SEATTLE, Washington — The extraordinary economic growth that Vietnam has experienced in the last few decades is also reflected in the higher living standards that many Vietnamese people now can enjoy. One of the most significant improvements in Vietnam in recent years is its healthcare sector. Alongside the economic reform that the government implemented in the late 1980s, healthcare in Vietnam also underwent a reform that generated many positive health benefits. The transformation from a fully public services system to a mixed public-private provider system in Vietnam introduced more selections and different alternatives for people to get better services.
The rapid economic development coupled with the improvement in the healthcare sector of Vietnam has been reflected in better health outcomes of its people. Between 1990 and 2015, the life expectancy at birth for Vietnamese increased from 71 years to 76 years. There was also a significant drop in the mortality rates of children under 5 years old from 58 deaths per 1000 live births to just 18 during that same time. Children also received better nutrition. The proportion of underweight children under 5 years of age decreased from 37 percent in 1993 to 14 percent in 2015. The country’s maternal mortality rate has dropped by 75 percent since 1990.
Universal Health Coverage
Vietnam first introduced health insurance in 1989 and began implementing the Vietnamese National Health Insurance in 1992. By 2010, nearly 60 percent of the population was enrolled in the program. By 2015, the government was committed to achieving universal health coverage (UHC). Since then, Vietnam has made great strides in expanding social health insurance.
Today, 87.7 percent of the population in Vietnam is covered by social health insurance. According to a recent joint report by WHO and the World Bank, the proportion of Vietnamese children receiving standard immunizations stands at 97 percent, which is even higher than in the United States where the rate is 95 percent.
While healthcare in Vietnam has improved significantly, there are still numerous shortcomings in the system that need to be addressed. The Ministry of Health admitted that there is an imbalanced distribution of human resources and a severe shortage of highly specialized physicians in fields such as cancer, cardiac, orthopedic and pediatrics. A specialized physician in the city could see more than 100 patients each day.
In 2015, Vietnam only had around eight physicians per 10,000 population, which is quite low when compared to other Southeast Asian countries. Furthermore, it is insufficient to meet the medical needs of its rapidly aging population.
Aside from the severe lack of qualified physicians, public hospitals also have a chronic bed shortage. The
total number of hospital beds in Vietnam increased to 254,885 by 2016 from 209,485 in 2011. Although the number of beds per inhabitant provided by the network of hospitals is high, the bed occupancy rate in Vietnam much higher than the 80 percent threshold that WHO recommends. In the packed public hospitals, the Health Ministry estimated that the bed occupancy can reach up to 170 percent. It is not uncommon to see multiple patients sharing hospital beds or waiting outside the hospital on bamboo mats.
The lack of resources, both manpower and facilities, to meet the demand of the patients means that not everyone would be guaranteed the best care. With the public hospitals overstrained and often running past capacity, the government is looking to the private sector to help address the issues. Many big domestic corporations like Vingroup and Hoan My Corporations have started to create hospital and clinic chains across Vietnam that offer high-quality medical care. The number of private clinics and hospitals now far exceeds the public ones.
While Vietnam has decentralized its healthcare system and formalized recognized private services nearly 30 years ago, private facilities are often overpriced and reputation is still limited. The Health Ministry estimated that only 7 percent of Vietnamese used private-sector health services. The government is now welcoming international firms to help shoulder the burden of the overrun public hospitals. It promises to not put restrictions on qualified foreign doctors who want to practice in Vietnam.
Many people worry about the long lines in the overcrowded public hospitals where the waiting time averages four to seven hours. However, they don’t want to pay the exorbitant price at private clinics. So, some people often choose to self-medicate when they are not feeling well. The only prescriptions they would need are recommendations of drugs from friends and relatives or from the pharmacists, who oftentimes do not have the required qualifications.
Medications, including antibiotics, are readily available at private drugstores in Vietnam without a doctor’s
prescriptions. According to the Ministry of Health, 88 percent of antibiotic sales in urban cities do not have prescriptions. This figure is as high as 91 percent for rural areas. The habit of self-medicating has led to a high rate of drug resistance in Vietnam. WHO has listed Vietnam as one of “the countries with the highest antibiotic-resistant infections.”
Even though there are state regulations that pharmacies should only sell drugs with prescriptions, many often ignore them since they would not be able to compete with others if they insisted on prescriptions. With only mild penalties for violations, almost no drugstore would ask for prescriptions from buyers. The director of National Tropical Diseases Hospital in Vietnam commented: “It is no exaggeration to say that drugs, especially antibiotics, are bought and sold … as easily as vegetables.”
Improving Healthcare in Vietnam
The advancements that healthcare in Vietnam has made over the past few decades are commendable. Positive health benefits that can be seen through longer life expectancies and the drop in maternal as well as infant mortality rate. However, significant challenges are still present in the medical landscape of Vietnam with the major issue being overloaded public hospitals and limited alternative options. Vietnam is undertaking some healthcare reforms to improve its situation.
In addition to encouraging the private sector, Vietnam is also requiring healthcare facilities at central and provincial levels to help build up the capacity of those at the district and commune levels. The policy focuses on technical skills transfer with the key objective to alleviate the stress of those at higher-level hospitals.
Additionally, with foreign investment in the healthcare system increasing, people’s access to and attitudes toward the medical facilities are improving. Hopefully, the shortcomings that healthcare in Vietnam is facing right now are temporary, and Vietnam will soon be able to take its healthcare system to the next level of development.
– Minh-Ha La