Vietnam - Higher fees at hospitals burden poor, uninsured

Provinces and cities are preparing rate hikes to increase revenues, but their poor and uninsured constituents are bearing the brunt of the new fees.

>> Poor local governments to increase health fees
>> New prices of 447 health services not yet in place
>> Patients burdened with hospital fee increase
>> Ministry proposes hike in hospital fees

“I have heard that the state is going to increase hospital fees,” she tells Tuoi Tre while at the hospital. “Poor people like us are very anxious about it.”

Her concerns are echoed across the country as dozens of cash-strapped cities and provinces try to raise revenues with higher fees for heath services.

Many hospitals hope the increased income will reduce their dependence on state subsidies. But the upcoming price hikes, based on national guidelines issued by the Ministries of Health and Finance in February, fall hardest on the backs of people with low income and without health insurance.

“I am very worried to hear that health service fees will be raised,” said Thach Sen, a man with kidney disease in Soc Trang Province’s Vinh Chau Town. “I spend about VND3 million (US$144) every month on my treatment. When the new fees are applied, I will likely have to pay VND2 million more, which I cannot afford.”

Dinh Van Ke, of Hoa Binh Province, can’t afford the new fees either. His son has been treated for weak kidneys at Yen Thuy District Hospital for four years. The family pays just 5 percent of total costs, with health insurance for the poor kicking in the rest. But because his son needs treatment each year, “that payment is not small at all.”

Ke added, “If the fee and other fees increase, we will have not enough money to maintain treatment for my son.”

Unreasonable and unconvincing

Ly Ngoc Kinh, former head of the Medical Examination and Treatment Department, said the Health Ministry has not adjusted its fee table according to each locality’s socio-economic conditions, with different brackets for the rich, middle class, or poor.

Therefore, provinces and cities have been left to set their own rates, up to a limit, which Kinh said was unreasonable and unconvincing.

Some provinces expect their new fees to take effect as early as August, when Can Tho and Hau Giang will charge 70 and 62 percent, respectively, of the ceiling allowed by the ministries.

One member of Quang Ngai Province People’s Council has protested that the rate hikes in his province are a burden on the poor, who account for 21.4 percent of the local population. What’s more, the increases have not come with expanded facilities or improved doctors, he said.

The man said his council approved the fees, which are 66 percent of the ceiling and three to five times higher than present, quickly and with little discussion.

Another official, Nguyen Duong Trieu, head of the Culture and Social Committee of the People’s Council of Quang Nam Province, expressed dissatisfaction with new fees in his area, representing 75 percent of the maximum, because the provincial Finance Department hadn’t approved them.

Clients seem to agree. A woman in Cao Bang Province said her family had to pay for services because their insurance covered only a fraction of the cost. Thai Thi Lan, whose husband is a civil servant with heart disease, told Tuoi Tre, “I wonder how people without health insurance can pay for their treatment when hospital fees increase.”

TUOI TRE

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