At some public hospitals in Vietnam, modern medical equipment, whose procurement was covered by the state budget or private firms, has been left idle, while patients are waiting for treatment.
The situation will affect such patients and put them at a disadvantage if it lingers.
The healthcare sector is facing difficulties as multiple healthcare officials, including the health minister, have faced criminal charges and been in detention for their wrongdoing in medical equipment procurement, suspending the purchase of medical equipment and medicines.
Equipment has no fault
As a case in point, two robots, named Mako and Rosa, had been used for joint and cranio-cerebral surgeries at Bach Mai Hospital in Hanoi since 2017.
However, the two robots have been suspended and when they will be put to use again is unknown.
These two robots are related to a price gouging case at the hospital whose former director was arrested along with many leaders and employees of the robot installation company.
Currently, the robots are sealed off. The agencies who have the right to remove the seal are unknown.
A former director of a hospital in Hanoi said he took his family member to Singapore for a shoulder joint surgery which cost up to VND600 million (US$25,950).
Meanwhile, the cost for such surgery at Bach Mai Hospital is some VND50-60 million ($2,200-2,600).
The case at Bach Mai Hospital has come to an end as guilty people have been imprisoned, but equipment did not cause the crime.
Policies to resume the use of the equipment to serve patients should be considered, the former director added.
At Bach Mai Hospital, apart from the robots, many other devices obtained through cooperation with private firms are also on ice.
Patients must be transferred to other hospitals, use less advanced technologies, or wait for treatment, which will adversely affect the treatment results.
Rotating gamma systems for stereotactic radiosurgery and PET scans used in the diagnosis and treatment of cancer patients are treated as scrap, while the number of patients in need of them is huge.
In February 2019, People’s Hospital 115 in Ho Chi Minh City used the second-generation Modus V Synaptive robot in a delicate brain surgery for a woman in Tay Ninh Province.
The hospital had earlier signed a contract with an investor to install the robot and would appoint staff to operate it and share profits with the investor.
To operate the robot, the hospital sent Dr. Chu Tan Si to a training course in the U.S. in 2017 and another in Switzerland in 2018.
However, the robot has been out of service after more than a year of operation.
A leader of People’s Hospital 115 said that the application of the robot to surgeries was limited. It had been used for serious brain tumor cases only.
“Compared with the robot’s capacity, the number of medical operations that need the machine is small," the hospital’s leader.
"Because of high costs and the small number of patients, the robot assisted the surgeries of only 20 patients during three years.
“The inefficient operation of the robot has led to the hospital’s decision to return it."
High costs, insufficient medical supplies
It is difficult to operate machines and robots funded by the state budget.
Being put to use in 2014, a surgical robot at the Vietnam National Children’s Hospital, which cost more than VND80 billion ($3.5 million), has been used in the surgeries of only 200-300 child patients, who did not have to pay for the utilization of the machine.
However, the device has not been used due to the high cost, at $10,000, of each tool kit which can be used for only ten operations.
Although surgeries are mainly financed by organizations, the investment in the robot is not effective.
“As compared to laparoscopy, robotic surgeries are more pre-eminent, but the differences between them are not too big," said a surgeon at the Vietnam National Children’s Hospital.
"As for costs, robotic surgeries are much more expensive so most patients may choose laparoscopy.
“We are weighing the return of the equipment to the Ministry of Health so that the ministry can allocate it to hospitals for adults, but no institution has elected to receive it.”
Similarly, surgical robots using public investments at some hospitals in Ho Chi Minh City are sometimes left idle, despite the use of these machines being maintained.
The Da Vinci robot, manufactured by the U.S., has been used at Cho Ray Hospital since late October 2017, bringing many benefits to patients.
However, some patients said that certain surgical services using the robot are currently suspended.
Dr. Nguyen Tri Thuc, director of Cho Ray Hospital, confirmed the information, saying that the robot was suspended due to a shortage of consumable supplies.
“Because of difficulties in bidding, a series of hospitals have faced a lack of supplies, causing patients to flock to Cho Ray Hospital, breaking our reserves," Dr. Thuc said.
“For example, the hospital’s anti-rejection medication reserves for patients undergoing kidney transplants for six months have been used up within two months as patients from other hospitals have gravitated to our institution."
Directors of hospitals in a dilemma
In reality, directors of public hospitals are always in a dilemma.
If they are determined to procure more equipment for their hospitals, they may make mistakes during the procurement process.
Otherwise, their employees will find it hard to make ends meet and their patients cannot be treated with modern facilities.
The position of a hospital director is currently full of risks and many have thought of resigning to protect themselves.
A director of a major hospital in Ho Chi Minh City admitted that he would do his best for patients but with a thought of ensuring safety for himself first.
“Although we do not intend to commit violations, unclear mechanisms and overlapping regulations have caused difficulties in managing hospitals and we may face charges following inspections," he said.
As the number of healthcare officials involved in violations is increasing, managers or operators of hospitals have become precarious positions.
A director of another large hospital in Ho Chi Minh City was even advised to resign from the position.
“My parents advised me to resign and open a clinic, but as the hospital’s leader who must take responsibility for the livelihoods of my employees and saving patients, I can’t do that,” he said.
In the current situation, directors of many hospitals have chosen to make no headway, but “my professional conscience does not allow me to do the same, as it will put my patients and medical workers at a disadvantage,” he added.
Service fees should be publicized
As per the Ministry of Health’s regulations, the bidding process for medicine and medical supplies at hospitals is as follows: designing bidding packages including estimated prices, which were earlier approved by the Ministry of Health if the hospitals are under its auspices, but now are approved by the medical institutions themselves – bidding – announcement of results.
The process seems simple, but the head of medical supplies at a hospital in Hanoi commented that: “Hospitals find it hard to know the benchmark prices of equipment. Sellers want to earn high profits, while buyers want to buy high-quality goods at low prices.
“There are many complaints about the prices of medical supplies and equipment, but how to determine the rates?
“In my opinion, it is necessary to disclose the CIF (Cost, Insurance, and Freight) price, develop a price frame, allow the use of the profit percentage plus the import prices (CIF prices), labor and transport costs, and bank interest to calculate the selling prices.
"Goods that are priced abroad, which account for a small proportion, will be reviewed and handled later.”