Health sector needs deeds, not words
by Thu Huong Le
The nation's healthcare picture has never been grimmer. A female patient died under the hands of an unlicensed Chinese doctor in Ha Noi in mid-July, maternal deaths due to misdiagnosis occurred in several provinces across the country – and residents literally fought for their turn to buy medicines in HCM City last month due to the sudden closure of pharmacies at several major hospitals.
As hospital fees rose from yesterday in many provinces and cities, the burden on poor patients has become even heavier. It has always been a bit scary visiting public hospitals and private clinics in Viet Nam. There are the risks of being treated by unlicensed doctors, being scolded at by overworked medical staff – or those who aren't offered bribes beforehand. Then there is the additional problem of being treated in hospitals as crowded as sports stadiums.
Healthcare, education and culture are the three pillars of basic social services. They are at the core of good governance. In developing countries, the government plays a more central role in ensuring that basic social services are accessible and affordable.
The current healthcare system has been going around in circles after the delivery of many unfulfilled promises. In the meantime, basic healthcare services quality has continued to decline. And there's little relief in sight.
Health officials promise that higher medical fees will reduce overloading at central hospitals because patients often rush to them for treatment due to their lower costs and better quality. But little has happened.
In March, the Ministry of Health issued a list of 447 fees for different services as a guideline for clinics and hospitals nationwide. The list allowed increases of up to 20 times the current levels.
However, many hospitals plan to raise their fees to the highest level regardless of the quality of service or equipment that they offer. This would prompt patients to select hospitals, for example, in Ha Noi, which has lifted fees by an average of 73 per cent of the maximum set by the health and finance ministries. Few would choose hospitals in nearby Bac Ninh Province where fees have shot up by an average of 85 per cent.
At the same time, only about 65 per cent of residents are covered under medical insurance nationwide and in some areas, especially rural and mountainous localities, the rate is even lower.
Even those covered under health insurance have to bear the burden of paying five to 20 per cent of medical costs.
Even before the death of a female patient at Maria Clinic in Ha Noi, health officials promised to increase inspections and tighten regulations for private medical clinics, especially those that are foreign-run. Now, as patients die through alleged malpractice, not a single person has been held accountable.
Even at a meeting into the Maria Clinic incident, the head of the city's health inspection department did not deliver any concrete action plans on how to better regulate these dangerous places. The trouble, he said, had to do with lack of a legal framework to fine or prosecute those involved.
Concerned about the overloading and high costs at public hospitals, patients turn to these private clinics, some of which are managed by unlicensed medical staff. They are placing their lives at risk.
Health officials promised that by 2015, in-house patients would not have to sleep two to a bed and that a doctor would not see more than 50 patients during an eight-hour working day.
The Health Ministry's project outlined plans to add more than 6,600 beds at national hospitals and establish satellite departments in provincial institutions to ease congestion at national hospitals. These numbers sound impressive but, without commitments, they will lead to few tangible outcomes.
So far efforts to revamp the healthcare system have been mostly from the top down. The simple truth is we need not just good, but responsible and ethical doctors and nurses. Besides the money to build new hospitals, investment to modernise professional training and improve the level of medical research must also be on the agenda.
Those who teach at medical schools should be told about upholding medical ethics. We need an inspection system that make sure medical errors and malpractice can be quickly identified. Corruption in healthcare is also a major hurdle.
Punishment for medical malpractice at all levels must be stricter and the threat of criminal charges introduced. Private medical clinics that do not meet standards must be closed and the news publicly disclosed so that patients can avoid them.
Without a system of healthcare inspection and genuine official commitments, the undelivered promises of the healthcare sector will continue – and certainly beyond the year 2015.
Meanwhile, those with money continue to fly south to Bangkok and Singapore for their treatment. — VNS