Julie L. Kessler
lawyer traveler writer


Healthcare in Vietnam

I am an incredibly lucky traveler in that, despite having traveled to sixty countries, I have never really gotten sick. Perhaps I should rephrase that. I have had the occasional stomach upset while tasting street vendor delicacies in Indonesia, and I once got food poisoning from some bad fruit juice in the former Yugoslavia. And one time I got a fairly nasty exhaust pipe burn on my calf from a rickety old motorcycle I was stupidly riding somewhere up in the hills of Northern Thailand. But nothing more serious than that, and nothing that required a trip to a hospital or even to a clinic — that loud sound you hear is me knocking profusely against the wood desk at which I am sitting.


I was in-house counsel to a surgical facility for several years, and often inadvertently saw plenty of surgical detritus; my brother is a doctor, and my mother’s second career was nursing. To even my surprise, however, I don’t think much about healthcare while traveling overseas. Perhaps it’s blind luck, or perhaps it’s simply magical thinking.


Last month, seven years after my first visit to Vietnam and Cambodia with my then ten-year-old daughter, I took my husband to Vietnam. We started the trip in chaotic Saigon in the south, and traversed the beautiful coast in Nha Trang and the sleepy island of Ninh Van. Then, following the hustle and bustle of Hanoi in the north, we ended up 400 kilometers to the very northwest of the country in the hills of Sa Pa, not far from the Chinese border. The good news is that we had a great time. And no, other than one nasty spider bite of unknown origin on an overnight  boat junket in the World Heritage Site of Ha Long Bay in the east of the country at the very end of the trip, no one got sick.  The bad news is that we learned that one never, ever wants to get sick anywhere in Vietnam.


There has been incredible economic progress in many sectors of Vietnam since its doors opened to foreign travelers in the mid-1990’s. One sees everywhere the ready appearance of Communism “light,” at least from a market standpoint: business is simply booming and construction in rampant. However, one sector in Vietnam which is far, far behind even that of other emerging nations is its healthcare delivery system.


In a country of approximately 91 million people, as of the end of 2012, there were only 1.2 physicians per 1,000 inhabitants; this reflects virtually no increase since 2008. For comparison purposes, Greece has 6.2 physicians per 1,000 people, and the U.S. 2.4 per 1,000. In several state-built and state-run “hospitals” in Vietnam, especially in the more remote northern regions of the country, there simply are no doctors at all, not even visiting doctors, just a few nurses to tend to a wide variety of the population’s ailments. And in the bigger city hospitals in Saigon and Hanoi, there are precious few nurses as well. But that, of course, is only one part of the problem. Another, perhaps potentially more systemic problem is the rationing of services to those best able to pay bribes to physicians and their staff. One should keep in mind that the average public school teacher (and teaching is considered by many to be a good job) makes the equivalent of $150 per month. Indeed, Vietnam’s GNI for 2012 was the equivalent of $1,400. Many working people, especially those who work for large companies, have state health insurance, at least in theory; in reality, however, it may not provide them with care, or at least not with care that is acceptable.


We know a Vietnamese couple who live in Hanoi, both of whom work in tourism. The wife works for a large French hotel chain which provides her with health insurance. When she was about to have their first child, she learned it would be necessary to schedule a Caesarian section. Had she gone to the public hospital for the delivery, she would have had to share a hospital bed with another female patient, and that bed would have been in an unbelievably overcrowded ward. She would have also had to bring several family members to tend to her pre- and post-operatively around the clock, because of the severe nursing shortage. Those family members would not have been given so much as a chair, but would instead have to sleep under the patient’s bed on the floor, usually on a straw mat which they would likewise have to tote along. They would have also been required to bring supplies, including food, water, and other items for the patient. So instead, our friend took his wife to a private hospital where he paid bakshish in an amount equivalent to $300 to the physician (paid in cash in secretly following the successful birth). An additional $200 went to the hospital for use of the operating room and medicines, and $80 went to the semi-private room at $20 per day.  Following the birth, our friend was subsequently reimbursed the sum of $25.00 by his wife’s insurer. This was, ostensibly, the amount that would have been paid directly to the public hospital had the delivery occurred there. A friend of the couple had a child two months ago at the same private hospital with the same physician, but this was a normal vaginal delivery. The bakshish to the doctor in that case was “only” $150. However, the friend’s infant was born with a lung infection which required anti-biotics, costing an extra $300, and requiring a three-night stay, for an additional $60.


While the numbers are, of course, minimal by U.S. healthcare cost standards, they are shocking when viewed in light of the average Vietnamese person’s annual income. Clearly there is nothing in a U.S. hospital that costs $20, except perhaps the daily parking charges. However, I have certainly received a reimbursement check from an insurance company in the U.S. for $25, though I think the submitted charges were something like $500 — or perhaps it was $5,000.


In case this story seems hard to believe, take a gander at the photos below, all of which were taken at Bach Mai hospital in Hanoi. Here you see the line to get in to the hospital, a photo of the corridors, and one taken of the wards.

So if you are heading east, pack along a good first aid kit, travel safe, and take a pass on the ever-present motorcycle taxi should you find yourself in Vietnam. And the next time you think to complain about health care delivery in the U.S. in general, or Obamacare in particular — and if you do, you will need to get line right behind me — you may want to take a look at these photos again. Then thank your lucky stars that our health care is as “awful” as it is.

Date Posted:  Aug. 20 2013