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Health and wellbeing demand of expatriates in Ho Chi Minh City An empirical study Rebecca Mayer

2014


Rebecca Mayer

Abstract Author: Rebecca Mayer Title: Health and wellbeing demand of expatriates in Ho Chi Minh City

There are few academic papers about the health care need of expatriates in South-East-Asia, and none about expatriates in Vietnam. But health care institutions especially in larger cities like Ho Chi Minh City are dependent on information about their clients to be able to improve health care services. This study provides a first insight into health related issues of expatriates in Ho Chi Minh City. A quantitative study, including an online and a telephone survey were conducted. Participants were asked about their life in Ho Chi Minh City, their health care needs, their preferred health care providers and the kind of treatments they are accessing. Furthermore, qualitative face-to-face interviews completed the work and provided a deeper understanding of   expatriates’   thoughts   and   emotions   regarding their health care experiences in Vietnam. The results of the analysis show that health care and health related issues are major concerns of expatriates while living in Vietnam. Preferred health care providers are private hospitals and clinics. Public hospitals are unpopular, because of their bad reputation or bad experiences expatriates had there. They are associated with low hygiene, crowdedness and staff lacking skill, as well as language barriers and missing trust. Complains about private hospitals are mostly about high prices and the lack of specialized care. Even if most of the expatriates access regular medical care in Ho Chi Minh City, the analysis indicates that for more complex treatments and dread diseases expatriates prefer to fly home or abroad. The findings of the study suggest that improvements on specialized care in the private sector and improvements on public medical care on the most basic level has to be done, to make expatriates feel safe when accessing health care in Ho Chi Minh City.

Keywords: expatriation; expatriates in Ho Chi Minh City; health care need; wellbeing; health care providers; quantitative study; qualitative study

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Rebecca Mayer

Table of Contents 1.

2.

Introduction .......................................................................................................................................... 4 1.1.

Background ................................................................................................................................... 4

1.1.

Objective ....................................................................................................................................... 4

1.2.

Methods and procedures.............................................................................................................. 4

1.2.1.

Online survey ........................................................................................................................ 4

1.2.2.

Telephone survey .................................................................................................................. 4

1.2.3.

Face-to-face interviews ......................................................................................................... 5

1.2.4.

Procedures ............................................................................................................................ 5

Profile of the questioned expatriates ................................................................................................... 5 2.1.

3.

4.

Demographic characteristics......................................................................................................... 5

2.1.1.

Online Survey ........................................................................................................................ 5

2.1.2.

Telephone Survey.................................................................................................................. 6

2.1.3.

Face-to-face interviews ......................................................................................................... 6

2.2.

Income level .................................................................................................................................. 6

2.3.

Annual spending on health care and sources of finance for health care ..................................... 6

Expatriates’ life  in  Ho  Chi  Minh  City...................................................................................................... 7 3.1.

Health and wellbeing .................................................................................................................... 7

3.2.

General concerns .......................................................................................................................... 7

Health care need of expatriates in Ho Chi Minh City ............................................................................ 8 4.1.

Information about health care...................................................................................................... 8

4.2.

Kind of treatments ........................................................................................................................ 8

4.3.

Preferred health care providers .................................................................................................... 9

4.4.

Remarks about improvements.................................................................................................... 11

4.5.

Limitations................................................................................................................................... 12

5.

Conclusion ........................................................................................................................................... 13

6.

Appendix ............................................................................................................................................... A

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Rebecca Mayer

1. Introduction 1.1.Background There are few papers about expatriates’ need on health care in Vietnam. Information is found only on expatriates’ blogs   and   on   health   insurance   websites,   which   are promoting their services. For health care providers the knowledge about the health care need of expatriates is essential. They need to know which services they can offer and how to address this target group. With the right adjustment of their services to the needs of expatriates, improvements on health care among the expatriates community can be done.

1.1.Objective The goal of this survey is to identify the health and wellbeing demand of expatriates in Ho Chi Minh City. Therefore expatriates’  choice  of  health care providers, the kind of treatments they are accessing in Ho Chi Minh City, their general wellbeing and worries, their income level, as well as the amount of health care expenses and their source of financing was examined.

