By: Deanna Altomara

Of all the countries I visited on my study abroad program in the Spring of 2019, Vietnam felt the most foreign. This southeast Asian country had a completely different language, culture, and history than anything I’ve ever experienced. There is also a unique system of public-private healthcare run by a Communist government, something that might seem unfathomable to many US citizens. 

Starting from its independence in 1945, Vietnam embraced a model of public healthcare. For over forty years, all healthcare services were provided free-of-charge to citizens. In 1978, the system began to incorporate primary healthcare. However, this fully-public system proved unsustainable and was adjusted shortly after the economic Renovation of 1986. In 1989, the first healthcare service fees were charged in Vietnam. Since then, the fees have increased, limiting access to healthcare, but the poor and children under six continue to be completely covered by public insurance.[1] 

Vietnam’s current health system is modeled off that of the Soviet Union. The Ministry of Health oversees the system and divides its duties into three pillars: prevention, treatment, and administration. Each of these pillars is managed at the communal, district, provincial, and national levels. At each level, health centers specialize in primary care, while hospitals specialize in treatment of developed diseases, and health departments coordinate administrative activities.[2]

While public insurance is widely used, private insurance is also available. Private insurance policies allow patients to receive primary care (like regular physicals) on an outpatient basis, while public insurance might not. Instead, publicly-insured patients might be forced to use emergency care for conditions that might have initially been prevented or treated with primary care. For example, someone who can’t get a regular physical might not realize they have a complication like high blood pressure, which when untreated can lead to escalation of symptoms and in some cases, medical emergencies.

Additionally, wealthy patients with private insurance are more likely to live in urban areas with greater access to primary care. Poorer people living in rural areas might have to travel farther in order to reach a health center than their urban counterparts. Healthcare coverage is a crucial protection for these vulnerable groups, as the poor generally receive more exposure to disease and little means to prevent or care for it. The differences in healthcare between urban and rural populations is seen in child mortality, which was more than twice as high in rural regions compared to urban regions in 1984-1993.[3] However, it is also important to take into consideration that these differences might not just be due to access to healthcare, but also nutrition, language barriers of ethnic minority groups, and other health factors. In either scenario, the inequity between the rich and poor, as well as urban and rural, is appalling. 

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A woman measures out a prescribed dose of a straw-like herb at the Hospital of Traditional Medicine in Hanoi

Many national and provincial hospitals are centrally located in cities, where they can treat the most patients. These national hospitals serve the entire population of Vietnam, and so have the largest resources and specializations. Patients in need of complex care are often required to travel to the cities for treatment, regardless of how far from the hospital they live. Doctors also often prefer to live in cities, where salaries are higher. Consequently, there are hospitals and health professionals in cities like Hanoi and Ho Chi Minh.

Unfortunately, with a population as large as Vietnam’s, large numbers of patients are forced to migrate to the city for specialist care. The national hospitals are often overwhelmed by the sheer number of patients, causing severe overcrowding and long wait times. It is not uncommon to find two patients sharing a hospital bed in an urban national hospital.[2] Overcrowded conditions do not only strain the hospital’s resources, but also create mental and physical stress for patients and doctors alike. The close quarters also facilitate the spread of infectious disease among patients, visitors, and doctors. Unsurprisingly, hospitals were a major center in the spread of infections like SARS in 2003. Patients, who often may already have a weakened immune system, may acquire new infectious diseases in the hospital, increasing morbidity and mortality. Furthermore, the widespread use of unprescribed antibiotics in Vietnam has led to a wave of antimicrobial resistance. The air in hospitals in considered to be dangerous, and many families avoid bringing children to hospitals to visit their loved ones.

A unique facet of Vietnam’s healthcare system is that it wholeheartedly champions the use of traditional medicine. Vietnam’s history of traditional medicine has deep roots, including the revered Hai Thuong Lan Ong, known today as the Father of Traditional Medicine. Hanoi’s well-frequented traditional medicine street, which features a multitude of shops and countless herbs, is dedicated in his name. It is held as common knowledge that traditional medicine has many curative properties, but is much more effective with chronic diseases or preventative treatments than for acute situations. While traditional medicine is more popular among the rural and older populations, it is made available to everyone through the healthcare system. The esteemed National Hospital of Traditional Medicine in Hanoi is packed with patients receiving acupuncture, therapeutic massages, and carefully-measured doses of herbs to dissolve in their tea. People from near and far are eager to access these services, which are delivered by well-trained and experienced professionals. 

Vietnam has many challenges to face, but it also has incredible strengths. As the country continues to grow, it has tremendous potential to improve the lives of its denizens—starting with quality healthcare. 

References:

[1] Le, D., Kubo, T., Fujino, Y., Pham, T., & Matsuda, S. (2010). Health Care System in Vietnam: Current Situation and Challenges. Asian Pacific Journal of Disease Management, 4(2), 23-30. doi:10.7223/apjdm.4.23

[2] Cheng, T. (2014). Vietnam’s Health Care System Emphasizes Prevention And Pursues Universal Coverage. Health Affairs, 33(11), 2057-2063. doi:10.1377/hlthaff.2014.1141

[3] World Bank. 2001. Viet Nam – Growing healthy : a review of Viet Nam’s health sector (English). Public expenditure review (PER). Washington, DC: World Bank.

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