The problems with Vietnam's limited healthcare funding

By Vo Xuan Son   September 13, 2019 | 08:37 pm PT
The current healthcare system in Vietnam does not benefit the poor when it limits the fund that could aid them to get access to healthcare service.
Doctor Vo Xuan Son]

Vo Xuan Son

I was on a field trip to the University of Michigan in the U.S. 10 years ago.

Prof La Marca took me to a hospital. We saw a brain surgery that involved some complications, and the cost rose to around $1 million because of that.

The patient was a homeless person, and it was the U.S. government that covered the cost.

My first reaction was surprise at the high cost, and the next thing that crossed my mind was how doctors and hospital staff would deal with all the paperwork.

"How many reports would they have to file for that huge amount of money?" I asked.

La Marca said doctors did not have to do anything and the secretaries would take care of that. And from what he knew, the procedure was not very complicated.

Then it was his turn to be surprised as he wondered why as a doctor I asked such questions.

He went on to say that a doctor with a salary of several hundred dollars per hour should not spend time dealing with paperwork, and that procedures should be simplified so that the hospital could get by by paying secretaries $20 per hour.

I also found the answer to the other question. In any country, especially those more developed than Vietnam, the government has to consider how to ensure poor people access healthcare services like anyone else.

In Vietnam, every once in a while the Ministry of Health increases the cost of healthcare services. And every time that happens, the public would become angry, and many would lament that while the costs increase the quality does not, and that the price hike does no good to poor people.

They would also label the medical system as heartless for refusing to treat patients without money.

Doctors for their part would indignantly claim how they are overworked but paid little. The response would be that they had chosen to be doctors, and if they want more money they should find another job.

The Internet, from social media to forums and newspapers, is then flooded with whining, resentment, arguments, and, sometimes, vituperation.

Everybody justifies their stance; they see problems only in others and not in themselves. Society is in an uproar.

Vietnam has faced a shortage of doctors since the war against France in the 20th century.

At that time the government decided medical students would go to rural areas and treat patients. Then, after finishing their basic course, they would go to hospitals to intern before returning to complete their major.

The wars finally came to an end. But peace did not bring much change to the medical system.

To change things, the healthcare sector should first set minimum standards for services. The minimum desirable standard of living for health workers should also be identified. The cost of medical services must then be fixed in such a way as to cover all the costs, including medical staff salaries.

Once the costs are identified, the health insurance premiums should be decided based on that.

But what we are doing is looking first at how much the government has allocated and then deciding how much we should spend.

We have set a percentage of the basic salary as the premium each person has to pay. That ratio is 4.5 percent, but no one can provide a rationale for why that rate has been chosen; it has been set arbitrarily.

I know some people think that when we have just this much salary and we need to spend this much on other things, we only have this much left for healthcare.

But that argument makes things worse because, then, health has already been pushed to the lowest position in the hierarchy of needs, and there are so many other needs that get much greater priority.

If health is the biggest asset as the saying goes, the spending on healthcare should be the highest and healthcare should be given top priority, meaning we should identify the spending on healthcare first and earmark money for the remaining needs after that.

A doctor cares for a patient at Bach Mai Hospital, Hanoi, August 2019. Photo by VnExpress/Giang Huy.

A doctor cares for a patient at Bach Mai Hospital, Hanoi, August 2019. Photo by VnExpress/Giang Huy.

In developed countries, despite much higher incomes, the ratio of income payable as health insurance premium is much higher than 4.5 percent.

And because health is not considered as valuable as it is often claimed, it has come to a situation where health insurance decides what type of checks doctors do for patients and what types of medicines they prescribe to ensure the cost is covered by the insurance.

Meanwhile, many public healthcare facilities collaborate with private players to run healthcare businesses and earn profits.

It means they use resources meant for the poor on the rich, people who can afford to pay their hospital a sum equivalent to a month's salary of a poor person for one night.

Only when we can truly appreciate the importance of health, only when we have proper and scientific policies for healthcare and only when we know how to allocate a reasonable amount for healthcare for the poor will we no longer have to deal with a public backlash when healthcare costs are hiked.

I’d like to emphasize that medical workers do what they do to earn money and do not become doctors or nurses to do charity.

It is the government's responsibility to make sure medical staff are treated well and work in a proper environment.

Where I work, I try my best not to let doctors, nurses, pharmacists, and other staff get involved with patients’ money.

All issues related to money must be as transparent as possible. Everyone coming to a hospital should know the cost of everything, from a small tablet to a complicated surgery, but when it comes to collecting money, only accountants and cashiers should need to work.

It should not be assumed I do not trust doctors and nurses and other employees when I do not let anyone of them touch money since I honestly look at my method as a way to respect them, to ensure they can completely focus on their work without being distracted by money.

*Vo Xuan Son is a doctor the EXSON Center for Minimally Invasive Spine and Spinal Cord Care in HCMC. The opinions expressed are his own.

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