Private hospitals have struggled to attract patients in the ten years since they were permitted to operate and have been unable to share the burden with public hospitals.
Being treated in a public hospital has never been an easy experience for Ms. Nguyen Thi Khi, a retired school teacher in Hanoi. Most members of her family, she said, seek treatment at public hospitals such as Bach Mai Hospital or military hospitals like the 103 Military Centre Hospital.
Over recent years, patient overload at public hospitals has become a pressing problem. Occupancy can sometimes run at 110 per cent, with patients sharing beds. As a means of addressing the issue the government has encouraged investment in the private healthcare sector. Yet many people, including Ms. Khi, still prefer public hospitals over private hospitals, and this is one of the difficulties the latter continually faces.
Large investment, low capacity
It’s often noted that private hospitals are growing rapidly. There are now nearly 170 around Vietnam, with total investment capital standing at VND120 trillion ($7.5 billion), representing 11 per cent of the national healthcare system. There are also large-scale private hospitals providing 400-500 beds, which contribute to some extent to reducing the overload at public hospitals. Mr. Nguyen Van De, Chairman of the Vietnam Private Hospital Association, said that ten years after private investment in the healthcare sector was permitted, many developers have invested in private hospitals and shared responsibility for treatment with the public hospital system.
He acknowledged, however, that despite its ongoing development the private hospital sector in recent years has faced significant problems in attracting patients. A recent report from the Bureau for Examination and Treatment Management at the Ministry of Health (MoH) indicated that the private hospital sector has increased from 40 to 70 hospitals in ten years. Meanwhile, the percentage of patients coming to private hospitals has stayed at less than 10 per cent of the total every year. Occupancy is always low, at 40 to 60 per cent. As patients share beds in public hospitals, empty beds are a common feature of private hospitals.
Difficulties to address
The public hospital system has been built and developed for the 60 years since Vietnam claimed independence in 1954 while private hospitals have only be around for ten years. According to Mr. Pham Van Gia, Deputy Director of Trang An Hospital, the government has provided State budget funds for public hospitals to invest in modern equipment. Public hospitals have also engaged many specialist and doctors. The private hospital sector has not received any budget funds at all, he said, so most infrastructure at private hospitals is not as good as at public hospitals, which is one reason for the quality imbalance between the two.
Speaking at a recent workshop on health, Mr. Luong Duc Khue, Director of the MoH’s Bureau for Examination and Treatment Management, said that in the northern region there are nearly 1,800 public hospitals compared to just 70 private hospitals, 23 of which are in Hanoi. “I have been in many countries around the world but nowhere has such an uneven distribution of hospitals as in Vietnam,” said an experienced doctor from Doctors Without Borders. Throughout the country there are clusters of hospitals and clinics in certain areas while other areas have too little in the way of medical facilities.
The higher cost of private hospitals doesn’t represent “better” healthcare in some cases. Many private hospitals have made huge investments in infrastructure to attract patients. While some large-scale private hospitals are equipped with high technology and treat large numbers of patients, not every private hospital is in a similar situation. Despite their modern infrastructure, some private hospitals must still coordinate with public hospitals regarding difficult surgical procedures. The quality of human resources is a key issue. Mr. Hoang Dinh Chan, Director of the Hung Viet Hospital, said that human resources are the most important factor at a hospital, followed by modern facilities and price. “A good doctor means saving more patients,” he said. It’s not easy, however, for some private hospitals to find good doctors.
Importantly, the beliefs of patients are a main factor in a hospital’s development and is a major problem facing Vietnam’s private hospitals. Mr. Chan said that, in Singapore, most patients will go to private hospitals for treatment but in Vietnam the opposite is true. According to experienced doctors contacted by VET, health insurance is one of the main reasons this is the case. Patients with health insurance receive a subsidy of 60 per cent on public hospital visits against 30 per cent for private hospital visits. Moreover, the cost at private hospitals is always higher than at public hospitals.
Private hospitals will play an important role in Vietnam’s healthcare sector in the future, representing 20 to 30 per cent of all hospitals in the country, according to Mr. Gia. “Therefore, the government needs to support private hospitals by reducing State budget funds for investment in public healthcare and creating a balance between public and private hospitals, so the competition will improve the quality of healthcare,” he said.
In order for the private sector to make a major contribution to Vietnam’s economic growth and to force the State sector to become more efficient, the Vietnam Private Hospital Association needs to call for cooperation among members to strengthen the activities of each. Workshops should be organized where private hospitals can exchange experience and learn about investment management from foreign hospitals. About 90 per cent of private hospitals are members of the association, Mr. De said. Moreover, private hospitals must invest in facilities and equipment and attract good doctors to work for them. “The Ministry of Health has considered directing leading public hospitals to transfer technology to private hospitals,” said Minister of Health Nguyen Thi Kim Tien.
“The private hospital model needs to focus on the quality of existing facilities over the next few years rather than simply focus on the number of hospitals being built. Private hospitals should expand their scale, support all patients, from high-income earners to low-income earners, and treat all types of ailments.”
Mr. Pham Van Gia, Deputy Director, Trang An Hospital
“Public hospitals may not want to share the overload with private hospitals in some cases. In order to reduce overloads at public hospitals the government needs to create favorable conditions for private hospitals to work with public hospitals.”
Mr. Hoang Dinh Chan, Director, Hung Viet Hospital
“With the local economy developing rapidly many Vietnamese people can now pay for high quality healthcare services. Being of good quality, Vietnam’s public hospital system is always overloaded and private hospitals are not be able to meet the demand for healthcare services. As a result, the number of Vietnamese people going abroad to access foreign healthcare services is on the rise.
Minister of Health Nguyen Thi Kim Tien