Report on Healthcare

Sector in Vietnam
Issue Date: 24 May 2012
Part of StoxPluss Market Research Reports for Vietnam

@ 2012 StoxPlus Corporation.

All rights reserved. All information contained in this publication is copyrighted in the name of StoxPlus, and as such no part of this
publication may be reproduced, repackaged, redistributed, resold in whole or in any part, or used in any form or by any means graphic,
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#
Table of Contents

Our research contacts for Part Content Page

this report are:
1 Executive Summary 4-7
Thuan Nguyen, FCCA
CEO 2 Overview of Healthcare Sector in Vietnam 8
thuan.nguyen@stoxplus.com
+84 98 38 90 000 2.1 Market Size and Growth 9 - 15

Ninh Do, MBA 2.2 National Healthcare Expenditure 16 24

Head of Research
ninh.do@stoxplus.com 2.3 Organisation of Healthcare Sector 25 33
+84 90 32 21 613
2.4 National Health Insurance System 34 36
Cuong Nguyen
Associate 3 Key Drivers of Healthcare Services in Vietnam 37
Research Division
cuong.nguyen@stoxplus.com 3.1 Demographic Characters 38 42
+84 19 99 29 36 36
3.2 Health Cost Affordability 43 45
Ngan Pham
3.3 Problems of Modern Lifestyle 46 47
Research Assistant
Research Division
3.4 Health Issue Pattern 48 53
ngan.pham@stoxplus.com
+84 12 39 12 99 02
3.5 Health Insurance Coverage Policy 54 56

4 Competition Analysis 57

4.1 Market Concentration 58 59

4.2 Foreign Participation 60 61

4.3 Key Challenges for Private Players 62 67

4.4 Key Hospital Operation Players Profiles 68 74

4.5 Key Laboratory and Diagnostic Service Players Profiles 75 85

2
Table of Contents

Our research contacts for Part Content Page

this report are:
5 Policy & Regulatory Framework 86
Thuan Nguyen, FCCA
CEO 5.1 Legal Framework 87
thuan.nguyen@stoxplus.com
+84 98 38 90 000 5.2 Operation License 88 93

Ninh Do, MBA 5.3 Key Regulations for a Lab Business 94 95

Head of Research
ninh.do@stoxplus.com 6 A Closer Look into HCMC 96
+84 90 32 21 613
6.1 Overview 97 100
Cuong Nguyen
Associate 6.2 Hospital Overloading Situation 101 104
Research Division
cuong.nguyen@stoxplus.com 6.3 Doctors and Manpower 105 106
+84 19 99 29 36 36
6.4 Healthcare Investment Projects 107 109
Ngan Pham
Research Assistant 7 Appendices 110
Research Division
ngan.pham@stoxplus.com 7.1 Appendix 1: Full list of 34 Private Hospitals in HCMC 111
+84 12 39 12 99 02
7.2 Appendix 2: List of Key Foreign Players in Healthcare Market in Vietnam 112

7.3 Appendix 3: Full list of 29 Private Health Insurance Service Providers in Vietnam 113

DISCLAIMER
All information contained in this publication has been researched and compiled from sources believed to be accurate and reliable
at the time of publishing. However, in view of the natural scope for human and/or mechanical error, either at source or during
production, StoxPlus , its Directors and employees accept no liability whatsoever for any loss or damage resulting from errors,
inaccuracies or omissions affecting any part of the publication. All information is provided without warranty, and StoxPlus makes
no representation of warranty of any kind as to the accuracy or completeness of any information hereto contained.

