VietNamNet Bridge – There are good signs in perception and action to pave the way for equitization of hospitals as a necessary direction, though this has come at a late time.

Another problem in the health sector is the unequal division of resources of the State. Resources are often allocated to the central hospitals to address overcrowding. That is the wrong policy that has been applied for a long time.

All public hospitals ranked at the first level (provincial and central hospitals) should have mobilized funding by themselves and taken responsibility for finance and operation. Let them live their lives, because these clinics are more than capable of seeking resources for their development.  The next step is equitizing them, in parallel with creating equal conditions of competition for the development of private clinics within a strict legal framework, with quality and financial control.

There are good signs showing the government has started to recognize and pave the way for equitization of public hospitals as an inevitable path.

In fact, the face of the health sector would have been changed if the project to equitize public hospitals, which was implemented in a pilot manner at the HCM City-based Binh Dan Hospital, was not stopped for unclear reasons in 2006.

If the project was implemented at that time, we would have had a solution for the fair playing field for the public and private hospitals, making healthy competition for service quality.

Equitization can erase the existence of the “envelope culture” and the disguises of hundreds of small private hospitals hiding behind a public hospital.

Under a recent decision, the Transportation Hospital will be the first in Vietnam to be equitized. Although it is nearly 10 years late, this is still a good sign.

Results from recent studies suggested that the budget for the health sector must be concentrated in the grassroots level, especially commune clinics, where they suffer the most difficult burden for the health sector and are the first places to receive patients, particularly poor patients.

The commune-level hospitals are places that lack manpower (only 60% commune clinics have doctors), equipment and essential drugs. Perhaps only the medical staff at this level and those at some hospitals that treat infectious tropical diseases are worthy to be commended for their "silent sacrifice".

The best way to keep the workforce in these places is equal remuneration or even higher pay compared to those working at provincial or central hospitals, and to give more training.

Public and transparent practices

The fourth problem is the lack of transparency, capacity and cost of all services in both public and private hospitals.

The patients need to know information but the response from the public health facilities contains little. The information on capacity of the private health facilities are often exaggerated and not verified.

There must be rules that, in the entire country, all health facilities should be transparent in information about health care, services, capacity, powers and responsibilities. Large and private health facilities must have websites, with published prices.

It should not be allowed to rely on the private sector. Transparency, along with equitization, is needed to end the public - private mixing, as doctors at public hospitals work for private hospitals. This is the abuse of state time, making it difficult for the patient, or colluding with private clinics to take patients from public to private hospitals.

The fifth matter is to reform the personnel. At district level, all hospitals lack doctors, but non-treatment centers as preventive medicine or medical rooms have too many staff.

Current status of Vietnamese medical sector

Let's look at the facts, even though they are disappointing. Vietnam medicine likes a colorful shirt, but it is made with cheap materials. It is still at the risk of falling behind even with countries like Cambodia or Myanmar.

However, there is some sign of change, seen in the reduction of overcrowding in some big hospitals, and the start of financial autonomy and equitization. These are two bright spots that may underlie the greater change.

The first bright spot is the structure of the health care network with the specific character of the public health system is decentralized from the central to the local level. This is a wonderful legacy and it has created a quite stable form for the “shirt” of Vietnam medicine.

This structure is particularly suited to Vietnam and even developed countries have do not have it, especially at the commune level. Moreover, this structure in Vietnam is significantly enhanced by the network of health and population collaborators, and the village health station network covering all areas, including remote areas.

The second bright point is the universal health insurance policy which is underway.  Its coverage is growing, with spending that might be called reasonable.

Many changes need to be made, and the strategic objectives must be stabilized, but it is not only the health sector that can make the change. These changes do not demand a huge budget. Specific actions are expected from the Ministry of Health, and the People's Committees of provinces and cities.

Dr. Nguyen Cong Nghia

University of Waterloo, Ontario, Canada