Communist Vietnam is moving to privatize some parts of its health care system, raising questions about the state’s duty to guarantee care for all as a basic right, and about its budget to do so.
A publicly funded medical school in Ho Chi Minh City said this month it is looking for a private investor to help it build a new training and outpatient center on its campus. The Pham Ngoc Thach University of Medicine said the idea is for it to handle the clinical operations and training, while a private company would handle the actual construction.
Tapping private funding
“Ho Chi Minh City’s health care needs are critical due to rapid urbanization and a growing population,” said Dr. Ngo Minh Xuan, who is the rector of the Pham Ngoc Thach University of Medicine. “However, we cannot cater to these needs effectively and timely by relying solely on public budget.”
The shift to partially privatize these health services is an ongoing trend as the country of 100 million people turns ever closer to capitalism. More and more international hospitals are popping up and expanding, like Hanh Phuc and the Vietnam Germany Hospital, as the government increasingly opens up the sector to private parties, such as through a trade deal with the European Union that permits higher foreign investment.
A record of health care for all
Since its establishment as a communist nation at the end of the Vietnam War in 1975, the country has provided universal health care, with most citizens having access to subsidized insurance but also paying out of pocket for some expenses. As public opinion generally supports the idea that all people are entitled to health care, doctors treat their roles as a public service, doing regular rotations from their home base to hospitals in rural areas and other underserved communities. The government also works to improve access in the countryside, through a network of commune health centers that are the first point of contact for patients when they can’t make it to bigger city hospitals.
Vietnam’s record on health services is part of the reason it ranks relatively well on the Sustainable Economic Development Assessment (SEDA), which takes a look at not just how rich a country is, but also how well it translates its riches into creating a good quality of life for the public. Vietnam outperforms the Southeast Asian average on health care in the SEDA index. Between 2009 and 2018, its life expectancy rose from 74.8 years to 75.9 years, while rates of infant mortality, tuberculosis, and undernourishment fell and measles immunization rose.
There are financial strains on the current system
“Over the last decade, Vietnam made significant improvements, placing it in the first quartile of SEDA score change,” the Boston Consulting Group, which created the index, said in a statement. “In 2018, Vietnam's wealth to well-being coefficient of 1.28 highlights the country's well above average ability of converting wealth to well-being.”
Still there are shortcomings in the health care system that are prompting calls for more private sector involvement. It is not uncommon for a patient to pay a bribe to a doctor to request better care, nor for patients to share hospital beds or wait outside buildings on bamboo mats.
There are concerns about affordability for a state that has gotten close to its public debt ceiling of 65 percent of gross domestic product. Amid the strained public budget, Vietnam has undergone a drop in the rate of physicians per 1,000 people and in the relative number of hospital beds available in the past decade, according to the BCG. That is a particular burden for Ho Chi Minh City, the southern business center of as many as 13 million residents, accounting for about a quarter of Vietnam’s overall demand for health care. There are more than 100 hospitals in the city, according to the Vietnam Chamber of Commerce and Industry.
At the same time the country is expected to transition from a lower middle income nation to an upper middle income nation in the next decade or so.
“This [transition] will make Vietnam a fast-growing market for a wide range of goods and services” -- including health care -- said Asia Pacific chief economist Rajiv Biswas and principal economist Bernard Aw in a joint report for investment research firm IHS Markit in February.
With medical needs on the rise, Vietnam’s debate about public versus private health care will only deepen in the coming years.