Robyn Bainbridge investigates Vietnam’s medical reputation to find out what access to healthcare really looks like in the region and how the landscape is changing
Vietnam is the outermost country that curls around the north-eastern shoreline of Southeast Asia. A 1,092-mile stretch of land lies between the two main metropolises to the very north and very south – Hanoi and Ho Chi Minh City. And that’s a lot of ground to cover for anyone finding themself in need of medical care while travelling outside of these cities. Though an ideal location to buy yourself a sparkly new set of teeth, Vietnam has not always been renowned for having an international standard of healthcare. For many years, patients requiring emergency medical care have often been evacuated to more advanced facilities in the Southeast Asia region, including those in Bangkok and Singapore. And even those local to the area requiring routine procedures would much rather hop on a plane then wrestle with the bedlam of an oversubscribed hospital. However, with the phenomenal numbers of travellers that visit the country every year, the medical landscape is inevitably changing and reputable facilities are popping up.
Distinguishing the good from the bad
There are countless hospitals located across Vietnam’s 63 provinces and cities – Dr Vu Ha Nhu Anh of the house-call doctor team for Care of Asia Ltd cites more than 1,167 public hospitals, 191 private hospitals, more than 30,000 private polyclinics, 87 small-sized maternity hospitals, 30 foreign-invested clinics, and 29 clinics with involvement of foreign doctors across the country – though anyone lacking all but an extensive knowledge of the Vietnamese healthcare industry would be forgiven for not knowing about these, and really, many would argue that only a small percentage of these provide an ‘international standard’ of care.
Niklas Lindberg, Chief Operating Officer at American International Hospital in Ho Chi Minh City, explains that, in the last five years, Joint Commission International (JCI) accreditation has become one of the most important goals for all the international hospitals in Vietnam; but CEO and Founder of Family Medical Practice Dr Rafi Kot disputes this; he questions the credibility of achieving this accreditation, suggesting that facilities that have JCI accreditation – which he states are few and far between – often only maintain the JCI standards for the few days surrounding the audit date.
Dr Vu expounded this view: “Generally speaking, medical facilities in Vietnam, in both public and private sectors, are quite basic compared to Thailand and Singapore in Southeast Asia.” But she reasoned that a recent surge in foreign investment in the Vietnamese healthcare system has improved the standards of facilities, including the new Cho Ray Hospital and new Children's Hospital in Ho Chi Minh City, the Vinmec hospitals, Hanoi French Hospital, Franco Vietnamese Hospital and City International Hospital (CIH). “There are more and more international-standard hospitals being built, which will give great access to healthcare for international patients in the coming years,” she said.
Having too many patients in higher level hospitals has become an urgent problem in recent years, with two to three patients sharing a bed becoming common in many central and provincial hospitals
Three’s a crowd
Medical talent in more rural areas, meanwhile, leaves a lot to be desired. “Outside of the major cities in Vietnam, there is a significant shortage of specialised doctors and nurses,” said Dr Geoff Ramin, Chief Medical Officer APAC Region, Allianz Partners. “Often there is limited access to diagnostics, medical equipment and treatment modalities.” He also said that there are often language barriers, and usually these facilities are not suitable for the standard of care many assistance companies look to provide for their customers.
As a result of this, there is a great strain on those few facilities that do offer quality healthcare. What’s more, Dr Vu explained that increasing expectations of service quality, improvement in convenience of transportation from remote areas to central areas and limited differences in hospital fees at different administrative levels can all contribute to overcrowding in more reputable facilities.
“Having too many patients in higher level hospitals has become an urgent problem in recent years, with two to three patients sharing a bed becoming common in many central and provincial hospitals,” she said. “Bed occupancy rates have reached 120-160 per cent, especially in the central hospitals of some large cities.”
On the other hand, Lindberg notes that, compared to European countries where there are ageing populations with chronic diseases, in Vietnam, a young average age means that infections are more common. “The [bed occupancy] rate does not reflect the demands or needs of a market,” he reasoned.
Still, overcrowding in hospitals is an inherent problem in Vietnam: “This may lead to a drain on resources in higher level hospitals and subsequent wastage at lower levels,” warned Dr Vu. “If the current situation is not improved, this will eventually result in major inefficiencies across the entire Vietnamese healthcare system.”
There is still a deep-rooted mistrust of the Vietnamese healthcare system
Beggars can’t be choosers
With such an unlevel medical playing field, it’s important for assistance companies and insurers to have a good lay of the land.
Dr Vu explained: “In emergency cases, many insureds get admitted to local rural state-owned hospitals.” She noted that, because many assistance providers are still quite new to the country, state-owned hospitals will often still not accept direct guarantee of payment from either assistance companies or insurers, and in these facilities, it is also often impossible to ask for a medical report officially.
“English is still spoken poorly among many doctors,” said Dr Kot, referencing medical access in more rural areas. “The notion of operating in a communist state and dealing with mainly local patients left most facilities unprepared for foreign patients in terms of service or payment. Not so long ago, foreigners paid the same as the Vietnamese for medical services in state facilities, with prices dictated by the state.”
