Poor struggle with rising medical care costs

HA NOI — Taking a short rest after spending the day selling a batch of organic vegetables, 55-year-old Tran Van Tang's face seemed to be bright with the hope of earning more money for his next dialysis treatment.

Tang, who comes from a poverty-stricken family in central Ha Tinh Province, 340km south of Ha Noi, receives hemodialysis treatment at the Bach Mai Hospital three times per week. He has been coming to the hospital for the past six years for treatments that cost about VND2 million (US$105) per month.

He earns only between VND2.5-3 million per month by selling vegetables and boiling water, which he uses to pay for his treatments, food and accommodation.

If the health ministry's draft decree on increasing health exam and treatment fees goes into effect, the costs for many treatments will increase by several times, which means that poor patients like Tang will have to struggle even more to receive the treatment they need.

The ministry is preparing to raise the fees for 350 of the 3,000 health services offered at all public hospitals from between 2.5 to 10 folds.

If the decree moves forward, Tang treatment's will increase to a minimum of VND5 million ($263) per month.

"I've already sold all my assets to pay for previous treatments. If the fees for health services increase too much, I do not know if I'll be able to afford my treatments and my health will get worse. Maybe I will return home," Tang said in a low voice while preparing to boil water in the 9-sq.m room he shares with three others to sell to other patients in the hospital.

The ministry said the increase was necessary because the current fees were out of date, set in 1995. The higher cost would not impact the poor because most of them had health insurance, it said.

However, poor people will still bear a burden because they are required to pay for between 5 and 20 per cent of their health exam and treatment fees even if they have health insurance.

With a two-to-ten fold fee increase, the proportion of the fee that health insurance card holders have to pay will also increase accordingly.

"For people like us, earning several hundreds of thousands of Vietnamese dong is not easy. Although we have health insurance, the amount we have to pay for treatment over such a long time is a fortune. And that excludes accommodation and food costs," Tang added.

Head of the Bach Mai Hospital's hemodialysis department Nguyen Cao Luan agreed that higher costs for health services was essential, but added that a roadmap was needed to gradually increase the fees to minimise the negative effects on the poor.

"Hospitals should establish funds to support poor patients which are mobilised from health services fees," he said.

Head of the ministry's health insurance department Tong Thi Song Huong agreed that many poor patients had difficulty paying the current fees.

With the higher fees, thousands of poor patients would not be able to afford healthcare without more support policies, including those with health insurance she said.

There are currently about 21 million poor people in the country.

In response to questions relating to the proposed fees, deputy head of the ministry's Planning and Finance Department Nguyen Nam Lien said the ministry was collecting opinions from different ministries and agencies and would establish a fee appraisal council to make the draft more suitable.

Although the ministry proposed the higher fees, many hospitals have been charging similar increased prices for years.

The National Hospital of Paediatrics in Ha Noi, the Gia Dinh People's Hospital and the HCM City Hospital of Tropical Diseases in HCM City, for example, have been charging VND20,000 for an exam, rather than the set VND3,000.

Doctor Nguyen Chi Hung, director of the Binh Dan Hospital in HCM City, said the ministry's fees were outdated and that hospitals could not operate by charging only VND3,000 for an exam.

He said hospitals needed more money to replace old equipment and materials.

Research conducted by the World Health Organisation in 2006 showed that the total health expenditure per capita in Viet Nam was $151 per year, while the per capita income for that year was about $715.

The fee adjustments were expected to help improve the quality of health services and allow hospitals to increase their buying power, said the health ministry.

Health exam and treatment quality depended on many factors, such as the knowledge and professional skills of health workers, facilities and equipment, said deputy head of the ministry's Health Exam and Treatment Management Department Nguyen Quy Tuong.

"Vietnamese doctors are capable of performing modern healthcare techniques but the lack of equipment hinders their work," he said.

Therefore, higher health service fees would give hospitals more capital to invest in improving the quality of health care services, he said.

However, many experts, including health officials, have cast doubt on the ministry's promise.

Head of the Viet Nam Social Insurance's Department of Health Insurance Policy Implementation Pham Luong Son said the increase was not suitable with the country's condition.

The proposed fee for use of a hospital bed, for example, which would increase to between VND100,000-180,000 ($5.2-9.5), was expected to allow each patient the use of one bed in an equipped room. However, it was difficult to expect this standard in Viet Nam where most hospitals were overloaded with two or three patients sharing one bed, he said.

At a recent meeting with the press in Ha Noi, a representative from the health ministry admitted that the proposed fees were calculated based on direct hospital expenditures, such as what they paid for equipment, staff and medicine, which meant the increased fees would not contribute to building more hospitals.

Therefore, the fee adjustments would not help reduce the hospital overload which forced two or three patients to share one bed, he said.

At present, there are an average of 20.5 beds per 10,000 people in Viet Nam while other countries have between 30-40 beds per the same number of people. — VNS