2014年经济学人 越南卫生保健 一路跛行

（单词翻译）

Health care in Vietnam

Limping along

Ordinary folk are sick and tired of their public hospitals

Full to overflowing¹

WAS the tumour² malignant³? Nguyen Thi Hoat's doctors could not tell because their public hospital lacks brain-scanners. Ms Hoat's only option was to travel 130km (80 miles), on the back of her sister's motorbike, from her village to a crowded public hospital in the capital. Yet her state insurance policy covers just 30% of any medical expenses incurred⁵ outside her home province. The $150 that Ms Hoat, a rice farmer, put towards blood tests and a brain scan is equal, for her, to a month's earnings⁷.

It is the job of the authorities to look after health care. The Communist Party of Vietnam first pledged health-sector⁸ reform as early as the 1920s, well before it declared the country independent in 1945. It developed a publicly financed healthcare system even as it was fighting wars against France and then America. The provision of health care is supposed to be one of the pillars on which the party's legitimacy⁹ is based.

Yet the health-care system, like the state-dominated economy, is limping. The 3% of GDP the state spends on the system (nearly half of total health spending) is not enough to improve health infrastructure¹⁰. Hospitals have outdated¹¹ facilities and maddeningly opaque¹² bureaucracies. A law on health insurance passed in 2008, created to assist the poor and ethnic¹³ minorities, is far from comprehensive. But the government knows that providing proper health care is key to preventing the kind of social unrest that undermines its authority.

Some reform is under way. The government has given some hospitals more autonomy. And in June the national assembly passed a new version of the insurance law designed to make participation¹⁴ compulsory¹⁵. The idea is to lure¹⁶ into the fold poorer and black-market workers who have long avoided paying insurance.

Yet distrust of the system runs deep. Some public hospitals have built flashy new wings which cater¹⁷ to well-heeled patients but do little to meet general demand. Bed-sharing is common, especially in urban wards⁶ flooded by patients from the countryside.

Though this is an authoritarian¹⁸ state, ordinary Vietnamese are remarkably¹⁹ outspoken²⁰ about social issues. In health, they complain of the prevalence of “out of pocket” payments, which happen in around half of health-care transactions. Many of the payments are really bribes²¹ paid on top of formal hospital fees. They mean that affordability²² is often a larger factor than need, for all but the richest patients. In a typical case, a university lecturer in Hanoi says she slipped doctors and nurses about $250 to ensure attentive²³ treatment when she gave birth at a public maternity²⁴ hospital. The rate, she says, was $1 per injection, $2 for a bath and $5 to sidestep a queue.

The health minister, Nguyen Thi Kim Tien, has faced blistering²⁵ criticism this year after a parade of health scandals, including a measles²⁶ outbreak that killed more than 100 children. Online, thousands have called for her resignation. A popular television satire²⁷ advises sick patients to avoid corrupt²⁸ doctors by curing themselves. The fault is not all the minister's—or the doctors'; they have long earned as little as $100 a month, for instance.

In order to get by, doctors moonlight at private hospitals and clinics that are popping up in cities, led by Hanoi and Ho Chi Minh City, to serve foreigners and affluent²⁹ Vietnamese, people who would otherwise opt⁴ for treatment in Singapore or Hong Kong. One such institution is Vinmec International Hospital, a 600-bed facility financed by Vingroup, a property developer. Its director, Nguyen Thanh Liem, says private hospitals help to minimise overcrowding elsewhere. And they showcase an international standard of care that may one day spread to the public sector.

That is cold comfort for Nguyen Thi Hoat, the rice farmer with a brain tumour. She says if her tumour proves cancerous, she will need to borrow from her brother and sister for surgery in Hanoi. Her family is worried. Yet poorer neighbours, she says, have fewer options. She considers herself lucky.