When Pham Quang Tinh's doctor told him the coverage of his lung cancer medications would be halved on January first, he burst into tears.
The pills he takes cost VND1.35 million (US$63) a day.
According to the new rules that go into effect in 2015, the state's health insurance fund will no longer cover the full cost.
In a country where the average person like Tinh earns less than $15 a day, his fate is sealed, said the patient at Huu Nghi Hospital in Hanoi. Tinh retired last August and survives on a pension of VND4.5 million ($210) a month.
“I had children late; my oldest is only in high school; my youngest is in fifth grade. Now that I have to pay half the cost of my pills, I have to stop taking them,” Tinh said.
His wife suggested he come home and switch to cheaper medicine.
“I’ll just try to get by,” he said.
The new health insurance policy, which reduces the state's pharmaceutical subsidy from the current 50-100 percent to 30-50 percent for 28 kinds of medicine will put tens of thousands of hepatitis, cancer and arthritis patients in Vietnam in a life and death dilemma, Tuoi Tre (Youth) newspaper reported.
At least a hundred of Tinh’s fellow cancer patients share his fate.
Vu Van Lai, 69, also a patient at Huu Nghi, takes medicine for his stage four lung cancer that costs VND1.4 million a day.
Following the bad news, he decided to leave the hospital rather than stay and pay half that cost.
“It will cost me more than VND20 million (around $1,000) a month," he said. "A pensioner like me cannot afford that.”
Lai spent 13 months taking cheap traditional herbs before his prognosis qualified him for the full pharmaceutical subsidy.
His roommate at the hospital, a hepatitis patient, also qualified to have his treatment regimen covered--at the cost of VND4 million per day.
The medication helped significantly reduce a tumor in the man's liver after seven months.
“The medicine is very good, but it’s also very expensive. Without the subsidy, you would have to sell your house, and if you don’t have a house, you can just wait to die,” the patient said through sobs.
A patient at the Huu Nghi Hospital in Hanoi holds up two kinds of cancer medicine Iressa (L) and Tarceva. Photo: Nguyen Khanh/Tuoi Tre
At a conference in October, health experts said the number of patients contracting certain types of cancers has doubled or even quadrupled over the past decade in Vietnam.
Cancer patients are also getting increasingly younger, they noted.
Vietnam logs around 150,000 new cases of cancer annually, more than half of which prove fatal, according to figures released by the World Health Organization (WHO) at the conference. At least 50 percent fail to seek timely treatment--many because they cannot afford to do so.
But Nguyen Chan Hung, a prominent doctor who chairs the Vietnam Cancer Society, disputed the WHO figures on cancer cases in Vietnam.
“According to my calculation, there are up to 85,000 cancer-related fatalities every year in Vietnam,” Hung said.
Tong Thi Song Huong, director of the Insurance Department at the Health Ministry, justified the policy as well in line with international norms.
Over 50 kinds of medications for cancer and auto-immune conditions remain covered by health insurance and the affected patients can switch to those, Huong said.
But Tinh, the lung cancer patient, said it is not that simple.
He said he and others were prescribed their expensive medications only after all other treatment measures failed.
Tinh believes he suffered the agony of chemotherapy for nothing.
Doctors told him the medication represented his last resort.
“My doctor suggested that I go back to chemo, but I did not respond to chemo,” Tinh said, raising his voice.
“My tumor used to be the size of a fist, but it shrank to 3.5 centimeters, thanks to the medicine.”
He said if the government needed to reduce the subsidy, they should have done so gradually.
Nghiem Tran Dung, deputy director of Huu Nghi, said that while the ministry was drafting its policy, he proposed they phase out the subsidies for Hepatitis C medication since it is listed by the World Health Organization as an essential drug.
But the subsidy was cut to 30 percent in the end.
Passing the buck
The rate cuts were determined at a meeting between ministry officials, expert doctors, and officials at the Social Insurance Agency, and the University of Medicine.
But the ministry and the social insurance agency seem unwilling to take credit for the impact of the cuts.
A health ministry official told Tuoi Tre they didn't want to cut subsidies on such a large number of medications, but the social insurers insisted as they were worried they would bankrupt the state fund.
However, an official from the insurance authority said “The ministry made the decision, they drafted the list. They cannot blame the insurer.”
Official figures showed that the health insurance fund has operated at a surplus since 2010.
That surplus has risen to VND20 trillion ($935.2 million) according to figures provided by the Ho Chi Minh City Social Insurance Agency.
Dang Huy Quoc Thinh, deputy director of Ho Chi Minh City Tumor Hospital, said they have not received an official statement from the state insurance authorities about the new policy.
Thinh said it could affect the use of a breast cancer medication called Trastuzumab and a ganglion cancer medication Rituximab, which are both new but have brought about some very good results.
He said the government should have consulted doctors before making their decision because he believes these medications are well worth their cost.
The doctor said that, since many patients now plan to abandon their treatment regimens, they should be grandfathered in to ensure that money the state has already spent isn't wasted.
He said insurance subsidy cuts should only be considered for expensive medicines that lack clear results.
“The new policy will cause public outrage, because it will affect many lives.”
To make matter worse, poor patients in Vietnam and other developing countries could suffer a significant hike in the price of medicine brought on by a regional trade pact that has been impossible to track.
The latest round of negotiations for the US-led 12-nation Trans-Pacific Partnership (TPP) wrapped up in late October in Australia with a sunny joint statement issued by high-ranking trade officials noting “significant progress.”
But soon afterward, Reuters reported that “no breakthrough was forthcoming on the thorniest questions." One of the biggest hurdles remains intellectual property rights, particularly for products like pharmaceuticals, it said.
Many in the pro-TPP camp see the pact as key to ensuring the US will continue to write the rules for trade in the Asia-Pacific region and stay central to the global economy at a time when many are organizing their manufacturing, agriculture, and service sectors around China.
But the trade deal comes at a time when Vietnam, a country of 90 million, is suffering from dramatic rises in cancer rates.
According to documents released by WikiLeaks, America's TPP negotiators have spent years pushing to obtain measures that would, in effect, constrain affordable access to life-saving drugs through the pact.
The most recent document, released on October 16, detailed ways in which the US had asked signatories to the treaty to honor US drug patents and marketing monopolies for even longer than many already do.
Health activists argue that these mechanisms inhibit the development of affordable cancer treatments, particularly in developing countries like Vietnam.
"Informed citizens and policy makers in Vietnam should reject the shackles of excessive intellectual property protection to ensure access to essential public goods like life saving medical technologies," said Brook Baker, an expert at the US-based Health Global Access Project.