Vietnam says no to privatising state-run hospitals (For Now)

Posted By Damjan DeNoble

This announcement showed up in my Google Alerts this morning

HANOI, April 11 — Vietnam’s ruling Communist Party said state-owned hospitals will not be privatised, effectively ending a debate of the past few years over a plan to diversify ownership of treatment facilities in the health sector.
But Vietnam encourages the private sector to join in building new hospitals run as joint-stock companies, joint ventures and private clinics, Saturday’s Liberation Saigon daily run by the Ho Chi Minh City Communist Party chapter cited a Politburo directive as saying.

I had a chance to do some work on a Vietnam project earlier this year, and it became clear very quickly that the state run health care system was failing to meet the demands of the population. It also seemed that the government was willing to open up the health care system to wider private player participation, so this announcement is a bit puzzling. Protectionism in a time of economic trouble perhaps?  In any case, some figures from a report I worked on that will give you an idea of what the state run hospitals/clinics in Vietnam are like.

Composed of four basic levels – community, provincial, district, and central -  the Vietnam health care system went into a state of overload in the late 90s as Vietnamese incomes went up and many started seeking out the best health care providers.  This led to Vietnamese who could, to bypass the lower levels of health care and enter the system at the Central level, composed of University and MoH run hospitals in the cities.  Vietnam had 37 general and university hospitals, representing all of the hospitals at the Central Level. They treated 40% of Vietnam’s 2 million patients in 2007 (Vietnam Net Bridge, 2008).

The international average for doctors per 10,000 patients is ±30 (ThinkQuest). Vietnam has a ratio of 6.4 doctors per 10,000 patients and this is number is on the rise, so that these doctors can staff commune level clinics. In practice, however, few of the doctors are willing to do so. The international ratio of nurses to doctors is 4 to 1, yet in Vietnam that number is at 1.1, a decrease from 1995. Thus, overcrowding in hospitals is compounded by a large staff shortage.

Looking at Hanoi alone, existing hospitals are struggling to meet the current inpatient demand. The average public city hospital in Hanoi operates at 119% occupancy.

Currently,  Hanoi has 4,448 actual beds (General Statistics Office Viet Nam 2007). Using the government statistics of 1.2 beds per 1,000 population, one can estimate the number of beds in the surrounding provinces to be 3,360. This brings the total number of hospital beds in Hanoi/Greater Metropolitan Hanoi to 7,808.
Based on a new Vietnam MOH targeted Average Length of Stay of 7 days per admission/discharge, the necessary number of hospital beds needed to cater for the current demand  would be 9,000 beds working at 100% occupancy. The government set a target of a total 12,000 beds needed for Hanoi by 2010.  This represents a shortfall of 4,192 beds.
2009 Hanoi Hospital Bed Needs Analysis
Current Number of Beds                                                             7,808 Beds
Current Occupancy                                                                        119%  Beds
ALOS                                                                                                         < 7 Days
Number of Beds Needed @ 100% Occupancy                    9,000 Beds
Beds needed for Optimum occupancy rate of 87%        12,000 Beds
Current Shortfall:                                                                            4,192 Beds

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