As such, many assistance companies will insist on transferring patients to the closest international hospitals in big cities like Ho Chi Minh City, Hanoi and Danang, commented Dr Vu. She added that Care of Asia is often requested by international insurers in rural hospitals to visit patients with a view to transfering the insured to the nearest and most appropriate international hospital. Therefore, Care of Asia stations ambulances and medical team members at various places across the county – in this way, the assistance company is able to reach any patient within a 15- to 45-minute timeframe.
Language barriers are not exclusive to rural parts of the country
Dr Ramin notes that Allianz aims to provide patient care in more developed or private healthcare facilities, and so avoids sending patients to public hospitals. “When placing patients or recommending facilities in Vietnam, we also prefer to have inspected them so that we can ensure the regulated standards of care. As a result, we are limited to a small number of facilities in Vietnam. The only cities we would look to retain patients in would be Hanoi and Ho Chi Minh City.” Even then, Dr Ramin reasons that he would not consider any hospital in Vietnam to be classified as a ‘Centre of Excellence’. He notes that the ones Allianz has successfully inspected are able, however, to provide an appropriate standard of tertiary care for select patients.
Communication is key
But even then, language barriers are not exclusive to rural parts of the country. “It has happened occasionally with some local private hospitals where the patient may have received very good medical treatment and pleasant service but some staff may not be able to speak good English," explained Dr Vu. "This wouldn’t make the process of assisting the insured go smoothly.”
Further still, language barriers are not exclusive to Western society. Dr Vu said that even in big international hospitals in the city, many doctors and staff may speak good English but not Korean, Japanese or Chinese.
In response, some assistance companies will insist on dispatching an interpreter team and providing telecommunication services, so that the treating doctor and patient can communicate with each other for simple outpatient cases. “However, when the requirements get more complicated,” said Dr Vu, “Care of Asia’s multilingual team can be dispatched to the hospital to stay beside the patient and help communicate with hospital staff and doctors 24/7 for any assistance.”
Communication is also essential when it comes to detecting and deterring overcharging and overtreatment. “Considering that the majority of expats and international tourists in Vietnam have health insurance with very broad coverage, some hospitals take advantage of this to inflate bills, which at times can end up being exaggerated,” warned Dr Vu. Though, for an assistance provider or insurer with a good level of field knowledge that is well-versed in the Vietnamese healthcare system, this is a little easier to manage. Dr Vu explained that her company can dispatch one of its doctors to a treating hospital to help obtain a verbal medical report and settle the insured’s payment by cash, as per instruction from the insurers. “Over-treatment will be considered as fraud and the supplier will be taken off our list,” she said.
A recent surge in foreign investment in the Vietnamese healthcare system has improved the standards of facilities
Then again, Dr Vu noted that international and private hospitals in Vietnam are adapting quickly to the insurance procedure: “They increasingly have their own insurance department to deal with assistance companies or insurers to provide medical reports and estimated costs on a daily basis so that the insurers can validate patient’s policies in a timely manner and assist the insured effectively in due course. Then the assistance company can assist with settling the medical expenses right away.” She added that most international hospitals accept direct billing from insurers or assistance companies.
Changing the narrative
Ultimately, there is still a deep-rooted mistrust of the Vietnamese healthcare system, according to some experts. “Once international patients contact their insurance providers, in lightning speed, Bangkok becomes an automated referral centre,” Dr Kot said, noting that there is always a temptation for assistance companies to steer patients directly to Bangkok, under the impression that Vietnamese facilities will not be as efficient as those well-known to them in the Thai capital.
This instinctive deference allows issues with the medical infrastructure in Vietnam to come around full circle, say some, resulting in the ‘major inefficiencies’ that Dr Vu referenced above. And yet, many remain confident that things are soon to change.
Kot mentioned that those local to Vietnam seeking medical help are now keen to stay in the country, finding that Vietnamese doctors wield the same levels of expertise as those in neighbouring countries, and are often much cheaper. Indeed, change has to start from within.
What’s more, the tourism market is changing. “The percentage of European and North American tourists (who are mostly insured) are a mere 35 per cent of the total (they used to be 70 per cent), as massive amounts of Chinese, Korean and Russian tourists flood Vietnam,” Dr Kot explained.
“The hospitals, including the government hospitals, are realising that tourists are a source of income as well,” he observed. Still, he noted that only a few government hospitals have established international departments, and he reasoned that Vietnam, with a population of almost 100 million, is likely prioritising its care of resident patients.
Despite the obvious flaws, hospitals and insurers operating in the region seem to suggest that the limitations and restrictions of the Vietnamese healthcare system are only temporary. With foreign investment in the healthcare system increasing, attitudes towards the country’s medical facilities are slowly improving, as is patients’ access to healthcare. The changing face of the tourism market will likely drive further investment from other economically developed countries surrounding Vietnam. And this is a shift that could well see an influx of medical travellers from neighbouring countries eager to benefit from the competitive prices.
For now, the best bet seems to be to prioritise working alongside international facilities – particularly those in the larger cities – and to provide as much in-house assistance as possible. ■