Poor patients are
being squeezed out of the health care system as doctors accept significant
commissions from the pharmaceutical industry and more affluent patients
Dang Thi Kim Oanh has been reluctant to go to the hospital to be
examined and treated for a goiter she has been suffering from for more than 10
years.
“The Tumor Hospital is among a few that could offer adequate treatment
for this. But I have heard that patients must wait for hours before being
examined and that if you need surgery, you will have to wait several months,”
she said.
The small-trader in Ho Chi Minh City’s District 8, who earns a mere
VND70,000 per day, said she was afraid of having to pay additional unofficial
fees to doctors, surgeons and nurses – a common practice among many Vietnamese
patients.
Experts have blamed the lucrative commissions offered by pharmaceutical
companies and the acquiescence of patients willing to give “gifts” to doctors
and medical workers who in turn supply profit-driven medical services,
increasing the financial burden of poorer patients.
Trinh, a tubal infertility patient in Hanoi, said she had to pay more
than VND13 million for a surgery of her fallopian tubes, of which only VND2.8
million came in the way of hospital and medicine fees. The rest was given as
under-the-table payments to the hospital staff members in the hopes of
receiving better health care.
“The surgery was unsuccessful. I am thinking about doing an In Vitro
Fertilization but I am afraid that I will have to pay much more in support,”
she said.
According to a report released on March 12 by the Hanoi Medical
University, more than 76 percent of obstetric and surgical doctors admitted to
receiving “support” from pharmaceutical and medical equipment firms.
Jairo Acuña-Alfaro, policy advisor on anti-corruption for the United
Nations Development Program (UNDP) in Vietnam, said the report was consistent
with the organization’s findings over the past five years.
“It seems that the core of the problem is about pervasive or damaging
incentives in the sector,” he said.
Acuña-Alfaro said the practice has decreased the quality of the service
and forced the low income patients, who have few resources to pay, to buy
medicines they do not need.
“It’s basically an extra burden on poor patients already facing
increased fees for medical services in addition to these out-of-pocket
expenses,” he said.
The Ministry of Health has announced that fees for 70 percent of 220
health services will increase by up to five times as of April 15.
Health Minister Nguyen Thi Kim Tien said the increases are due to
inflation and the fact that the basic salary in Vietnam has increased nearly
sevenfold since 1995.
Giant kickbacks
In 2010, local media found that some doctors in HCMC were receiving
substantial commissions from pharmaceutical companies for prescribing their
products.
A doctor at the HCMC University Medical Center received monthly
kickbacks of VND528 million ($25,396) for selling US Schering Plough (SP)
Pharmaceuticals drugs to treat hepatitis. He also received another VND459 million
for pushing just one SP sale each month.
Another doctor at the center received VND226 million also for
prescribing SP hepatitis medication at his private practice. A doctor at the
Medic Medical Center and another at Cho Ray Hospital received similar
commissions from SP.
Vietnam’s annual per capita income is around $1,300.
Acuña-Alfaro said salaries for doctors and medical workers are not
enough to sustain a decent standard of living, forcing them to become dependent
upon earning pharmaceutical commissions.
“This suggests that the [privatization] of health services has moved
toward commercialization. Patients seem to be viewed as opportunities for
profit. This has created serious problems and placed pressure on authorities
because incentives to profit exist irrespective of patient needs,” he said.
But he noted that the problem is not unique to Vietnam and called for
thorough solution to the issue by ending these types of pervasive incentives.
“When doctors prescribe a medicine tied to a commission, he is not
going to think about the health of the patients, but the profit he is going to
make when that patient goes to buy the medicine,” he said.
Nguyen Tuan Anh, a researcher at Hanoi University of Pharmacy, believes
informal payments to doctors are “a dominant factor” in the high price of
medicine.
Anh published a study last year in which he interviewed doctors,
pharmaceutical representatives, government officials and pharmacists in both
the private and state hospital sectors. The study concluded that 40 to 60
percent of the final price could be spent to induce doctors to prescribe
particular medicines, and to persuade hospital procurement officers to buy
them.
Doctors surveyed said they took cash and non-cash offers to make up for
low salaries, and that it was common for commissions from the pharmaceutical
industry to become the main source of income for some physicians.
A 2009 survey by the Hanoi Medical University found more than 54
percent of doctors received official monthly incomes of less than VND2 million
($96).
Low salaries, overcrowded hospitals and a lack of appropriate training
have deteriorated the ethics of many doctors and medical workers, the study
found.
According to Acuña-Alfaro, the problem is exacerbated by the
gift-giving culture of Vietnam, where people tend to want to show their
appreciation for quality service, adding, “It will be very easy to
differentiate a gift of VND20,000 from obvious bribes of VND2 million or even
more which are given to procure faster or better treatment.”
In a recent online forum held by the central government’s website,
Health Minister Tien admitted that even her own family members sometimes resort
to offering unofficial donations to hospital staff members in order to receive
preferential treatment at overcrowded hospitals.
No excuse
Less than a third of Vietnamese doctors consider it necessary to inform
the patients of mistakes which take place during the course of their
examinations and treatment, according to a survey of 1,000 doctors in Hanoi,
HCMC and Hue released on March 12 by the Hanoi Medical University.
Just 30 percent of doctors think their patients should be informed of
such information.
“I think it is necessary to inform patients of relevant mistakes,” said
Jairo Acuña-Alfaro, policy advisor on anti-corruption for the United Nations
Development Program (UNDP) in Vietnam, adding that it’s a question of medical
ethics.
When 37-year-old patient, Hua Cam Tu, was admitted to Can Tho General
Hospital in the Mekong Delta last December, her husband signed a waiver giving
the hospital permission to remove the left kidney in a worst-case scenario, but
the right kidney was supposed to remain intact.
Tu’s husband, Nguyen Thien Tri, said he had been informed that the
surgery was successful and the right kidney remained intact.
“I only saw her the following day in critical condition. The doctor
instructed an ultrasound scan and I heard the medical workers asking each other
why they did not see any kidney,” he told Tuoi Tre (Youth) newspaper, adding
that the doctors explained their priority had been saving his wife’s life, not
informing him of her situation.
The doctor who removed both Tu’s kidneys has been suspended and she is
now being treated at the Hue National Hospital and several people have agreed
to donate one of their kidneys to help her.
By Khanh An, Thanh Nien News
Business & Investment Opportunities
YourVietnamExpert is a division of Saigon Business Corporation Pte Ltd, Incorporated in Singapore since 1994. As Your Business Companion, we propose a range of services in Strategy, Investment and Management, focusing Healthcare and Life Science with expertise in ASEAN. We also propose Higher Education, as a bridge between educational structures and industries, by supporting international programmes. Many thanks for visiting www.yourvietnamexpert.com and/or contacting us at contact@yourvietnamexpert.com
No comments:
Post a Comment