospital. In Vietnam, unless patients pay extra, their daily needs like food and hygiene are not cared for by hospital staff, so families often accompany their loved ones, regularly camping out in rooms, hallways or lobbies to provide meals, laundry and other necessities. For two years, he and his daughter have not returned home. All the families’ time, money, efforts and energy goes to Cat’s medical treatment.

Fortunately, a VND100 million donation from a charity fund eased some of the financial strain. After the transplant, Cat entered a maintenance phase, requiring regular medication (mainly for leukocytosis and platelet stimulation) and follow-up exams, adding another VND12 million to the family's expenses.

Currently, the family is VND150 million in debt, and the only non-borrowed income is Cat’s mother’s VND5 million monthly salary as a kindergarten teacher.

Borrow, pay, repeat

Similar to Tuan, Le Trinh, 35, from the southern province of Long An had to leave her job to care for her daughter, Nhu Quynh, who was diagnosed with leukemia at age six. The treatment, spanning three years and five stages, has cost hundreds of millions of dong. The family, already financially strained, faced deepening poverty.

Trinh's husband, suffering from ankylosing spondylitis, earns VND4 million per month, half of which goes to his medical bills. Her VND8 million salary previously supported the family, but she had to quit her job to care for Quynh, who required frequent hospital visits.

"My child is too young to be in pain, and I have no idea how we can afford her treatment," Trinh said.

During the first two stages of treatment, Quynh was hospitalized almost full-time. In subsequent rounds, the mother and daughter would have to travel over 50 km from their home to Children's Hospital 2 in Ho Chi Minh City for treatment twice a month. This constant travel makes it difficult for Trinh to find a stable job, forcing her to borrow money from various people.

Trinh saved as much as possible, spending only on her child's illness. Staying in the hospital and unable to cook, she was forced to buy meals from outside for her child, each costing VND30,000. For rounds 1 and 4, the medication increased Quynh's appetite, leading her to consume meals equivalent to three times the usual amount. Instead of buying more food for herself Trinh often ate her child's leftovers or waited for charity meals.

"I can eat instant noodles for three meals a day, to save money for my child’s nutrition," she said. Despite careful spending, the high cost of living in the city resulted in monthly expenses of VND5-7 million.

After a year of treating their child's cancer, Trinh and her husband lived in a cycle of borrowing, paying, and repaying debt.

Each time she asks for a loan, she only dared to borrow a few million dong from friends and relatives, an amount she could manage to "pay off." She took every opportunity to earn extra money by working in restaurants or part-time as an accountant for stores, but the work was inconsistent.

"At the hospital, receiving the payment due notice is one of my biggest fears. That being said, my child must be treated no matter how sick she is," the mother said.

Tears of joy

Of the five stages of treatment, induction is the most expensive due to the many initial tests that must be performed. Nhu Quynh's medical costs just in this initial first phase of treatment reached VND80 million, with health insurance covering only VND52 million, leaving Trinh to manage the remaining VND28 million herself. The amount was divided to be paid in three installments. The couple borrowed nearly VND11 million to pay for the first part. For the remaining two parts, Trinh hid the loans from her husband and worked to pay them off when her child returned home between rounds of chemotherapy.

"I'd rather take on everything myself than let my husband and child suffer," the mother said.

After less than three months in the hospital, Quynh turned seven, reducing her health insurance coverage from 100% (for children under six) to 80%. Though she only had to pay 20%, it was still a significant amount. Learning from other parents at the hospital, Trinh discovered local government's policy supporting those in extreme hardship and serious illness, granting 100% health insurance.

Her husband ran around Long An collecting all necessary documents: a "certificate of difficult circumstances," a summary of medical records, hospital bills, and confirmation from the hospital. After two months, Quynh's application was approved, providing VND900,000 per month and comprehensive health insurance benefits. The couple shed tears of joy.

What health insurance lacks

Families like Tuan's and Trinh's, despite receiving significant health insurance support, often fall into debt and poverty.

Nguyen Mai Linh, a doctor at Hue Central Hospital, highlighted the high cost of repeated tests and treatments not fully covered by insurance. The burden is exacerbated when parents must leave work to care for their children.

During the treatment process, high costs are largely due to tests such as CT scans, MRIs, myelograms, immune markers, bone marrow biopsies, and pathology tests. These procedures are expensive and pediatric patients must undergo them multiple times during treatment.

"Health insurance still does not cover all treatment costs, especially for tests and drugs for cancer," Linh stated. Additionally, cancer patients face a significant burden from medication costs, especially when public hospitals run out of medicine and families are forced to buy from private suppliers at higher prices.

Kim Hoa, Deputy Department Head of Oncology - Hematology - Bone Marrow Transplant at Hue Central Hospital, recounted numerous instances where the hospital had to find ways to procure medication to ensure uninterrupted treatment for children.

"If there is no medicine, the children will definitely not get better, and there is a risk of relapse. When medication is not available on time and must be bought externally, we face quality risks and financial burdens," she said.

"If you have a serious disease like cancer, even those who are not poor will become poor," said Tran Thi Trang, Director of the Health Insurance Department at the Ministry of Health.

The purpose of health insurance policy is to help vulnerable groups by sharing risks between healthy and sick individuals in society. However, due to the limited Health Insurance Fund, only children under 6 years old receive 100% benefits, while older children receive partial benefits. Achieving a bigger fund would allow for more children to be fully covered.

Trang noted that while the scope of health insurance coverage has expanded and public spending has increased, patients' out-of-pocket (OOP) expenses remain high. Currently, OOP expenses account for about 40% of total treatment costs, nearly double the World Health Organization's (WHO) recommendations. The Ministry of Health aims to reduce this rate to below 30% by 2030.

Expenses outside health insurance primarily stem from two issues: incorrect and incomplete pricing of medical services, and an insufficiently comprehensive health insurance list. The Ministry of Health is addressing these gaps to minimize additional expenditures required of patients.

The most challenging aspect today is calculating the accurate and complete price of medical services due to complex price laws and processes. Current prices do not reflect reality and omit many components such as depreciation costs, high technology application, and incidental expenses. Hospitals collect the difference from patients in the form of other costs.

To ensure patient rights, the Ministry of Health is updating Circular 20 on payment rates and conditions for drugs within the scope of health insurance benefits.

According to Trang, children over 6 years old currently receive partial health insurance (80-95%), causing significant difficulties for serious diseases like cancer. To support this group, the Ministry of Health issued Decree 75 in 2023, allowing local People's Committees to mobilize resources to cover costs not covered by health insurance.

As an expert, she believes that supplementary health insurance may be a future solution. In cases of serious illness with only partial insurance coverage, patients could pay a premium to receive 100% coverage. However, the current Health Insurance Law lacks a mechanism for this policy. Implementation would require the participation of other health insurance components under a business model, while health insurance is a welfare policy, not for profit.

Looking more broadly, the Director of Health Insurance advocates for early disease screening and remote disease prevention as the best solutions. During the process of advising on the draft revised Health Insurance Law expected to be submitted to the National Assembly this year, she repeatedly called for health insurance to cover early cancer screening and detection, prioritizing women and children. Early diagnosis would help reduce treatment costs, increase cure rates, and partly reduce the risk of families falling into financial disaster.

"Investing just one dong in disease prevention will save dozens of times the cost of treatment later," she said.

Phung Tien

*The use of images in the article has been approved by the pediatric patients and their families.