ConsThe major cons of the reform th

Cons
The major cons of the reform that can be easily identified include
the potential for “induced demand” by health care providers.
Although quantitative evidence is currently unavailable to the
knowledge of the authors, the induced demand problem is
qualitatively reported frequently by the official mass media in
Vietnam, such as the national television and newspapers [9].
Demand can be induced in at least four ways. First, patients
are recommended to undergo too many diagnostic tests. In
reality, this is because of the imbalance in medical knowledge,
making it hard for patients to say “no” to the advice of doctors.
This is coupled with the test repetition for those who are referred
to another health care facility because one does not want to
accept (or trust) the tests’ results done by another.
Second, too many drugs are prescribed [10]. Sometimes they
are unnecessary, harmless but costly. Sometimes they are even
harmful such as antibiotics. For example, in a hospital in 2010,
90.4% of inpatients were prescribed the intravenous protein
therapy and many were prescribed supplements, such as glutathione
and arginine [11]. In another hospital in 2009, many
normal delivery women were prescribed Klamentin (an antibiotic
drug) for 16 consecutive days [12].
Third, hospitals tend to hospitalize patients with a condition
that does not require inpatient care [9]. It is observed that many
inpatients just come to hospitals to see doctors in the morning,
stay there for a while (some hours) to receive treatments (if any),
and go home in the afternoon or evening and then come back
next morning, and so on. It is likely that these inpatients have a minor condition and they should be treated as outpatients
instead.
Finally, hospitals tend to keep inpatients longer than necessary.
This phenomenon is clearer for those patients who are
covered by health insurance. According to Sepehri et al. [13], the
hospital length of stay of insured patients increases by factors of
1.18 to 1.39.
Consequently, there is an increase in health care expenditures
for both patients (out-of-pocket) and health insurance agencies
that may lead patients into a medical poverty trap (especially the
poor and near-poor who are not covered by health insurance) and
the insurance agencies into a situation that needs bailout from
government or an increase in premiums. According to the
Ministry of Health [14], the poor spends the equivalent of 17
months of household nonfood expenditures for each inpatient
episode. The health gap between the poor and the rich increases,
and care is allocated more according to ability to pay than need
of care.
Even the insurance companies face problems because health
care bills for insured patients exceed health insurance premiums.
According to Vietnam Social Insurance [15], this difference was
VND 1709 billion (about US $100 million [3]) in 2009, 18% higher
than that of the previous year. As a result, the premium of
compulsory insurance for former-sector workers has increased
from 3% to 4.5% of salary since 2009 [16].
In summary, Vietnam’s socialization of health care means
to mobilize financial resources in society toward health care. In
other words, it is a process of privatization. Besides the benefits
of getting more financial investment, reducing the workload for
public health care facilities, and increasing the quality of care,
the reform faces problems of induced demand created by
health care providers to maximize their benefits. There is,
however, only qualitative evidence of this abusive behavior. A
comprehensive study using both qualitative and quantitative
methods is needed to confirm and measure the problem, as
well as to identify the holes in current policies and regulations.
Such information will definitely help policymakers find
solutions.
Source of financial support: This article was financially supported
by the Institute of Health Economics, Edmonton, Alberta,
Canada.
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