After the five biggest public hospitals in Hanoi banned their staff from taking ‘envelope’ (tip or black money) from patients in September 2011, VietNamNet has launched a forum on medical ethics and we have received emails from hundreds of readers making comments on this topic.
A survey by the Ministry of Health’s Trade Union reveals that up to 45 percent of interviewed patients said that they were displeased with health workers and administrative procedures at public hospitals.

VietNamNet’s survey also shows that most of patients complained about quality of health services and the bad attitude of health workers. Whenever they have to go to hospital, they are worried of being scolding or treated chilly by doctors, of having to wait for a very long time, of knowing nothing about complicated procedures at hospitals.

The results of these surveys are similar to a research work by the Center for Public Training and Development under the Union of Vietnam Sci-tech Associations.

According to this research work, within one year, a newly-recruited health worker will become an ‘addict’ of “envelope.”

While patients moaned that health workers claim ‘envelope’ otherwise they would provide poor services, health officials said that they need patients’ cooperation to curb the so-called ‘te nan phong bi’ (envelope evils) at public hospitals.

Tran Van Thuan, deputy director of Hanoi-based K Hospital, one of the hospitals that banned employees from receiving patients’ tip, said: “I see Vietnamese people’s selfishness somewhere. For example, when they are on the road, everyone wants to barge to go first. At hospitals, patients who come later want to be examined first. I think this is the main reason that urges patients to give ‘envelope’ to doctors”.

Doctors complained that they are overworked while wage is very low. This is not an excuse for doctors to receive ‘envelope’ but it makes favorable conditions for the ‘envelope evils’.
Dr. Tran Tuan, Director of the Center for Public Training and Development, told VietNamNet that it is unfair to blame doctors for the downgrade of medical etiquette and the ‘envelope evils’. He said that the ‘bad environment’ has nurtured the bad to develop.

The key reason of the “envelope evils’, according to Dr. Tuan, are problems associated with the structure of Vietnam’s medical system, which is not transparent, unfair and ineffective. Low wage for doctors is also a reason.

K Hospital’s Dr. Thuan said that medical ethics and ‘envelope evils’ must be solves step by step, with a package of solutions. Improving medical ethics has to go with solving overload at hospitals and raising income for doctors.

The Center for Public Training and Development’s Dr. Tuan suggested restructuring the medical system by dividing it into three sectors: private, public and charity sectors and establishing an independent health service quality supervision agency to raise transparency.

Accordingly, the private health sector will focus on treatment while public health sector concentrates on preventive health and public health and charity health sector assists needy patients. Dr. Tuan also urged to provide health insurance to the entire people.

Ngoc Anh