An extract from The Healthcare Law Review, 4th Edition
As of 29 June 2020, Vietnam, a country of 97 million people, has recorded only 355 confirmed cases of covid-19; Vietnam has reported 340 recoveries to the World Health Organization (WHO). Although newscasts in Western countries would have the viewer believe that South Korea, Hong Kong, Taiwan and, perhaps, Germany, are the models for how a country should respond to covid-19, the facts – as confirmed by the WHO – tell a different story.
Accordingly, Vietnam has been widely recognised for its successful handling of the novel coronavirus outbreak. After implementing early preventative methods such as contact-tracing and quarantining by area and apartment buildings, culminating in a three-week nationwide lockdown, Vietnam lifted various social distancing and restrictive rules and life in Vietnam gradually returned to normal.
Not only has Vietnam's healthcare system successfully managed the covid-19 global pandemic – as at 29 June 2020 – but Vietnam's industry has also taken the opportunity to combine innovation, which has seen successful collaboration between universities and the private sector to produce the covid-19 test kit LightPower iVA SARS-CoV-2 1st RT-rPCR. This was certified by the WHO and the United Kingdom as early as 8 March 2020 and supplies were exported to European nations in the following months.
This chapter is a short summary of Vietnam's developing healthcare system. We have set forth a basic overview that should be useful to academics, investors, attorneys, and those with a general interest in the state of Vietnam's healthcare system (e.g., individuals considering Vietnam as a potential retirement destination).
The healthcare economyi General
The current healthcare services available in Vietnam are a balance of powers between the Vietnamese government's investments in healthcare infrastructure, a strong demand for high quality health products and services and, at the same time, the ongoing implementation of Universal Healthcare Coverage (UHC) as set out by Vietnam's 2012 Masterplan. As 8 June 2020, the National Assembly voted to pass and adopt the EU-Vietnam Free Trade Agreement (EVFTA) and the EU-Vietnam Investment Protection Agreement (EVIPA), which will considerably increase trade and investment for pharmaceutical/medicinal products and medical devices from the European Union, as the result of a 99 per cent cut in tariffs and other trade barriers. As 55 per cent of drug demand in Vietnam is driven by patient and healthcare professional (HCP) demand for products manufactured in the European Union, these new treaties will have a significant impact on the health of Vietnamese patients, the treatment of diseases in Vietnam, and hopefully, on competition in the market by lowering prices for such drugs.ii The role of health insurance
In Vietnam, as at 2019, 87.2 per cent of people enjoyed UHC, which ensures all individuals and communities access to good-quality health services that are affordable. At the same time, unfortunately, there is an imbalance of 'supply and demand' between supply and demand for hospital beds in Vietnamese hospitals. The number of patients needing treatment for diseases and the overcrowded hospitals are a challenge that the Ministry of Health (MOH) aims to overcome.iii Funding and payment for specific services
The state budget is relatively low because of, among other things, poor income tax compliance and weak property taxes levy, whereas the state's international debts are relatively high (particularly when contingent debts are included – e.g., potential government guarantees under BOT Contracts for infrastructure projects), the need for a more active and robust private sector and for public-private partnerships (PPPs) is preeminent in Vietnam. This will allow a deeper development of a Vietnamese healthcare sector, in general – particularly for a low-middle income country – and a sustainable healthcare financing model. This will not be an easy transition but the drafting of a Circular guiding PPP in the healthcare sector presents opportunities for all stakeholders from the public and private sector, onshore and offshore. This PPP Circular would focus on: (1) capacity building; (2) training of HCPs; and (3) healthcare delivery particularly in rural settings and individuals from areas with poor socioeconomic statistics. The ultimate goal of the PPP Circular will be to lay the foundation for a sustainable environment that encourages investment through a continuous dialogue between government, industry and the academy. Furthermore, the upcoming revision of the Health Insurance Law represents an opportunity for investing legislative and investor time in establishing the first stages of a 'government-industry dialogue to identify practical policy solutions to balance the budget realities and long-term sector development objectives'. In Vietnam, the pricing of healthcare services is publicly determined by the MOH and calculated each year based on a combination of market mechanics and socioeconomic realities. Thus, a locally produced drug will not necessarily be automatically subjected to a low price required by law, and, thus, the development of the healthcare sector, while addressing short-term state budget concerns, can also accommodate investors seeking long-term objectives of increasing profits on an annual basis.
Primary/family medicine, hospitals and social care
The framework for healthcare facilities in Vietnam consists of state healthcare facilities, private healthcare facilities and other healthcare facilities. The state healthcare facilities are divided into four levels by administrative structure: central, provincial, district and commune. Vietnamese citizens paying for health insurance do not have to pay for medical services at public healthcare facilities. However, in many cases, Vietnamese people opt for private care as these facilities are better equipped. The main objective of the government is to provide affordable and universal access to healthcare for Vietnamese people.
The scope and role of practice of corporate and professional health and social care providers, including for state healthcare facilities, is found in Section 1, Part I of the Hospital Regulations issued with Decision 1895/1997/QD-BYT. According to Vietnamese law, a hospital is a facility for medical examination, treatment and healthcare for patients, which has the main tasks of medical examination and treatment; training of officials; scientific research; directing routes; disease prevention; international cooperation; and economic management. The applicable laws are, essentially, the Law on Medical Examination and Treatment and Decision 1895/1997/QD-BYT on Hospital Regulations. Corporate, professional healthcare, and social healthcare providers are subject to several statutory limitations (e.g., delaying or refusing first aid, practising without, or owning false, certifications or licences, selling drugs or otherwise harming patients' rights).
Vietnam does not have a separate healthcare system for older people. This means that they must participate in the health insurance system to receive benefits when receiving medical examinations and treatments. Recently, healthcare for older people became a priority in Vietnam. Several policies on healthcare for older people have been put into practice, such as the Vietnam National Action Programme for the Elderly for the period 2012–2020 aiming to improve the quality of care for older people, as well as the Health Care for the Elderly Project for the period 2017–2025.
Alternatively, Article 10.3 of the Law on Medical Examination and Treatment enables access to medical consultants through a referral system. Patients have the right to choose any representatives to perform and to protect their rights and obligations during medical examinations and treatments. Consequently, in June 2019, the Vietnamese Deputy Minister of Health announced the launch of electronic health records (HER) pilots in eight provinces and cities of Vietnam. These technological tools aim to improve the management of healthcare services thanks to direct access to blood group diseases, allergies and other relevant health data of Vietnamese patients. While these HER are not yet fully integrated within the whole territory, from December 2019 they became mandatory within all of Ho Chi Minh City's hospitals.
According to Article 8 of the Law on Medical Examination and Treatment, patients have a right to confidentiality of their health status and private information given in their case history dossiers. A patient's data may be disclosed only when agreed by the patient or for professional information with practitioners directly treating the patient.