1.2.Methods and procedures 1.2.1. Online survey Since there is a lack of academic papers in this field an online survey based on the statements of expatriates on   various   expatriates’   blogs   and on the personal experiences of the author has been created. The online survey was promoted through various social media, like facebook, expatriates’ blogs and through personal contacts. Furthermore, English language schools, international sport clubs and organizations in Ho Chi Minh City were contacted and asked to share the link to the survey with their foreign staff. If not mentioned explicitly the numbers in this report will be taken from the online survey. 1.2.2. Telephone survey With the results of the online survey another questionnaire was conducted. These questions were asked via telephone to patients at Cao Thang Eye Hospital. This second step guarantees that interviewees have had health care experiences in Ho Chi Minh City already and therefore have a deeper understanding of the health care system in Vietnam and their own health care needs.

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Rebecca Mayer 1.2.3. Face-to-face interviews A third method, personal interviews, was chosen to discover the thoughts and emotions of participants when speaking about their own personal experiences with health care in Ho Chi Minh City. Depending on

their

stories,

individual

questions

and

focus

points

could

be

made.

Furthermore an expert interview with two representatives of a health care insurance consulting company (IF-Consulting) was conducted. 1.2.4. Procedures This paper has been divided into five parts. After the introduction, which contains the background of the study, the objectives and the methods used, the second part deals with the profile of the respondents, and is divided into the different interview methods. Chapter three presents the wellbeing and the concerns of expatriates while living in Ho Chi Minh City. In the fourth section the health care need of expatriates is discussed. It focuses on five key themes: Information procurement, types of treatments, health care providers, health care concerns and remarks about improvements in the health care sector in Vietnam. Finally, the conclusion gives a brief summary and critique of the findings.

2. Profile of the questioned expatriates 2.1.Demographic characteristics 2.1.1. Online Survey 55 individuals returned the questionnaire, from which 45 completed the whole form. This number is no representative sample of the   expatriates’   community   in   Ho   Chi   Minh   City   and therefore figures and percentages need to be interpreted with caution. That means that the study just offers a small insight into opinions and trends of expatriates regarding health care in Ho Chi Minh City. It gives the opportunity to obtain a first idea, which subjects and issues are relevant. The majority of people who participated in the online survey are between 25-44 years old. The United States, United Kingdom, France and Germany are the countries where most of the respondents come from (with seven or eight people from each country). Five expatriates are from Australia. The rest splits up to other countries in Europe and Asia. It was not possible to investigate significant relationships between demographic data and provided answers to the survey, caused through the small sample size.

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Rebecca Mayer 2.1.2. Telephone Survey The telephone survey was held with roughly 10% of the international patients at Cao Thang Eye Hospital, which means a total of 20 patients. 15 people were male and five female. That correlates with a derivation from just under 4% with the actual distribution of the international patients at Cao Thang Eye Hospital. More than half of the respondents have been living in Ho Chi Minh City for more than three years. The patients questioned are between 28 and 73 years old, the mean is 42 years. 30% of the respondents come from France, another 15% from the United Kingdom. The other respondents are from North America, Asia and Australia. Respondents from both, the online and the telephone survey, mostly come from Europe or the United States. Only a small number of those interviewed are from Australia or Asia. This does not reflect the expatriate community in Ho Chi Minh City, in which quite a high percentage comes from Japan, China and South Korea. This group could hardly be reached, because of the researchers own origin (Europe) and the language barrier. 2.1.3. Face-to-face interviews The personal interviews were conducted with one Australian, one Canadian and one Singaporean. They are all working in different areas (Consulting, Education, and Tourism) and have stayed in Vietnam for at least three years. This ensures that they have developed their own lifestyle and have a feeling for their wellbeing in Vietnam and it increases the chance that they know about health care in Ho Chi Minh City and that they have made health care experiences themselves. The expert interview with If-Consulting was conducted with a Vietnamese woman, who is responsible for French clients, and with a European staff, who is, among other tasks, responsible for Marketing.