3
Executive Summary
Market Size and Growth
Based on official data released by the
Ministry of Health and some other
researches, the size of Vietnamese
healthcare market by the end of 2011
could be in the circa of US$9.3bn.
Healthcare service is the largest
segment at US$6.67bn, representing
72% of total market; Medical
equipment sales including the lab and
diagnostic imaging equipment about
US$1.89, or 20%; and Drugs sales
was about US$0.73bn (8%).
During the period 2006-2011, CARG of
Vietnamese healthcare market was
12%. For the next five-year period,
2012-2017, the market is expected to
grow faster. CARG will be about 15%.
The growth of healthcare market is
driven by economic growth thus
improving revenue per capital, higher
awareness for health issues, changes
in living and working habit as well as
rapid urbanization and
industrialization.
Market Size and Growth (contd)
However, based on our conversation
with experts of the industry, especially
managers of private hospitals and
policlinics, we believe the actual
market size could be significantly
higher than estimates above for a
number of reasons:
Revenue of hospitals are usually
understated. Hospitals and
policlinics outsource much of the
business to their related entities and
do not maintain proper accounts.
Managers of private hospital and
policlinics reveals that true revenue
could have been1.5-2 times higher
than the reported if accounts were
maintained properly.
The figure does not take into
account money that rich Vietnamese
spend on oversea healthcare
services. According to the MOH,
about 40 thousand people spent
about US$1bn on healthcare
services oversea, mostly in
Singapore, Thailand and Hong
Kong.
Competition Dynamics
As a legacy of socialist healthcare system,
Vietnam healthcare market is dominated by
public hospitals. Private hospitals only
accounted for 3% of total countrys hospital
beds. There are only 135 (8%) private
hospitals over 1184 hospitals in Vietnam
currently. Also, private hospitals only
provided 4.2% and 5.1% of total hospital
systems inpatients and outpatients in 2011,
respectively.
Public hospitals are heavily subsidized.
Financial resource from State budget
allocation and health insurance are usually
from 60-70% of their revenue. In addition,
public hospitals, especially leading ones in
HCM City and Hanoi, have long history and
enjoy good perception that they have the
best trained, experienced doctors in the
country. They have great appeal to patients
and doctors.
Private hospitals in Vietnam have a short
history. The oldest ones were established in
the mid 1997. The perception about private
hospital is that they provide better caring
services but they dont have good doctors
as their public counterparts.
4
Executive Summary (cont'd)
Competition Dynamics (contd)
Consequently, private hospitals have
to cooperate with doctors from public
hospitals, especially in early years of
their operation, in order to attract
clients before they can build their own
doctor team and their own clientele.
Privatization of public hospitals in
Vietnam has been discussed for more
than 10 years but it seems that the
plan is impossible because of strong
resistance from doctors.
Until now, there have been few foreign
invested hospitals in Vietnam. Like
private hospitals, foreign invested
hospitals are handicapped by the
perception of Vietnamese patients that
they dont have good doctors. Bringing
foreign doctors is not necessarily a
solution because of language and
cultural differences. In addition, foreign
invested hospitals normally target
premium segments and rich
Vietnamese people can choose to use
healthcare service oversea.
Competition Dynamics (contd)
Foreign players in Vietnam such as
FV International and Viet-France
International from a group of French
doctors, Fortis Healthcare Group from
India with Hoan My as a local brand,
Columbia Asia from Malaysia, Family
Medical Practice from Israel. Most of
these foreign players are making a net
profit margin of 20%, on average while
local large players reported very thin
margin from 5-10%.
Doctors in Vietnam are allowed to
have their own clinics, doctors from
public hospitals are allowed to
cooperate with private, foreign
hospitals (after official hour or after
they finish some quota with public
hospital). Most doctors from public
hospital have their own clinics or
cooperate with a private
hospital/policlinic. They earn more
money working with private hospital
but rarely quit their job at public
hospitals. This shapes a very
important character of competition in
healthcare market in Vietnam.
Competition Dynamics (contd)
Attraction of doctors from public
hospitals, especially highly respected
names, is considered the key competitive
advantages of private hospitals/policlinics
as a good doctor can bring hundreds of
visits/patients per day. Cooperation
between doctors with private hospitals is
mainly in revenue sharing schemes.
As part of our competition review, there
are 6 main challenges for a private
healthcare service providers :
Mobilizing and rewarding doctors;
Acquiring customers or patients;
Maintaining a sustainable partnership
with public hospitals who heavily
dominating the market;
Replicating or expanding existing
business model;
Non-transparency in term of policy,
financial and doctor rewarding system;
and
Obtaining permit for health insurance
claim system.
5
Executive Summary (cont'd)
Key Drivers and Trends
Looking forward, we believe that there
are still great opportunities for local
and foreign private players, because:
While public players are dominating
the market, new investment by the
Government will not be enough to
satisfy growing demand. Vietnam
has a relatively high national health
spending over GDP (7.3% in 2011)
and State budget allocated to health
spending reaching the 10% cap. In
addition, the Government is even
cutting down public spending,
sources of funding from international
donors via ODA is decreasing. There
exist a real demand for private
investments in healthcare sector.
Overload, especially at leading
provincial and central hospitals has
been worsening and should be
resolved. Countrywide, Bed
Occupancy Rate at 116% in 2011 but
it is from 150%-400% at many
specialized and general public
hospitals.
Key Drivers and Trends (contd)
Based on our research, we have
preliminarily noticed a number of
concepts and business models that
could be a market trend in coming
years. Of course, the concepts are
subject to further evaluation:
A diagnostic service center providing
medical lab and imaging services.
These are the most profitable
segments in public and private
general hospitals and policlinics at
the moment. However, the key
challenge is to seek acceptance and
partnership with public hospitals.
HCMC authority is in initial step to
build up a high-tech medical center.
A joint venture could be a possibility.
A general hospital with a strong
focus on orthopedic treatments,
plastic surgery and wellness
services.
A well-branded healthcare service
chain tapping a mass market
demand for a better checkup
service.
HCMC Health Snapshot
We have confirmed our preliminary
understanding that HCMC is a good
location to establish a healthcare service
business to not only serve HCMCs citizens
but also surrounding provinces where the
health facilities are in very poor conditions.
HCMC is the largest city in Vietnam with
9 million population and is the economic
center of Vietnam. In addition, HCMC is
medical center of the whole South East
area. Patients from other provinces in the
South East usually go to HCMC for
medical services. For example, 70% of
patients from Medic are from other
provinces surrounding HCMC such as
Binh Duong, Vung Tau, Dong Nai, Vinh
Long etc.
In 2010, hospitals in HCMC delivered 28
million consultations to patients which is
4 times higher than Hanoi. Number of
inpatients, outpatients and inpatient days
are also about 2 times greater than
Hanoi.
6
Executive Summary (cont'd)
HCMC Health Snapshot (contd)
HCMC Authority has been very active
in designing and creating mechanisms
for improving the healthcare service. It
has very clear design for the 4-
healthcare clusters and a more friendly
welcoming to private sector.
In HCMC has 34 private hospitals, 176
private policlinics and nearly 17
thousands of private clinics or
specialty units.
In lab and diagnostic imaging services,
Medic currently accounted for 20%
total market share with total reported
revenue of about US$20mn in 2010.
Some public hospitals are also very
strong in these businesses and it was
built in-house as their departments.
Hundreds of private followers are very
small and highly fragmented.
Key Regulations
The Law on Medical Examination and
Treatment and its guiding documents
with effect from 2011 set various
requirements for an establishment of
a healthcare service operation license.
Minimum conditions are specified for
functions of operations; construction
design and facilities; personnel and
practicing certificates; and waste
management and staff safety.
However, the guidance is very
minimum. An investor should consult
and work closely with the authority for
obtaining an operation license,
changing the scope of operation and
making an acquisition of an existing
license.
Acquisition of an existing hospital and
clinics must be made with due
attention to the renewal of license in
accordance with the new regulations.
Additional costs would incur to bring
the establishment up to standards
under the new law.
Key Regulations (contd)
Operation license for a foreign hospital
must be approved by the Minister of
Health. By law, the license for foreign
policlinic is within the provincial authority
but in practice, it must be brought to the
attention and no objection by the
ministerial level. It takes approximately 3
months in obtaining a policlinic license
and 6 months for a hospital license, at
least.
Private and foreign participation in
healthcare services is encouraged by the
Government.
Hospital business is subject to 10%
business income tax (which is 15% lower
than the normal business) and an
incentive of 4-year land use right tax
exemption and 50% reduction in the next
9 consecutive years if the hospital
investment has 100 beds at minimum.
Healthcare service fees in Vietnam is at
discretion of the business management.
In contrast to drug market, the
Government doesnt interfere in the
price.
7
Contents

