“I had to pay up to VND18 million ($900) for 13 days in hospital, just because of dengue fever. This is a huge amount of money. It is true that the poor should not be ill,” said Mrs. Lien, 40, from Ha Nam, a northern province in Vietnam.

Lien’s four-member family is very poor. Her husband has to leave his family to work as seasonal worker. Lien stays at home to plant rice on a small land plot. They have to save every penny to take care of their two children.

Lien recently caught dengue fever. As the disease had side-effects, she was moved to Hanoi’s Bach Mai hospital. Lien didn’t have a health insurance card so she had to borrow money to cover the hospital fees.

“My family has been exhausted after my illness,” Lien said.

There are many people like Lien. Sickness has pushed them into poverty and even hunger.

According to a survey carried out in Hanoi in 2008, 33 percent of interviewed families said that illness reduces their living standards and prevents it from improving.

“Vietnam has many achievements in healthcare but there is still an inequality in benefiting from the healthcare system. The rates of inborn death are highest in the country’s two poorest region (northern mountainous region and the Central Highlands), which are 21-23 out of 1000 inborn babies. The rate is only 8 per 1000 in the northern delta,” said Dr. Duong Huy Lieu, Chairman of the Vietnam Health Economic Science Association.

Dr. Ly Ngoc Kinh, former chief of the Ministry of Health’s Health Treatment and Examination Department, said that the poor have higher need for healthcare but their access to health services is more limited than other groups.

The quality of health services for poor people is also lower than those for the rich. The poor mainly use services at grassroots clinics while the rich go to central-level clinics.

“Though they use health services and grassroots clinics, where the service fee is lower, but for the poor, the burden of healthcare spending is still too large,” said. Dr. Kinh.

On average, the well-off and rich people see doctors 4.7 times annually, compared to 2.9 times for the poor. As a result, once the poor have to go to hospitals, their hospitalization time is longer.

“Even for the poor who have health insurance or those who are exempted or entitled to reduced fees, hospital fee is still a big burden, which is on average equivalent to around ten months of spending. A research revealed that nearly 60 percent of poor families incur debts due to illness,” Dr. Kinh said.

Experts said that spending on medicines accounts for a large part in the total healthcare expenditures due to poor control of medicine prices. The prices for the same medicine may be very different at different drug stores.

PV