2.2.Income level The mean income of most of the expatriates, questioned in the online survey lies between $20.000 $39.999 a year. It must be noted, that a quarter of the respondents preferred not to disclose their salary. The salary reflects the primary area of employment of expatriates: The education sector, in which 38% of the respondents work.

2.3.Annual spending on health care and sources of finance for health care According to the answers in the online survey expatriates’ average spending on health care a year (in US-Dollar) is $1284. This corresponds with a number provided by If-consulting, which estimates that the average premium for a health insurance for expatriates is $1300 a year (Interview If-consulting, line number 457).

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Rebecca Mayer This number  can  widely  vary  depending  on  the  expatriate’s  health  care  need  and  if  the  expatriate  has  a   health care insurance or pays out of his own pocket. 80% of the online survey respondents equally split up between financing health care expenses through an insurance and bearing the expenses themselves. Emergency costs, which are only included in the calculation, if the expatriate has an insurance, could increase the expenses for a single individual a lot, if he or she has to pay for it out of his or her own pocket.

3. Expatriates’ life  in  Ho  Chi  Minh  City 3.1. Health and wellbeing The online survey provides the evidence, that the expatriates’ community in Ho Chi Minh City is healthy. Three quarters rated their overall health excellent (29%) or good (46%). This result cannot be seen as surprising, if taken into account the young age of the expatriates participated in the survey. The three expatriates personally interviewed summarized what they mainly need for feeling healthy and good: Healthy food, the possibility of doing exercises and social contacts for the mental wellbeing (Interview I, line number 74-75). All of them do not find it difficult to live a healthy life in Ho Chi Minh City, as the access to fresh vegetables and fruit is easy (Interview III, line number 114), exercises can be done in a serviced apartment (Interview I, line number 72-73) or in the gymnasium (Interview II, line number 33) and the online survey proofs that the social life is no major concern for expatriates. One interviewee mentioned that it is difficult to do outdoor activities in Ho Chi Minh City, as she was used to in Australia (Interview II, line number 36-39). The online survey provides similar indications through comments from respondents, in which they complain about the lack of opportunities for outdoor activities and the environmental situation.

3.2. General concerns Expatriates’ most common concerns are health care, food safety, road safety and hygiene standards. Especially the general safety on the street was mentioned constantly. A connection between the fear of a motorbike or car accident and the health care situation in Ho Chi Minh City is pointed out by an interviewee during the telephone survey. He said that he worries most about having a car accident, because he has no trust in Vietnamese hospitals and doctors (Telephone Survey, ID 16). On the contrary, expatriates did not just state food as health concerning, but more than one third believe that it is healthy and delicious as well. The interviewee from Singapore indicated: “Food was  a  bit  different,  but  it  was  not  tremendously  affecting  ones  wellbeing” 7


Rebecca Mayer (Interview I, line number 70-71) and “coming from Singapore you would say, you know, have the spoons and the chopsticks been washed entirely before they are served to the next costumer, have the food that they are serving been kept on a certain temperature, (…) reducing the risk of certain bacteria multiplying. These would be the slightly kills that one would consider, but (…) you  can  feel  comfortable  with  the  fact  that  what  you’re   eating  it’s  not  going  to  cost  you  severe  health  poison.”   (Interview I, line number 82-88).

4. Health care need of expatriates in Ho Chi Minh City 4.1. Information about health care The results of the online survey show, that just seven out of 48 people have been provided with information about health care in Vietnam before their arrival. That number provided the fundament to ask patients during the telephone survey, if and why health care was / was not an important issue for them at the time they were thinking about moving to Vietnam. It could be confirmed, that just a small number of patients (26%) were seeing health care as an important issue. Reasons for that, given during the telephone survey, are: Expatriates feel healthy and have no medical history (43%), expatriates are not worrying, because they are having a health insurance (29%) or because they are still young (29%). 21% are also mentioned, that they can easily access health care in Thailand, Singapore or their country of origin. Once expatriates are in Vietnam, most of them (60%) are provided with information about health care and health care providers. The source they are using is the internet (42%) and they are asking other expatriates for advice (58%). This shows that, in addition to modern technologies, word-to-mouth plays a major role in passing information.

