As the Health Ministry prepares to jack up hospital fees many wonder where the money is going
People wait near the admission window at Ho Chi Minh City's Children Hospital No. 1. Under a draft fee scheme that would increase the cost of 350 health services, 220 services will more than double in cost while another 70 will shoot up between seven to tenfold.
Trinh Thanh Giang says she pays VND15,000 (US$0.7) a day to share a bed with another patient at the Ho Chi Minh City Oncology Hospital.
"I'm willing to pay more for a private bed," said the 57-year-old woman from the southern An Giang Province, who is being treated for breast cancer.
The hospital offers "˜service' beds which provide faster and better services for higher fees but they are always full.
A nurse at the public hospital said that part of her job involves persuading patients to make room in their beds for new patients.
Nguyen Thi Tat, who is also being treated at the hospital, said she had to rent a room near the hospital following her surgery. Every day she comes in for examinations and injections.
The Ministry of Health maintains that the hospital fee scheme established in 1995 has become outdated and must be increased. During the past decade, health officials have debated an increase in hospital fees every year. The proponents of the increase have consistently argued that hospitals won't be able to improve their services until they address their low revenues.
Now, they are finalizing a new fee scheme that would increase the cost of 350 services. Under the plan, 220 services will more than double in cost; another 70 will shoot up between seven to tenfold.
The increase has been attributed to the rising price of medical supplies. For example, a pair of surgical gloves has increased from VND200 to VND3,000. Stitches, which once cost VND2,000 have since been replaced by VND50,000 surgical thread that can be absorbed by the body.
In 1995, a government circular set the cost of one day's stay in a hospital bed at between VND2,500 and VND17,000. The ministry said that hospitals are all currently operating at a significant loss; hospitals pay roughly VND10,000 per person per day to provide electricity, water and sanitation services alone.
The ministry said it is seeking to increase its minimum fee to VND10,000 per day for a bed at a communal medical station. The new plan would raise the cost ceiling to VND100,000 per bed per day at other hospitals.
Many experts agree that hospital fees should be increased, but only for certain services. At the same time they have agreed that hospitals should provide adequate services if there is to be any increase in costs.
Pham Luong Son of Vietnam Social Insurance (VSI) the agency charged with managing the nation's pensions and health insurance said that the Health Ministry should provide a detailed explanation of hospital fees if and when they are increased.
"There should be an increase in [outdated] hospital fees to cover input costs, but fees should vary depending on the quality of services and medical facilities," he said, adding that the new fee scheme should ensure adequate remuneration for medical workers, technical services and medicines.
According to research conducted by VSI, the average doctor examines 300 patients a day at central hospitals and 200 patients a day at provincial hospitals.
Son anticipates a significant increase in insurance payouts if hospital fees go up by VND800 billion ($38.7 million) a year under the Health Ministry plan.
Currently, Vietnam's public health insurance fund pays policyholders a total of VND20 trillion ($967.6 million) in reimbursements every year. Sixty percent of these payments cover the costs of medicine; the rest goes out for services.
While much has been published about soaring medicine costs (particularly about hospital pharmacies) little attention has been focused on the poor quality of medical services.
Nghiem Tran Dung, deputy director of the Ministry of Health's Insurance Department, said that hospitals are guilty of lax oversight of medical services.
"Hospitals have failed to provide quality treatment and examinations particularly on the [commune and district] level," he said.
A 2009 survey conducted by VSI found that hospitals ordered unnecessary diagnostic tests for patients with health insurance, including blood and urine tests, X-rays, ultrasounds and electrocardiograms.
Another VSI survey of 416 X-rays at six provincial hospitals found that many radiologists consistently failed to follow proper procedures.
The same survey also found serious diagnostic flaws. Between 22 and 61 percent of each hospital's X-Rays were found to contradict the doctor's final diagnosis.
"As a result, sometimes healthy individuals were diagnosed as having a disease and vice versa," Dung said.
Officials from VSI also said that hospitals have abused a number of hi-tech services.
Nguyen Minh Thao, deputy general director of VSI said that the Health Ministry should increase hospital fees but the new fees should be based on input costs and the quality of services provided.
"Hospitals need to ensure suitable tests and treatment," he added.
Thao also said that the new fees should not be applied to subsidized non-profit communal hospitals.
Just plain poor
Even as the Health Ministry debates the merits of raising costs, many in Vietnam already avoid going to the hospital, for fear of the financial consequences of treatment.
Last week, Nguyen Thi Mai was admitted to the HCMC Oncology Hospital in severe pain.
Her friend, Huong, said that Mai had been treated for liver cancer several years ago but she refused to seek treatment after the cancer returned. Mai said she couldn't cope with hospital fees.
"We were determined to take her to the hospital, fearing that she would die soon," she said. "Her belly was badly swollen. I hope the hospital will support her treatment."