With Vietnam's public hospitals stretched beyond their limits and private healthcare a fledgling sector, there's billions to be made courting deep-pocketed Vietnamese for medical treatment overseas.
It's a tidy niche that one former Vietnamese medical student carved out for herself. She made $3,200 a month - 20 times the average income of her peers - working the phones to earn hospitals in nearby Singapore a slice of the $2 billion that Vietnam hemorrhaged on overseas healthcare last year.
With that flight of overseas cash equivalent to 60 percent of state health spending, private operators both foreign and domestic are smelling opportunity in keeping that in Vietnam. Local conglomerate Vingroup is planning huge hospital expansion from next year.
Some 40,000 Vietnamese a year won't take their chances with the snaking queues, chronic bed shortages and overworked doctors at home. While Vietnam's medical spending as a percentage of the economy is the highest in Southeast Asia, it hasn't kept up with the population's demand for quality and timely medical care.
"It's a matter of trust. They don't feel safe in Vietnam," said the former student, who spoke on condition of anonymity. "Vietnam only has a few private hospitals, a drop in the ocean, and people with money prefer to go to a pricier place with certified and better doctors."
Vietnam has a 90 million population, and its middle class is expected to grow five times bigger in size by 2020, owing to annual economic growth of over 5 percent since 1999.
According to a 2014 report by property consultancy Frank Knight, the Communist country also has the world's fastest-growing number of super-rich, with Vietnamese holding net assets of $30 million projected to swell to 293 from 110 in a decade.
But the wealthy have limited options.
Private facilities are used by just 7 percent of Vietnamese, and that adds strain to packed public hospitals where waiting time averages 4-7 hours and bed occupancy can be 170 percent, according to the Health Ministry.
In 2012, Vietnam's health spending was the highest in the region as a percentage of gross domestic product, the latest data from the World Health Organization shows. But at $102 per capita, that's less than half of Thailand's, a quarter of Malaysia and about 4 percent of Singapore.
Capacity in cancer, cardiac, orthopedic and pediatrics is severely lacking, and a specialist working in a city can receive as many as 100 patients per day, the ministry says.
"Facilities are a big problem," said Deepak Arora, an Indian expatriate who was treated at a private hospital in Hanoi, but went to India for a second opinion. "Local hospitals are very good, but they're overpacked."
The state put $3.4 billion into over 1,000 public hospitals last year, but the number of patients outstrip capacity.
The private health sector can't shoulder the growing burden either and a bad debt problem among local banks has tightened commercial lending. The number of private hospitals more than quadrupled to 170 over the past decade, but about half are "dying or dead", chairman of the Association of Vietnamese Private Hospitals, Nguyen Van De, said in March.
The government is welcoming international firms to fill that void, promising no restrictions on qualified foreign doctors to practice in Vietnam, deputy health minister Nguyen Thanh Long said last month.
Among interested firms are Thailand's Bumrungrad Hospital Pcl and Indonesian conglomerate Lippo Group, which wants to build 15 hospitals in Vietnam. Malaysia's IHH Healthcare Bhd is scouting sites in Hanoi.
"We are looking at Vietnam too... since there is good potential," said Engku Mashuri Engku Hussein of Malaysia's KPJ Healthcare Bhd, which wants to offer consultancy and management services. "If we take 10 percent of the population can afford private healthcare, that means 9 million people."
Stemming the flow
Leading the domestic healthcare drive is Vietnam's fourth-biggest listed firm, Vingroup, whose billionaire founder Pham Nhat Vuong built his empire from instant noodles in Ukraine to malls, private schools, condominiums, e-commerce and more.
It will increase its private hospitals, known as Vinmec, to 10 from one within five years, and will complete construction of a medical university in 2015. Vinmec's early focus will be cancer, cardiac, pediatrics and stem cells.
"Our group sees this is a potential market as the medical need from Vietnamese is increasing," Nguyen Thanh Liem, the head of Vinmec in Hanoi, told Reuters. "Why do we need to go abroad?"
Vinmec wants certification from Joint Commission International, which rates medical safety standards and has accredited 37 Thai, 13 Malaysian and 21 Singapore hospitals, but only one so far in Vietnam.
Vinmec is following the lead of Thailand, Singapore and Malaysia in targeting medical tourists with hospitals in travel hotspots Ho Chi Minh City, Phu Quoc, Nha Trang and Ha Long.
Though three quarters of Vietnamese are entitled to state social insurance, the health ministry says about half those covered pay out of pocket for treatment and are willing to pay for better care.
"Everyone feels the same," said Nguyen Thi Nguyet, who sought treatment at Vinmec for her baby son.
"A human life is more important than anything else. Cost comes second."