Section 2: Overview of Healthcare Sector in Viet Nam

Market Size and Growth

National Health Expenditure

Organization of Healthcare Sector

National Health Insurance System

8
Section 2: Overview of Healthcare Sector in Vietnam
Market Size and Growth

Total healthcare market is estimated at about US$9.3bn in 2011. This total market size accounts for 9%
of the country's GDP. Healthcare service is the largest segment.

Total medical device market is estimated at US$0.73bn, or US$8.1 per

capita in 2011.
US$0.73bn Medical devices are products used for diagnosis or therapy in patients
Medical Devices and include a wide range of products, including syringes, thermometers,
(2011)
blood-sugar tests, prosthetic limbs, ultrasound scans and X-ray
machines, among others.

Total pharmaceutical sales is estimated at US$1.89bn in 2011, 12.8%

over 2010, US$23 per capita.
Pharmaceuticals US$1.89bn Total drug sales are the sum of revenues generated by domestic and
/Drugs (2011) foreign pharmaceutical companies for generic, patented, and over-the-
counter drugs through hospitals, retail pharmacies and other channels.

Total healthcare service market is estimated at US$6.67bn in 2010. The

healthcare services providers include 13.598 facilities nationwide with
US$6.67bn total 252.747 beds.
Healthcare
Services (2010) The system delivered 205 millions of consultations; 11.6 millions of
inpatients; and 32.8 millions of outpatients in 2010.

9
Section 2: Overview of Healthcare Sector in Vietnam
Market Size and Growth

Medical device market is estimated at US$0.73bn in 2011 and CARG of 15.2% over 2012-2016. 90.7% of
the market is made up of foreign goods.

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10
Section 2: Overview of Healthcare Sector in Vietnam
Market Size and Growth

55% of medical devices imported to Vietnam are diagnostic imaging equipment, medical consumables
and patient aids.

Figure 2: Breakdown of Medical Device Market, 2009 (US$mn)

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Source: MoH, StoxPlus, Espicom.

11
Section 2: Overview of Healthcare Sector in Vietnam
Market Size and Growth

Drug market is estimated at US$1.89bn in 2011, or 19% y-o-y growth. Drug Administration of Vietnam
released that the market will top approximately US$2bn in 2012.

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12
Section 2: Overview of Healthcare Sector in Vietnam
Market Size and Growth

Drug sales: The market is highly regulated. Prescription drugs accounted for 73%.

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13
Section 2: Overview of Healthcare Sector in Vietnam
Market Size and Growth

Healthcare Service: it is our own estimation that the market is at least US$6.67bn in 2011.

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14
Section 2: Overview of Healthcare Sector in Vietnam
Market Size and Growth

Details of our estimation of healthcare market are presented in Figure 5 below. Service usage date are
sourced from MoH and service fee rates taken from latest market offerings.

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15
Contents

Section 2: Overview of Healthcare Sector in Viet Nam

Market Size and Growth

National Healthcare Expenditure

Organization of Healthcare Sector

National Health Insurance System

16
Section 2: Overview of Healthcare Sector in Vietnam
National Healthcare Expenditure

National health expenditure is US$8.64bn, or 7.2% GDP in 2011. In which, Government spending is
US$3.4bn, or 37% and private sector contributes US$5.4bn, accounting for 63%.

Figure 6: Health Expenditure Breakdown and % GDP

Private Healthcare Expenditure (US$bn)

Public Healthcare Expenditure (US$bn) %
US $bn Healthcare Expenditure/GDP (%)
18.0 8.0
7.81
16.0
10.45 7.8
7.66
14.0
9.29
7.6
12.0 8.17

10.0 7.1 7.27 7.4

7.25
6.15 7.21
This part is intentionally left blank 8.0
7.17
7.28 7.08 7.2
4.92 7.17
6.0 4.49 5.4
4.03 7.0
5.85
4.0 5.27
4.7
4.15
3.24 3.64 6.8
2.0 2.78 3.01
2.52
- 6.6
2008 2009 2010 2011 2012F 2013F 2014F 2015F 2016F

Source: MoH, StoxPlus, BMI

17
Section 2: Overview of Healthcare Sector in Vietnam
National Healthcare Expenditure

Public healthcare expenditure/GDP of 7.2% is significantly higher than peer countries because of the
low efficient and the highly public dominated healthcare system and the massive spending on health
insurance.

Figure 7: Population, # of doctors and % health exp/GDP

Doctors/10,000 inhabitants
20.0 China
18.0
16.0 Singapore
14.0
12.0 Phillipines
10.0

This part is intentionally left blank 8.0 Malaysia

Vietnam
6.0
4.0
Indonesia Thailand
2.0
-
- 2.0 4.0 6.0 8.0 10.0
health exp. % of
GDP

Source: MoH, StoxPlus, BMI

18
Section 2: Overview of Healthcare Sector in Vietnam
National Healthcare Expenditure

The public spending burden is also because of the huge number of facilities at commune and village
levels operating at low utilisation.

