Bribes and gifts have become so commonplace that they are not seen as corruption by many patients.
Nguyen Thi Quy Hien paid the hospital cleaner VND20,000 (US$1.08) each time she cleaned the room where her four-year-old daughter was being treated.
"I had to do so to make the cleaner feel happy enough to clean the room for my daughter. Otherwise she would just do it in a very careless manner," the 30-year-old mother told Thanh Nien Weekly.
Hospital cleaners on average earn monthly salaries of VND1.4 million to 1.6 million ($79-90)
Hien, a teacher in District 7, had her daughter admitted several months ago with high fever at the Children's Hospital No.2 in District 1. The daughter was discharged after three days.
There were no regulations for extra-payment for the hospital cleaners, but everyone appeared to adhere to the unwritten rules, Hien said.
"For the nurses, I did not give money but bought them some fruits as a token of gratitude," Hien said.
For another patient in Hanoi, informal payment was a must to fast-track her treatment.
The breast cancer patient at the K Hospital in Hanoi said she was told by another patient sitting next to her in the hospital that in order to expedite the operation, the latter had to pay the doctor in charge VND2 million ($108) in advance, according to an article published on August 7 by Tuoi Tre newspaper.
"She told me that the money was not hidden in the envelope but put right on the desk in front of the doctor," the patient said, declining to be named.
"One day later, she was able to have the operation," she said. "For my husband, who had also finished an operation at another major hospital [in Hanoi], I was advised to buy ââ‚¬Ëœthank-you' gifts for the doctor in charge and his assistants."
CAUSES OF CORRUPTION
Experts have pointed out several major reasons for corruption in the health sector. Overloaded hospitals, time-consuming red tape, low salaries and benefits for staff, commissions paid by pharmaceutical companies for prescribing their medicines, loose law enforcement, and professional incompetence are all factors that foster corruption in the healthcare sector.
According to a study on medical ethics released in August by the Hanoi Medical University, over 70 percent of medical staff members interviewed admitted they sometimes or often breached medical ethics. The most common wrongdoing was asking for bribes and gifts from patients.
A study by the Union of Science and Technology of Vietnam done on 140 patients during 2009 shows 25 percent chose medical establishments based on whether they know someone from that establishment. It also found that the cost of presents made to medical personnel amounted to nine percent of the total cost of each treatment cycle.
Offering bribes or presents to doctors is a practice that has been plaguing the Vietnamese health system over the past years. It has become so common and routine that people do not even recognize it as a corrupt practice that could undermine the health sector.
Corruption in the health sector is a particular concern in developing and transitional economies like Vietnam where public resources are already scarce, speakers said at the Anti-Corruption Dialogue between international donors and the Vietnamese Government Inspectorate and other agencies Thursday in Hanoi.
In poor health
"Corruption deprives people from access to healthcare and can lead to wrong treatments being given. Corruption in the health sector hits people when they are most vulnerable and the only way out is to pay in order to get the health service you need," Swedish Ambassador Rolf Bergman said at the meeting.
The three key corruption-prone areas included state management, service delivery at the health facility and health worker-patient relations, and the management of health-insurance, said Dr. Thaveeporn Vasavakul, referring to a Sweden-sponsored study on corruption in the health sector in Vietnam.
The media has exposed several scams in the health sector during the last two years, highlighting the severity of the problem in Vietnam, according to Jairo Acuna-Alfaro, the UN Development Program (UNDP) Policy Advisor on Public Administration Reform and Anticorruption.
Of the exposÃƒ©s by six major media outlets, that of abusing patients take the majority, accounting 21 percent, AcunaAlfaro said.
Corruption by raising medicine prices to gain commissions also accounted for 18 percent, second on the list.
Doctors who overprescribe and over test patients are driving up healthcare costs for ordinary citizens around the country, the Health Ministry admitted at a teleconference in June.
For example, hospitals in Hanoi used more than VND1 trillion ($54 million) worth of drugs last year but many kinds of drugs prescribed were only supportive drugs, not real treatments, health experts said. It is a waste of money because those drugs are not necessary, they added.
In 2008, medicine expenditures accounted for 45 to 60 percent of all hospitalization costs, the Health Ministry found.
"The root cause is that health staff want to receive commissions from the drugs companies," Phap Luat (Law) newspaper quoted Ly Ngoc Kinh, the then Health Ministry's Treatment Department Head, as saying in August.
Patients have also been coaxed into using more medicines than they would need.
While the World Health Organization warns each patient should not be treated with more than five types of medicines, the Health Ministry's investigation showed 41 percent of patients were treated with combined antibiotics, 7.7 percent received three types of antibiotics, 10 percent received 11 ââ‚¬" 15 types of medicine and 1.7 percent received over 16 types of medicines.
Other corrupt practices in the health sector include personal gains from health insurance funds, providing access to modern equipment based on payment by patients, bribes in the process of licensing and mismanagement of public health properties as well as donations.
Given the pervasiveness of corruption in the health sector, no one is immune from the grave consequences of this endemic problem, Bergman said.
"Not only poor people are affected... Corruption in the pharmaceutical chain can also prove deadly, where anybody can be a victim."
No single measure
There was consensus at the meeting that the Vietnamese government should keep a closer eye on the procurement of health equipment at hospitals.
The management capability and accountability of hospital authorities should also be improved to stop the informal payment system between doctors and patients, participants agreed.
The fight against corruption in the health sector would not be easy and would need concerted efforts from different parties, Bergman said.
"We can never point out one single measure - it is the combination of laws, implementation, monitoring and change in individual behavior that can lead to success."