The poor still miss out on healthcare in Vietnam



VietNamNet Bridge – A doctor working at Bach Mai Hospital in Ha Noi said one of her patients committed suicide last year because he did not have enough money to pay for daily treatment for his kidney disease. The treatment fee was too much for the man to afford, especially since he was so ill he could not work.


"Those with chronic kidney disease can become very depressed while receiving treatment and feel like there's no way out," the doctor, who wanted to be unnamed, said.


The director of another big hospital in Ha Noi said he had met many patients with serious diseases who were very poor. Some even had to sell their properties and houses to come to Ha Noi for treatment, but many finally gave up because the fees were too high.


"Sometimes, patients just don't show up at appointments. When we ask, we find out they have gone back to their home towns to spend the last of their days," he said.


Another hospital in Ha Noi runs a message on its website, asking for support from benefactors and donors. The message says many patients were incapable of paying for treatment fees or daily meals - or any other costs at the hospital. It also said that, many times, the hospital had used part of its funding to help such patients, but pointed out this could was not a long term solution.


These stories contradict others that the Government has shown a strong commitment to achieving equity in healthcare. In the Prime Minister's Decision 122 in 2013 on the National Strategy to care for people's health, it is stated that:


"Health is the most precious resource of the individual and the society, and public health service is a special social service, not for profit. The Government is committed to improving the healthcare system towards a fair and effective system to ensure that every citizen, especially vulnerable people, have access to basic and qualified healthcare."


The issue was addressed even earlier. In 2002, the Prime Minister signed Decision 139 to establish the Health Care Fund for the Poor (HCFP) aimed at supporting medical treatment for poor people. The fund provided financial health care aid for the poor, ethnic minorities living in selected mountainous provinces designated as difficult, and all households living in communes officially designated as highly disadvantaged.


However, in one of its impact evaluation documents, the World Bank said that the programme had not reduced average out-of-pocket spending, and appeared to have negligible impact on utilisation among the poorest.


Moreover, a representative from the Ministry of Finance said only big cities, including Ha Noi and HCM City, had such funds, while many other provinces with lower incomes had difficulty finding funding.


The Government does have a programme to provide health insurance for poor people with serious diseases.


Pham Luong Son, head of the Health Insurance Policy Implementation Department of the Social Insurance Agency, said even if the insurance covered 95 per cent of treatment costs, the remaining five per cent could still be a burden for poor people.


In 2013, the Ministry of Finance and the Ministry of Health issued an inter-sector circular on setting up a new model for a Health Care Fund for the Poor, but only few provinces and cities established funds.


But let's be frank: even if funds were established, would they be effective? Vietnam is known for complicated administrative procedures, and even corruption. Would the fund be easy for poor people to access? How long would it take them to get treatment, given that ailments cannot wait for red-tape.


Maybe, the long term solution is for universal health insurance to be given more serious thought. By 2014, more than 20 million people in Vietnam were uninsured. If health insurance is available for every body, then the health care fund for poor people could step in and help those in need.


But at the moment, all that many poor people can do is pray - and cry in silence.

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