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19
Section 2: Overview of Healthcare Sector in Vietnam
National Healthcare Expenditure

Where does the Government spend on healthcare?

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20
Section 2: Overview of Healthcare Sector in Vietnam
National Healthcare Expenditure

What are the main source of funding?

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21
Section 2: Overview of Healthcare Sector in Vietnam
National Healthcare Expenditure

Per capita basis, health expenditure achieved US$97.3 in 2011 (US$8.64bn/87 million population) but
the actual figure is unknown and could be significantly higher.

Figure 11: National health exp. per capita over years

US$
200
174.69
180 157.47
160 140.54
140 124.11
109.08
120 97.32
90.28
100 83.71
76.13
This part is intentionally left blank 80
60
40
20
0
2008 2009 2010 2011 2012F 2013F 2014F 2015F 2016F

Source: MoH, StoxPlus, BMI

22
Section 2: Overview of Healthcare Sector in Vietnam
National Healthcare Expenditure

Health spending per person in Vietnam is in similar scale with Philippines, Indonesia but significantly
lower than Malaysia, Thailand and China.

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23
Section 2: Overview of Healthcare Sector in Vietnam
National Healthcare Expenditure
Counter-measures by the Government in dealing with the soaring national health expenditure:
There have been a number of conferences hosted by MoH
and donors such as The World Bank, UNDP and UNICEF
for this topic. The fact is that donors and the Government
themselves want to further increase national health
expenditure to meet peoples demand and to improve
health services in a better standard. The donors and other
stakeholders also recommend the Government increase
public spending on health to 10% of total annual State
budget. Nevertheless, various issues including the hospital
overload, low penetration of doctors and beds per 10,000
population, etc are still prevailing.
Privatisation of public hospitals once discussed for a long
time but the process holds up infinitely and it seems that
private participation in this sector can be only lifted up by
the direct investments by their own projects. There are few
business cooperation contracts such as Vietnam-Japan
Hospital within Bach Mai Hospital but the move is rather
slow.
While the public spending will be challenging because of
the State budget deficit and the public spending cutdown
and the credit crunch, the Government are implementing a
number of measures to cope with the situation:
Government Bonds: This used to be a good source of
fund in the past and it is the plan by the Government to
continue this channel in coming years, as stated on the
MoHs draft proposal on reducing the hospital overload. At
provincial level, it is the plan by HCMCs People
Committee to issue VND5,000bn (US$250mn) municipal
bonds to finance the public hospital expansion and new
investments in HCMC from 2012-2016.
Foreign borrowings: NGOs and international agencies
contributed annually about US$100 to healthcare in
Vietnam. In a latest move, Prime Minister Nguyen Tan
Dung has just approved a total borrowing of US$100 for
two private hospitals from a European lenders in July
2012.
Public-Private Partnership: This scheme has been
discussed a lot and various efforts by Government such
as promotion to Japanese investors in recent conferences
but it is rather slow from our observation.
Encouragement of private sector: the land tax incentives
exemption for 4 years and 50% reduction in 9
consecutive years will continue. Financing up to 70% by
borrowings of investment capital for expansion and
upgrades with low interest rates have been and will be
provided to many private hospitals, especially the
provincial level hospitals.
24
Contents

Section 2: Overview of Healthcare Sector in Viet Nam

Market Size and Growth

National Healthcare Expenditure

Organization of Healthcare Sector

National Health Insurance System

25
Section 2: Overview of Healthcare Sector in Vietnam
Organization of Healthcare Sector

A sector in transition where public system is overloaded but private system is not yet well established
and hardly affordable to majority

Government Professional Units under Ministry:

Curative:30 hospitals with beds
MINISTRY OF HEALTH Preventive:17 institutes or centers
14 Departments and Administration Quality Control: 5 institutes or centers
The Cabinet Training:14 schools or colleges
Inspectorate Centre for health education and communication :17 units

Provincial Peoples Committee

Professional Units under the PHS:

PROVINCIAL HEALTH SERVICE
Office
Inspectorate
District Peoples Committee
General and specialized hospitals for curative care
Preventive Health Centers
Quality Health Centers
Training Middle Level Schools or Colleges
Centre for health education and communication

PROVINCIAL HEALTH SERVICE

District General hospitals District Preventive Health
Office
Clinics Centers
Inspectorate

Commune Peoples Committee

COMMUNAL HEALTH CENTRES

Head Village Health Workers
Healthcare Workers

26
Section 2: Overview of Healthcare Sector in Vietnam
Organization of Healthcare Sector

By design, healthcare facility system in Vietnam mostly available at provincial and district level.
Hospital and policlinics at central level (directly managed by MoH) accounted for 7.7% of total country
beds only.

27
Section 2: Overview of Healthcare Sector in Vietnam
Organization of Healthcare Sector

There are 1,189 hospitals in Vietnam in 2010 and public hospitals are still heavily dominating the
market. 97% of beds attributed by public hospitals. Private sector is being more active but only
provides 3% of total beds.

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28
Section 2: Overview of Healthcare Sector in Vietnam
Organization of Healthcare Sector

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29
Section 2: Overview of Healthcare Sector in Vietnam
Organization of Healthcare Sector

Although Bed Occupancy Rate at public hospitals are reducing over years, hospital overloading is still
a serious issue at central and provincial hospitals.

Figure 15: Bed Occupancy Rate (BoR) at Public Hospitals

%
124
122
120
118
116

This part is intentionally left blank 114

112
110
108
106
2007 2008 2009 2010 2011

Source: MoHs Health Statistics Year Book 2010

30
Section 2: Overview of Healthcare Sector in Vietnam
Organization of Healthcare Sector

Why is it seriously overloaded at central hospital level?