4.2.Kind of treatments The online survey shows that over half (55%) of those interviewed and those who are accessing regular medical care, access it in Vietnam. Another high percentage returns to their country of origin for regular health checks. 65% of the patients, interviewed on the phone, affirmed when asked if they are doing their regular health check in Ho Chi Minh City. One reason for the varying numbers might be the different sample size, as well as the way the question was asked. In the online survey the respondents had the opportunity to choose between different countries, whereas the interviewed people in the

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Rebecca Mayer telephone survey could simply affirm or deny, whether they are doing their regular medical checks in Ho Chi Minh City. Over half of the expatriates (57%) of the online survey thought that it is possible to receive a wide range of different treatments in Ho Chi Minh City. In contrary, just 22% thought the opposite. Even if the treatments are not specified in this question, the difference to the results of the online survey and especially to the personal interviews is surprising, because all personal questioned expatriates said they would return to their home country for complex or severe treatments. The representatives of IfConsulting confirmed that the basic insurance covers the evacuation of patients to Thailand or Singapore (Interview If-Consulting, line number 351-352) and that many of their clients would not like to go to a hospital in Ho Chi Minh City, in case of an accident, but instead prefer to be evacuated to Thailand (Interview If-Consulting, line number 479-483). There seems to be an obvious   discrepancy   between   various  treatments,   which   are   in   the   expatriates’   opinion available in Ho Chi Minh City and the fact that in most cases they themselves do not want to access more than regular and basic medical care in Vietnam. Following reasons might explain the discrepancy: Support of the family, which one interviewee mentioned (Interview I, line number 145), might be one reason, why expatriates choose to return to their country of origin. In some countries the access to health care is totally free. This is another motive for returning back home (Interview II, line number 89-90). Another interviewee explained it like this:  “I  would  be  scared,  if  I  breake  my  knee  (…)  I   would  trust  more  of  the  medical  practices  in  the  US  and  Canada.  In  Canada  there  is…  people  who  does   it,   they   have   accountability.   So   here   [in   Vietnam.   A/N]   they   don’t.”   (Interview   III,   line   number   43-45). The surveys and the interviews have proved that expatriates are more likely to access basic medical care in Ho Chi Minh City than complex medical treatments or medical care in case of dread diseases. Cosmetic surgeries or cosmetic dental care is not a common thing for expatriates to undertake in Ho Chi Minh City, as the telephone survey and the personal interviews show. Just three out of twenty respondents of the telephone survey ever accessed any cosmetic treatment in Ho Chi Minh City. Nevertheless, expatriates are aware of health care providers in Ho Chi Minh City offering more and more cosmetic surgeries. One respondent mentioned,  that  the  cosmetic  industry  is  “a  booming  industry   in  Vietnam”  (Interview  II,  line  number  136).

4.3.Preferred health care providers The regular health care provider of nearly half of the expatriates is the private hospital, followed by a general practitioner (26%) and a health clinic (17%). Just 7% visit a public hospital.

