Bursting at the Seams: Healthcare and Medicine in Vietnam

Health - Vietnam: June 7, 2019

Vietnamese healthcare struggles to keep up with population growth

Vietnam has one of the best hospital beds-to-inhabitants ratios in Southeast Asia, falling only behind Singapore

Hospitals in major cities in Vietnam are at 80% occupancy

The quality and availability of healthcare are critical components for people who are looking to relocate to a new city. However, not much has been said or is known about healthcare in Vietnam outside of the country. So, is the quality of healthcare in Vietnam good?

The short answer is yes, although it’s not at its best at the moment. However, it’s certainly improving.

Dealing With the Numbers of Those Seeking Healthcare in Vietnam

As with any other developing country, major cities grow rapidly, and so do their populations. This results in a strain on the infrastructure and especially healthcare facilities as authorities try to balance demand and supply.

According to Business Monitor International, healthcare expenditure in Vietnam was US$16.1 billion in 2017, making up about 7.5% of the country’s Gross Domestic Product. This figure is expected to hit US$20 billion by the end of this decade, a result of changes in living standards and an ageing population.

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Overcrowding in hospitals, shortage of medical staff and obsolete equipments and intensive care units have been some of the problems that the healthcare sector have been dealing with.

To prove the lack of confidence in their own system, Vietnamese patients have spent close to US$2 billion seeking medical treatments abroad, according to data released by Export.gov.

Understanding The Structure of Healthcare in Vietnam

Vietnam’s healthcare works on a decentralised system where provinces, districts and communes have autonomy to implement their own healthcare policies. The organisational structure of Vietnam’s healthcare system is divided into these four groups:

CENTRAL LEVEL

Under the purview and management of The Ministry of Health, this level consists of the government healthcare sector, together with hospitals, research institutions and universities.

CENTRAL-AFFILIATED PROVINCE/CITY

A collection of hospitals and medical centres, medical colleges, nursing and pharmacy programmes.

DISTRICT LEVEL

District health centres mostly offering medical and preventative services such as vaccinations.

COMMUNE LEVEL

Focusing on primary healthcare services at a community level.

Healthcare and Medicine in VietnamImage source: shutterstock.com

In terms of quantity, Vietnam’s healthcare network actually has a sizeable number of hospitals across the country. As of figures from 2017, there are about 1,160 public hospitals, in branch, provincial and national levels. However, 75% of these hospitals were built more than 20 years ago. There are also about 185 private hospitals scattered across the various cities bringing the total number of beds to over 200,000, or an average of 22 beds per 10,000 people.

Regionally, Vietnam has one of the best beds-to-inhabitants ratio compared to its neighbours, falling only behind Singapore which has an average of 27 to 10,000. However, while the figure may seem good on paper, it glosses over another important factor: the occupancy rate.

Are Vietnamese Hospitals Bursting at the Seams?

Vietnamese hospitals have been exceeding the 80% threshold occupancy rate set by the World Health Organisation. The worst hit are its national-level hospitals in the major cities which have hit occupancy rates far exceeding 100%.

In 2009, K Hospital hit a record 250% occupancy rate and more recently, Vietnam National Cancer Hospital registered an occupancy rate of 172%, Bach Mai Hospital at 168% and Cho Ray Hospital at 139%.

Although the reasons for overcrowding in hospitals can be pinned on a variety of reasons from population numbers to inefficiency, another reason is simply down to the general mindset towards the system.

Patients living in rural areas would rather take a 50km journey to a national-level hospital in the city than to a smaller hospital within their province as they feel the quality of care would be much better.

Healthcare and Medicine in VietnamImage source: sakurahanoi.com

Every efficient and demanding public service system requires a huge, well-trained workforce. Unfortunately, Vietnam’s healthcare industry is facing problems here too. With a shortage of doctors and nurses tending to the huge number of patients every day, many of them are overworked, with stressful conditions and relatively low wages.

According to Dr. Tran Quoc Khanh, Resident Doctor at Vinmec Hanoi and Spine Surgeon at Viet Doc Friendship Hospital, he believes the number of patients he has seen in his hospitals could be higher than in many other parts of the world.

“Did you know we had about 67,000 surgeries in Viet Duc Friendship Hospital in 2018 alone? Not many hospitals around the world has reached that amount and there were also a few surgeries that lasted between 4 to 10 hours”, he said.

He also added that one of the critical resources all hospitals need is blood. “No matter how good the doctors are, or how advanced technology is, no matter how well-trained the medical staff is, if there’s not enough blood, we will never be able to keep the patient alive”. He added that demand for blood has always been high at Viet Duc Friendship Hospital.

Public hospitals in Vietnam rely largely on a State budget to maintain and upgrade their facilities, equipment and services. Even though the budget has increased in recent years, it’s still struggling to keep up with modern day demands.

Healthcare and Medicine in VietnamImage source: tiepthidautu24h.vn

Other factors affecting the confidence of residents in Vietnam’s healthcare sector are the shortage of medical equipments for critical care, as well as the wide availability of pharmacies, which has turned out to be a double-edged sword: patients who start relying on self-medication for small ailments to save a trip to the hospital. As previously reported, the practice has created powerful new antibiotic-resistant bacteria.

Vietnam Plans its Way Forward

In 2014, Vietnam issued Decision 68, a national strategy to develop the country’s pharmaceutical industry by 2020. The plan under this strategy is to gradually replace imported medicines with domestically produced ones, keeping medicines available and affordable.

Decision 68 also covers public health, preventative medicine and primary care systems. According to the plan, the target by 2020 is to have 25 hospital beds, with at least eight physicians and two pharmacists available for every 10,000 people.

The total number of hospital beds has increased from 209,485 in 2011, to 254,885 in 2016. The government has highlighted the growing demand for beds by also increasing the share of private beds to 20% of the total beds by 2020, affording a higher quality of care for patients by building new private hospitals through public-private partnerships.

Looking Outwards

Besides strengthening the industry through domestic production, Vietnam is also embarking on foreign investments of up to 100% in healthcare establishments, pharmaceuticals, medical devices and medical training units.

These include hospitals, polyclinics and specialised clinics; homecare and nursing services; emergency evacuation services; and all activities related to pharmaceutical production and medical devices from manufacturing, testing and storage. Only distribution is not covered in this plan.

Healthcare and Medicine in VietnamImage source: nganhangphapluat.vn

Investors can also set up a vocational training unit or even a university for medical training and educational purposes either privately, or through public-private partnerships.

Taking Hospital Technology Into the Future

One way to curb the healthcare industry’s problems is through the use of technology. The government has begun piloting new systems which could potentially integrate healthcare with the internet of things.

One of the new systems is a Swedish-based single electronic medical record which communicates with a Microsoft-developed, cloud-based patient information system, entirely mobile and cloud-based.

Healthcare and Medicine in VietnamImage source: careplusvn.com

Another system consists of wireless medical device packs, the size of a small suitcase. These packs include devices for measuring blood pressure, blood glucose, a 12-channel ECG, stethoscopes, thermometers, dermoscopes and other rapid tests. The tele-assessment apps within these packs communicate directly with clinicians in hospitals situated in urban areas and are saved to a single electronic medical record and processes pre-analysis work for clinicians to make assessments.

While it’s still not clear if the goals set out for Decision 68 will be achieved, what is certain is that the healthcare industry is not just growing in numbers, but there is also a huge potential for businesses and investments, something that could propel Vietnam’s healthcare sector to be among the continent’s best.

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