A study by the Institute of Health Policy and Strategy Figure 16: Crossing over district hospitals
within MoH in 2010 has indicated that the percentage of
patients bypassing from district and lower levels to
provincial and central hospitals is from 50-80%. This is
Semi-rich people
because Vietnamese people place a great belief on
expertise and creditworthiness of doctors at central
hospitals. District
Hospital Provincial
In addition, it is poor services at district hospital system Hospital
while there is a increasing demand for higher service
District
qualities by the semi-rich people above. Hospital Central
As part of reducing hospital overload programme, Citizens Hospital
HCMC is to host a pilot project from November 2009 District
whereby a new network of general practitioners at three Hospital
health centers will attempt to divert patients with minor Provincial
Hospital
ailments to their clinics and reduce some of the
District
pressure on city hospitals. The municipal health Hospital
authorities announced that if successful it is the model
will be expanded to other city districts.
Rich people

Source: StoxPlus

31
Section 2: Overview of Healthcare Sector in Vietnam
Organization of Healthcare Sector

Bed penetration: There were 22.5 hospital beds per 10,000 population in 2010.

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32
Section 2: Overview of Healthcare Sector in Vietnam
Organization of Healthcare Sector

Doctors per 10,000 population in Vietnam is 7.2. In HCMC only, it is 13 doctors per 10,000 population.

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33
Contents

Section 2: Overview of Healthcare Sector in Viet Nam

Market Size and Growth

National Healthcare Expenditure

Organization of Healthcare Sector

National Health Insurance

34
Section 2: Overview of Healthcare Sector in Vietnam
National Health Insurance

Public health insurance:

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35
Section 2: Overview of Healthcare Sector in Vietnam
National Health Insurance

Private health insurance: total health insurance premium is US$125mn in 2010. Local players are still
dominating the health insurance market.

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36
Contents

Section 3: Key Drivers for Healthcare Sector in Vietnam

Demographic Characters

Health Cost Affordability

Problems of Modern Lifestyle

Health Issue Pattern

Health Insurance Coverage Policy

37
Section 3: Key Drivers for Healthcare Sector in Vietnam
Demographic Characters

The healthcare sector is growing fast driven by demographic pressure, industrialization and
urbanization trends

Population & Age Structure

Urbanization This part is intentionally left blank

Industrialization

Higher revenue per capital

38
Section 3: Key Drivers for Healthcare Sector in Vietnam
Demographic Characters

Vietnam is 13th most populous country in the world, the seventh in the Asia-Pacific, and the third in
the South-East Asia.

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39
Section 3: Key Drivers for Healthcare Sector in Vietnam
Demographic Characters

Currently Vietnam has a young population and is enjoying a golden demographic bonus. However,
Vietnam is entering period where population is ageing faster.

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40
Section 3: Key Drivers for Healthcare Sector in Vietnam
Demographic Characters

Urbanization is happening rapidly because of immigration from rural areas and creating huge pressure
on cities

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41
Section 3: Key Drivers for Healthcare Sector in Vietnam
Demographic Characters

Industry and services are taking over agriculture, forestry and fishery to become the largest labor
employing sectors

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42
Contents

Section 3: Key Drivers for Healthcare Sector in Vietnam

Demographic Characters

Health Cost Affordability

Problems of Modern Lifestyle

Health Issue Pattern

Health Insurance Coverage Policy

43
Section 3: Key Drivers for Healthcare Sector in Vietnam
Health Cost Affordability

Vietnams urban population by income is shifting from a pyramid structure with a wide base of low-
income population to a diamond structure with an expanding middle-class base

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Source: Statistical Yearbook 2009,2011 44

Section 3: Key Drivers for Healthcare Sector in Vietnam
Health Cost Affordability

Vietnamese consumers are spending mostly on necessity goods, but health and education will receive
more attention in upcoming periods

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45
Contents

Section 3: Key Drivers for Healthcare Sector in Vietnam

Demographic Characters

Health Cost Affordability

Problems of Modern Lifestyle

Health Issue Pattern

Health Insurance Coverage Policy

46
Section 3: Key Drivers for Healthcare Sector in Vietnam
Problems of Modern Lifestyle
Modern living style is gaining influence in Vietnam
Living
Urban environmental pollution, air and water pollution
increasingly become serious problems affecting directly
to the inhabitants health
Consumption of tobacco in Vietnam is high. 56.1% men
aged 15 and above smoke. Approximately 73.1% adults
aged 18 and above are reported to be exposed to
secondary smoke at home.
Smoking creates the most common burden of diseases &
mortality like lung cancer, ischemic heart disease, etc.
Drinking
Alcohol consumption is embedded deeply in Vietnams
culture and an essential part of many important festivals
According to the National Health Survey 2002, 46% of
men aged 15 and above drink alcohol. Those in the
managerial or leadership positions drink the most (70%),
followed by office staff (65%) and professionals (61%)
Eating
Due to robust economic growth in Vietnam, the
Vietnamese diet has progressed from shortage to
abundance.. Overweight and obesity are likely to become
the next health challenge in Vietnam
According to the Join Annual Health Review 2011, the
overweight rate among Vietnamese adult in 2000 was
5.4% in urban areas. Overweight affects about 1.3%
children in the under-5 age group and 0.8% in the group
aged 5 to 10 years.
Exercising
According to the Vietnam Health Report 2002 by the
MoH, nearly 12% of the population got regular physical
exercise.
The Vietnam National Health Survey 2006 estimates that
65% of people aged 15 and older do not participate in
physical exercise, among those with sedentary jobs
account for 67%
The lowest rate of regular exercise falls into the group
aged 25 34 years old.
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Contents

