IHHR Magazine Feature Contribution
Vietnam Spotlight to be published in the next issue of International Hospitals & Healthcare Review, a supplement publication of ITIJ .
Interviewed by Robyn Bainbridge
Writer and Copy-Editor
Voyageur Group
+44 (0)117 9226600
19 Lower Park Row
Bristol, United Kingdom
Ms. Robyn Bainbridge: Hello Care of Asia team, I’m hoping to address issues affecting the quality of, and access to, healthcare in Vietnam for both insurers and hospitals, and hopefully helping to identify how insurers/assistance providers and hospitals can better work together to address these.
Question 1: What would you say the standard of healthcare is in Vietnam within both the public and private sectors? For example, are facilities generally of an ‘international’ standard? Are there many accredited hospitals/clinics within the country? Are there many ‘centres of excellence’ or specialist medical units?
Care of Asia team: The majority of international hospitals in Vietnam, although not all of them, meet international quality standards, and offer service which is comparable to what you can find in the West. In these hospitals, the doctors and nurses are capable of speaking English, whether because they are foreigners or because they are locals who have studied outside of Vietnam. Especially in big cities like Hanoi and Ho Chi Minh city where we have excellent accredited medical facilities like Vinmec hospitals, Hanoi French hospital, Franco Vietnamese hospital and City International hospital (CIH)…. With more investment and facilities, Vietnam is now also offering its medical treatment to more than 300,000 foreign patients each year. Many of them are from Cambodia. For example, CIH also provided Cambodian speaking specialists to accommodate the growth of this market.
In Vietnam, there are more than 1,167 public hospitals and 191 private hospitals, The total number of hospital beds increased from 254,885 in 2016 to 286,690 in 2019. A report also showed that there are 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.
The general standard of healthcare has been improving over the years. Since the Vietnamese government is encouraging more foreign investment to upgrade their local medical facilities to a new level, provided that the following conditions are satisfied: Homecare, nursing, and emergency evacuation services are subject to approval on a case-by-case basis. Minimum investment capital for a commercial presence in hospital services of at least S$20 million for a hospital, US$2 million for a policlinic unit and US$200,000 for a specialty unit. Followed by many foreign investors, some of the best hospitals are being built or finished like: New Cho Ray hospital with more than 1000 beds, New Tumor Hospital or New Children Hospital in Ho Chi Minh city. Other domestic companies will also invest $95 million to build an international-standard hospital with 500 beds in Hanoi, with Phase I to be completed by the end of next year. India’s Fortis Healthcare agreed to pay $64 million for a 65% stake in Hoan My Medical Corporation, one of Vietnam’s biggest private healthcare groups with six hospitals and many other clinics and facilities nationwide. Many executives of a number of hospitals and pharmaceutical companies from Germany and France have come to Vietnam. They are showing the most interest in high-end healthcare market, which mainly serves wealthy people and foreigners working in the country. More upscale facilities are in the pipeline.
Question 2: What is the access to healthcare like in Vietnam?For example, in terms of geography, bed shortages, issues specifically relating to international patients. Are patients often flown out to Bangkok and Singapore for more extreme medical emergencies? Is patient steering a major problem in the country? How are these problems overcome?
Care of Asia team: Vietnam has 63 provinces and cities, every province has their own biggest general hospital. However, there are always more specialists, lots of different specialty hospitals in big cities like Hanoi, Ho Chi Minh city and Danang than rural areas and other provinces. Generally speaking, medical facilities in Vietnam in both public and private sector are quite basic comparing to Thailand and Singapore in Southeast Asia. There are more and more international standard hospitals being built which will give a great access to health care for international patients in the next coming years.
