The hospital looks like a refugee camp, complained Vietnamese Health Minister Nguyen Thi Kim Tuyen in her speech to the law-making National Assembly on April 17 about overloaded hospitals across the nation.

The trouble has been getting worse over the past decade.

“It’s broken-hearted to visit hospitals. Many patients take physical exercises in the early morning, then visit hospital for diagnosis or treatment and could only obtain access to medicine at 3:00pm in the afternoon,” said the minister.

The Ho Chi Minh City Oncology Hospital, for example, has a total of 600 beds but has to accept 1,500 – 1,700 in-patients, meaning that 2-3 patients share a bed. Some even lie under the bed.

Apart from insufficient infrastructure, Tien blamed the overload of hospitals on the patients themselves who favor major or ‘central’ hospitals over those nearest to them.

In Vietnam, state-owned hospitals are divided into district, provincial, and central level ones. Generally, a patient is not admitted into a central-level hospital -- which is deemed to boast better doctors and facilities -- without recommendation from that of a lower level.

Therefore, the minister promised at the meeting to work out strict measures to stop patients from visiting higher-level hospitals first without prior consultation with clinics at a lower level.

Solutions proposed

Minister Tien told the meeting she has been worrying about the trouble for two years and is bound to tackle it with a decision in June this year to stop the ‘line crossing’ practice.

Her solution is to ban a high-level hospital from receiving patients whose conditions can be treated at a lower level. Violating hospitals will be ‘downgraded’ as a punishment.

In other nations, a patient can ‘cross the line’ but must pay an extra fee of 60 – 70 percent. In Vietnam the cost for a higher-level hospital is not more expensive than that at a lower level, she explained.

The coverage of health insurance is also one of the solutions mentioned. But by late last year, only 66.8 percent of the national population have been insured and half of the working age people has health insurance.

A health insurance policy holder will not ‘cross the line’ to a higher-level hospital unless he is recommended by the unit to a higher level unit due to severe condition.

Another solution is to build more satellite hospitals, or branches, in different localities to share the burden with the central ones. That means a patient can receive treatment by the HCMC Oncology Hospital in Can Tho, Da Nang and other localities without having to travel to HCMC.

Patients are waiting outside a consulting room in HCMC Children Hospital in Ho Chi Minh City (Photo: Tuoi Tre)

Criticism

Le Van Lai, the National Assembly deputy from the central province of Quang Nam, turned down the measures as top solutions.

‘Unloading’ a hospital is quite different from unloading a truck, he noted.

“To be able to ‘unload’ a hospital, other satellite and lower level hospitals must first perform well.” Lai said.

Truong Thi Mai, chairwoman of the Committee for Social Affairs of the National Assembly, agreed that the ‘unloading’ of hospitals should be based on the improvement of quality and services at lower-level units. Then the problem will automatically be solved without the need of an administrative command or a certain ban.

It is unclear how the solutions will work, but the health minister announced last month in HCMC that she has set a target of eliminating hospital overloads by 2020.