Section 3: Key Drivers for Healthcare Sector in Vietnam

Demographic Characters

Increasing Healthcare Expenditure per Capita

Problems of Modern Lifestyle

Health Issue Pattern

Health Insurance Coverage Policy

48
Section 3: Key Drivers for Healthcare Sector in Vietnam
Health Issues Pattern

Health problems pattern are changing because of modern lifestyle

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Section 3: Key Drivers for Healthcare Sector in Vietnam
Health Issues Pattern

Health of Vietnamese people is improving but still below international standards

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Section 3: Key Drivers for Healthcare Sector in Vietnam
Health Issues Pattern

Vietnam is in an epidemiological transition with a double disease burdens while communicable

disease has not yet declined to a low level, non-communicable disease has risen to domination

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Section 3: Key Drivers for Healthcare Sector in Vietnam
Health Issues Pattern

The leading cause of death in Vietnam is stroke while leading forms of non-communicable diseases
are circulatory diseases and cancers.

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Section 3: Key Drivers for Healthcare Sector in Vietnam
Health Issues Pattern

Mental illness and Cardiovascular are the main disease groups causing burden of disease among men
and women in Vietnam

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53
Contents

Section 3: Key Drivers for Healthcare Sector in Vietnam

Demographic Characters

Health Cost Affordability

Problems of Modern Lifestyle

Health Issue Pattern

Health Insurance Coverage Policy

54
Section 3: Key Drivers for Healthcare Sector in Vietnam
Health Insurance Coverage Policy

Public Health Insurance Universal Health Insurance Program

The Health Insurance Law was passed in November Figure 39: Public Health Insurance Coverage 2002 2010
2008, effective in July 2009, which will make health
insurance compulsory for all citizens by 2014. Under
the Health Insurance Law, there are three levels of
%
benefits:
70.0
According to the MoH, by the end of 2010, 52,407,090 60.0
people, equivalent to 60.9% of the population were
50.0 60.9
covered under health insurance, an increase of 32%
40.0
compared to 2008. 43.9 43.8
30.0
At the moment, nearly all employees are covered by 20.0
compulsory health insurance. In fact, compulsory 16.5 21.1
10.0
health insurance made up 30% for the total insured 0.0
people in 2010. The voluntary proportion remained 2002 2004 2006 2008 2010
modestly at 8%.

Source: Health Statistics Yearbook 2010

55
Section 3: Key Drivers for Healthcare Sector in Vietnam
Health Insurance Coverage Policy

According to the Vietnam Household Living Standard Survey 2010 results, 66.7% people receiving
medical examination & treatment had health insurance/ health insurance free cards. This share in
urban areas & rural areas are 72.6% and 64.1% respectively

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56
Contents

Section 4: Competition Analysis

Market Concentration

Foreign Participation

Key Challenges for Private Players

Key Hospital Operation Players Profiles

Key Laboratory and Diagnostic Service Players Profiles

57
Section 4: Competition Analysis
Market Concentration

Healthcare service is highly concentrated in hospital operation segment but it is highly fragmented in
policlinics and home clinics segment.

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Section 4: Competition Analysis
Market Concentration

Public hospitals are operating at almost non competition basis or pressure. Since approximately 60-
70% of their revenue coming from State budget allocation and health insurance.

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Contents

Section 4: Competition Analysis

Market Concentration

Foreign Participation

Key Challenges for Private Players

Key Hospital Operation Player Profiles

Key Laboratory and Diagnostic Service Players Profiles

60
Section 4: Competition Analysis
Foreign Participation

Foreign industry players mostly focus in HCMC area

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Contents

Section 4: Competition Analysis

Market Concentration

Foreign Participation

Key Challenges for Private Players

Key Hospital Operation Player Profiles

Key Laboratory and Diagnostic Service Players Profiles

62
Section 4: Competition Analysis
Key Challenges for Private Players

The biggest challenge in a private healthcare service business model is how to mobilise and retain
doctors

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63
Section 4: Competition Analysis
Key Challenges for Private Players

Mobilising and retaining doctors is also the Key Success Factor for a private healthcare service
provider in Vietnam

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64
Section 4: Competition Analysis
Key Challenges for Private Players

Many private hospitals and clinics are so dependent on doctors

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Section 4: Competition Analysis
Key Challenges for Private Players

Many private hospitals and clinics are so dependent on doctors

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66
Section 4: Competition Analysis
Key Challenges for Private Players

Many private hospitals and clinics are so dependent on doctors

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67
Contents

Section 4: Competition Analysis

Market Concentration

Foreign Participation

Key Challenges for Private Players

Key Hospital Operation Players Profiles

Key Laboratory and Diagnostic Service Players Profiles

68
Section 4: Competition Analysis
Key Hospital Operation Players Profiles

Key Private Hospital Players: Average net profit margin is around 20% by foreign hospital business

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69
Section 4: Competition Analysis
Key Hospital Operation Players Profiles

France-Vietnam HCMC (FV)

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70
Section 4: Competition Analysis
Key Hospital Operation Players Profiles

Viet-France International Hanoi

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71
Section 4: Competition Analysis
Key Hospital Operation Players Profiles

Van Hanh General Private Hospital

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72
Section 4: Competition Analysis
Key Hospital Operation Players Profiles

Trieu An General Hospital

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Section 4: Competition Analysis
Key Hospital Operation Players Profiles

Thanh Nhan Public Hospital

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Contents

Section 4: Competition Analysis

Market Concentration

Foreign Participation

Key Challenges for Private Players

Key Hospital Operation Players Profiles

Key Laboratory and Diagnostic Service Players Profiles

75
Section 4: Competition Analysis
Key Laboratory and Diagnostic Service Players Profiles

Medic Medical Center

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Section 4: Competition Analysis
Key Laboratory and Diagnostic Service Players Profiles