There is still a fact that in rural areas, local patients couldn’t seek for a proper medical treatment. There’s also a shortage of qualified doctors in rural area. Many old medical equipments are still in use and they really need to be upgraded. Therefore, it drives thousand patients from rural parts of the country to visit central hospitals in Hanoi, Danang, Ho Chi Minh city everyday for even basic medical problems, making those central hospitals so crowded and overloaded. 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 . Bed occupancy rates have reached 120–160%, especially in the central hospitals of some large cities. Overcrowding in higher level healthcare facilities may have several causes, including limited healthcare quality in lower level facilities in districts and communes, and even in provincial hospitals; 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. This may lead to a drain on resources in higher level hospitals and subsequent wastage at lower levels. If the current situation is not improved, this situation will eventually result in major inefficiencies across the entire Vietnamese health care system.
In relating to international patients, normally, many patients will be transferred to closest International hospitals in big cities like Ho Chi Minh city in the South, Hanoi in the North, Danang in the Central. For example, in emergency cases, many insureds got admitted to local rural state-owned hospitals where it is impossible to ask for a medical report officially. That is why Care of Asia is usually requested by international insurers to dispatch our own staff there to visit the patient to reassure that they are being assisted as a family. Then, Care of Asia staff will help communicate with treating doctor to learn more about patient’s medical condition to update it regularly to the insurances. Treating doctor, insurer and our medical expertise will then find the best way for the patient to be treated. Most of cases, to serve the patients with our best possible care, the insurances will ask for Care of Asia’s assistance to transfer their insured to nearest international hospitals. With our ambulance network and medical team to be spotted throughout the country, our medical crew can approach to patient’s location within the timeframe: 15-45 minutes.
Some severe cases, an evacuation to Bangkok or Singapore is necessary. Care of Asia is handling this type of evacuation quite regularly. We keep the process especially Tarmac Access service, ground ambulance going smoothly with professional medical escorts and spacious comfortable aircraft. All is put in our hand-held service. It is a big contribution to solve major medical problems in Vietnam, Laos, Cambodia and Myanmar for international travelers and expats.
Question 3: What are some examples of the issues that assistance providers come up against when dealing with hospitals in the country?
For example, cases of over-treatment or over-charging for treatment; whether direct-billing is generally available between hospitals and insurers. Are there any communication issues, such as language barriers? How are these issues overcome?
Care of Asia team: Insurance assistance service is now quite new in the country and it will take time for this kind of wonderful assistance service to be recognized. For example, state-owned hospitals accept no direct guarantee of payment from assistance provider or the insurers due to their policy. Therefore, Care of Asia always manages to connect with our network doctors who can be dispatched to local hospitals where patients are admitted. We help obtain medical report verbally and settle the payment for the insured by cash as per instruction from the insurers
International and private hospitals in Vietnam are adapting quickly with insurance procedure. They have their own insurance department to deal with assistance companies or insurers to provide medical reports and estimated costs on daily basis so that the insurers can validate patient’s policies in time and assist the insured effectively in due course. Then assistance company can assist with settling the medical expenses right away. Most international hospitals accept direct billing from the insurers or assistance companies like Care of Asia.
Considering that the majority of expats and international tourists in Vietnam who have health insurance with very broad coverage, some of hospitals take advantage of this fact to inflate bills, which at times can end up being exaggerated. Overcharging or over-treatment is a major concern from the insurers and it could be a big problem for those medical facilities outside of Care of Asia’s medical network. Within our preferred network, cost containment is under control and prices from our network are very competitive and reasonable. Over-treatment will be considered as fraud and any supplier who ever applied over-treatment and over-charing on the patients will be taken out of the list.
Answering to the questions about communication issues, such as language barrier. It 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. This wouldn’t make the process of assisting the insured go smoothly. Also, even in big international hospitals in the city where many doctors and staff may speak good English but not Korean, Japanese or Chinese… Care of Asia’s interpreter team is available at all time as per client’s request. We can tele-communicate with the treating doctor and patient so that they can communicate with each other for simple outpatient cases. However, when the requirements get more complicated, Care of Asia’s multilingual team will be dispatched to the hospital to stay beside the patient and help communicate with hospital staff, doctors…24/7 for any assistance. Thank you very much!
By Dr. Vu Ha Nhu Ann - Care of Asia