Medic competitiveness is based on cost advantage which is derived from large operation
scale, strong technical expertise, strong franchise to attract client and cooperate well
known doctors, and a diversified client base

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Section 4: Competition Analysis
Key Laboratory and Diagnostic Service Players Profiles

Medic Checkup Department

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Section 4: Competition Analysis
Key Laboratory and Diagnostic Service Players Profiles

Medic Lab Department (MEDIC-LAB)

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79
Section 4: Competition Analysis
Key Laboratory and Diagnostic Service Players Profiles

Medic Medical Center

Approximately 30% of Medics patients are referred from clinics, policlinics and hospitals. Medics
testing and diagnostics results are accepted by many local public and private hospitals.

Medics Customer Flows

Medic

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Section 4: Competition Analysis
Key Laboratory and Diagnostic Service Players Profiles

Medic has the advantage of the first mover in HCM City. Overtime, Medic has become market
leader among private polyclinics in HCM City providing checkup, lab, pharmacy, outpatient
treatment.

Why Medic Successful?

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81
Section 4: Competition Analysis
Key Laboratory and Diagnostic Service Players Profiles

Medic is however facing some difficulties in growing and perpetuate its business. It has not
succeed in replicating the same business in other provinces such as Dong Nai, Can Tho.

Medics Key Challenges

Reliance on Dr Hai: Medic is a close, family business that owes its entire success to entrepreneurship of
the founder, Dr Hai who is now over 70 years old. Dependence on a single person keeps Medic from
putting in place best management and governance practices and exposes Medic to considerable risk of
succession and perpetuity.
Corporate restructuring: Like other healthcare service establishments in Vietnam, Medic is a non
transparent business model, especially in its legal status and its partnership with doctors. This expose
Medic to high legal, operational risks.
Expansion once upon failed: Medic has been struggling to set up their presence in other market such as
Dong Nai, Can Tho and other provinces in the South East and Mekong Delta. Lack of doctors in these
provinces and difficulties in inviting good doctors from HCM City to work in provinces are major obstacles.
Branding Medic, without reputation of some good doctors, might not be strong enough to attract patients.

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Section 4: Competition Analysis
Key Laboratory and Diagnostic Service Players Profiles

Vigor Health

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83
Section 4: Competition Analysis
Key Laboratory and Diagnostic Service Players Profiles

Medlatec

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Section 4: Competition Analysis
Key Laboratory and Diagnostic Service Players Profiles

VietSing International Clinic

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Contents

Section 5: Policy and Regulatory Framework

Legal Framework

Operation License

Key Regulations for a Lab Business

86
Section 5: Policy & Regulatory Framework
Legal Framework
Legal Framework
Along with the improvement of the social welfare, Vietnam has
made many attempts to improve the legal framework for the
healthcare sector. Most recently, the new Law and various
regulations issued to welcome high quality service provider in
this sector. The most important laws include:
The Pharmacy Law (2005)
The Health Insurance Law (2008)
The Law on Medical Examination and Treatment (2011),
guiding by following documents:
The Decree No. 87/2011/ND-CP dated 27 September
2011 guiding a number of articles of the Law on Medical
Examination and Treatment (Decree 87); and
The Circular 41/2011/TT-BYT dated 14 November 2011
(replacing the old regulation: Circular 07/2007/TT-BYT)
provides guidance on the granting of medical practicing
certificates and operation licences (Circular 41).
Foreign investment in hospitals
According to the WTO commitments of Vietnam (Section II.8)
and [Investment Law 2006] foreign medical service suppliers
are permitted to provide services through the establishment of:
100% foreign-invested hospital
joint-venture with Vietnamese partners; or
through a business cooperation contract.
Foreign investment in hospitals
Under the WTO commitments, the legal capital requirement for
a commercial presence in hospital services must be no less
than:
USD20 million for a hospital,
USD2 million for a policlinic unit, and
USD200,000 for a specialty unit.
However, it appears that none of the laws issued post-
WTO accession mention the requirements on minimum
capital. The minimum capital requirements are neither
stipulated on the Law nor its guiding documents (Decree 87
and Circular 41). We have put this question to the HCMCs
Department of Health, their view is that this is an ambiguous
issue for the HCMCs Department of Planning and Investment
who take charge of providing investment certificate for foreign
hospital investors as well.
We therefore recommend Investor should seek legal advices
on this matter in the next stage.
Practical hints:
It is our observation that there are a number of foreign
investors playing around the minimum capital requirement by
setting up a small-size policlinic by nomination or by
structuring as loans to a local doctor or citizen to avoid the
US$2mn capital requirement.
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Contents

Section 5: Policy and Regulatory Framework

Legal Framework

Operation License

Key Regulations for a Lab Business

88
Section 5: Policy & Regulatory Framework
Operation License

The Circular 41 provides various forms for a Medical Examination and Treatment Establishment
(METE) and minimum conditions for establishing a METE depending on its scope of professional
practice:

At least 30-bed size for general hospital and 20-bed size for
Hospital specialised hospitals. Conditions for obtaining operation license for
hospital establishment is defined in Article 23, Circular 41.
Among other conditions, a policlinic must have at least 3/4 specialty
Policlinic units: Medicine; Surgery; Pediatric and Obstetrics and Pediatrics.

Specialty Unit At least 10m2. Additional space required depending on the scope of
operation such as otolaryngology or stomatology.
Medical Examination
and Treatment At least 10m2. Additional space required depending on the scope of
Establishments Traditional Medicine
Clinic operation. Typical services are medical steaming, acupuncturing,
(METE) and traditional medicines.

Maternity Station Operates like maternity delivery services, mainly at commune levels.

Diagnostic Imaging Additional requirements for radiation conditions (for personal safety
Unit and environment) for CT scanner and MRI.

Lab equipment must be sufficient to at least one of six different type

Laboratory Unit of tests: (1) Microbiological; (2) Biochemical; (3) Hermatology; (4)
Immunological; (5) Pathology and (6) Genetic.

Dental Unit, Family Doctors, Optics, First aid (like SOS),

Other Establishments
Commune Health Stations

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Section 5: Policy & Regulatory Framework
Operation License

Minimum requirements for establishment of a Policlinic Unit, a Diagnostic Imaging Unit and a Lab Unit

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90
Section 5: Policy & Regulatory Framework
Operation License

Minimum requirements for establishment of a Policlinic Unit, a Diagnostic Imaging Unit and a Lab Unit

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Section 5: Policy & Regulatory Framework
Operation License

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Section 5: Policy & Regulatory Framework
Operation License

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Contents

Section 5: Policy and Regulatory Framework

Legal Framework

Operation License

Key Regulations for a Lab Business

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Section 5: Policy & Regulatory Framework
Key Regulations for a Lab Business

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Contents

Section 6: A Closer Look into HCMC

Overview

Hospital Overloading Situation

Doctors and Manpower

Healthcare Investment Projects

96
Section 6: A Closer Look into HCMC
Overview

9 million population. Of
which, 7.16 million people
counted on April 1, 2009
and 2.84 million non-
permanent people.
GDP accounting for more
than 25% of Vietnam.
GDP per capita in 2011:
US$3,130 (Vietnam in
overall: US$1300).
24 districts
5% of households
spending more than
US$750 per month but
68% of households
spending more than
US$225 per month.
Unemployment rate in
HCMC in 2011 is 4.5% but
the stable employment Key Health Capacity Indicator:
rate accounting for 47.8% 101 hospitals: 67 public and 34
only. private
Population density: 3530 9634 doctors or 13 doctors/10,000
people/km2 (Vietnam: 263; population
Hanoi: 1962) in 2011. 31,388 hospital beds or 40 beds
per 10,000 population.

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Section 6: A Closer Look into HCMC
Overview

HCMC Geographic characters

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Section 6: A Closer Look into HCMC
Overview

There are 101 hospitals in HCMC including 67 public hospitals and 34 private hospitals.

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99
Section 6: A Closer Look into HCMC
Overview

HCMC checkup activity is almost 4 times greater than Hanoi and treatment activity is about 2 times
higher than Hanoi.

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Contents

Section 6: A Closer Look into HCMC

Overview

Hospital Overloading Situation

Doctors and Manpower

Healthcare Investment Projects

101
Section 6: A Closer Look into HCMC
Hospital Overloading Situation

Reported overall BOR is 104.5% in HCMC based on the number of beds declared for State budget
subsidy. However, actual overload could be significantly higher especially at specialised hospitals.

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Section 6: A Closer Look into HCMC
Hospital Overloading Situation

The reason for the hospital overloading in HCMC is because of the poor and inadequate hospital
facility.

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Section 6: A Closer Look into HCMC
Hospital Overloading Situation

Almost all specialised hospitals in HCMC are overloaded with BOR more than 100%.

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Contents

Section 6: A Closer Look into HCMC

Overview

Hospital Overloading Situation

Doctors and Manpower

Healthcare Investment Projects

105
Section 6: A Closer Look into HCMC
Doctors and Manpower

HCMC is facing severe doctor shortage, especially when new licenses are put into operation

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Contents

Section 6: A Closer Look into HCMC

Overview

Hospital Overloading Situation

Doctors and Manpower

Healthcare Investment Projects

107
Section 6: A Closer Look into HCMC
Healthcare Investment Projects

Public Investments: The following public hospital projects in HCMC are under funding consideration:
State budget, Build-Transfer (BT), Build-Operate-Transfer (BOT). The project pipeline includes a large
lab center business model.

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108
 HCMC Department of Health
Development
Section 8: Overview of Healthcare Plan for Health Facility System Toward 2020
Sector in Vietnam
A Closer Look into HCMC Hospital Landscape Map

North Cluster: District 12, Cu

Geographic characters Chi, Hoc Mon districts:

-Total hospital in place: 0/34

Go Vap, Phu Nhuan, Tan

Binh districts:
7/34 private hospitals East Cluster: Q2, Q9, Thu Duc,
Binh Thanh districts:

-Private hospitals: 2/34

-Private players: Columbia Asia
Medic is here! Gia Dinh

District 1,3,5,10:
16/34 private hospitals
West Cluster:
- Binh Chanh, Binh Tan, Tan Phu
districts
- Hospitals in operation: 5/34
-Private players: Shangri-la Hoa
Lam, Columbia Asia Gia Dinh,
Trieu An Hospital South Cluster: District 7, Nha Be,
Can Gio, districts:

-Hospitals in place: 2/34

-Private players: FV Hospital, Tam
Duc Heart Hospital
District 8:
2/34 private hospitals 109
Contents

Section 7: Appendices

Appendix 1: Full list of 34 Private Hospitals in HCMC

Appendix 2: List of Key Foreign Players in Healthcare Market in Vietnamese

Appendix 3: Full list of 29 Private Health Insurance Service Providers in Vietnam

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Section 7: Appendices
Appendix 1: Full list of 34 Private Hospitals in HCMC

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Section 7: Appendices
Appendix 2: List of Key Foreign Players in Healthcare Market in Vietnam

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Section 7: Appendices
Appendix 3: Full list of 29 Private Health Insurance Service Providers in Vietnam

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