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Rebecca Mayer Confronting the expatriates in the online survey with different illnesses and tasking them to choose which health care provider they would contact, shows that in case of skin rash and high fever over 55% would go to a medical practice. In case of continuous pain in the stomach, diffuse discomfort or if the ability to see is getting worse, between 41%-49% of the people would either contact a medical practice or a private hospital. The public hospital plays a tangential role. In the highest case (diffuse discomfort) just 15% of the expatriates would visit a public hospital. These results show a clear tendency and preference for using a private practice, clinic or hospital, even in minor medical cases. Reasons for that, according to comments from expatriates, are bad stories they have heard about public hospitals or bad experiences they have made themselves in a public hospital. They claimed about low hygiene standards, crowdedness (64% of the expatriates are thinking that public hospitals are overcrowded) and about medical as well as management staff lacking skills. Expatriates also mentioned the language barrier and that they do not trust public hospitals in general. This is also reflected in the high disagreement of the statement, that public health care providers are reliable. Another, but smaller group of expatriates expressed their critical opinion about private hospitals, by mostly saying that private hospitals are too expensive. Some also mentioned a lack in specialized care, which explains the phenomenon of expatriates flying to Bangkok, Singapore or their country of origin for specialized care. One of the representatives at If-Consulting summarized it with  following  words:  “Once it’s  more  complicated  better  to  fly  somewhere.  And  that’s  very  normal.  You  have  the building with ten floor  of  (…) cardiac surgery. In Ho Chi Minh you have three. And on the 10th floor you have 20 cardiac surgeons. Of course you will have better care with that.”  (Interview  If-Consulting, line number 574-576). Not clearly differenced in the study are foreign-owned hospitals (all private) and Vietnamese hospitals, which can be public as well as private. Two of the personal interviewed persons mentioned that they have visited a Vietnamese private hospital and were very satisfied with the service and the medical treatment there: “When I went to the local hospital private clinic the results of the blood test, everything was amazingly fast”  (Interview  III,  line  number  63-64). It can be assumed that most of the expatriates questioned in the online survey are thinking about foreign-owned hospitals, when commenting on private hospitals. One interviewee explained this fact: “Many expatriates using, (…) FV [Franco Vietnamese Hospital. N/A] or Victoria, mainly because of the portrayal, (…) the common use of English as a language and also the portrayal of having the medical crew  from  around  the  world.  This  gives  a  bit  of  a  counterbalance   to  just   Vietnamese   specific  doctor.”   (Interview I, line number 95-98).

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Rebecca Mayer Another indication therefore is the fact, that all participants who were interviewed on the telephone, except of one patient, thought about foreign-owned hospitals, like Franco Vietnamese Hospital, Family Medical Practice or Centre Medical International in the first place. As mentioned before, this strong tendency towards foreign-owned hospital can be explained, among other aspects, mainly by the wish to speak the native language (French people questioned in the telephone survey were instantly thinking about hospitals, which have French-speaking doctors). Patients interviewed on the telephone were asked about criteria they require from a health care provider. Quality of care stands on first place with 75%, followed by hygiene, which 55% of the patients require, and no language barrier, which 45% of the patients prefer. This proves the drift towards foreign-owned hospitals. As long as public hospitals have the reputation, for doctors, who are not well trained, “And from  my  knowledge  none  of  the  Vietnamese   doctors   would  be  qualified  to  practice  medicine   outside  of  Vietnam.  (…)    So,  that  probably  tells me something is wrong with the medical schools here, the  quality  of  the  medical  schools  here.  So  I  would  not  want  to…  take  the  risk.” (Interview III, line number 96-100), for low hygiene standards, which respondents note in the online survey, as well as in the telephone survey and for having nurses and doctors, who cannot converse in English, “But   most…   even   the   local   clinics,   or   even   the [Vietnamese-owned. A/N] private   clinics,   they   don’t   speak English much, (…)  even the doctors hardly speaks English.”   (Interview III, line number 70-71) expatriates will hardly choose to go there. The telephone survey also asked about further demands on health care providers. The results show, that expatriates in 80% of the cases prefer better facilities to a better accessibility and a health care provider with more years experiences (65%) to the one which has a greater variety of treatments.

4.4. Remarks about improvements Whereas the online and telephone survey concentrated only on the current situation of expatriates’ health care need, the face-to-face interviews gave more room for expatriates to compare the current health care situation to the past or even have a look into the future. The respondents mentioned improvements of health care in Vietnam. One interviewee commented:  “I  think  health  care  comparing  to  (…)  my  impression  to  first  time  (…)  I  was   in   Ho   Chi   Minh   City,   it’s   improving   drastically.”   (Interview   III,   line   number   153-154). This view is

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Rebecca Mayer supported by a participant of the online survey, who connects the improvement with the opening of foreign clinics (Online Survey, ID 91). Interviewed expatriates confirmed that these improvements happen in private institutions, accessible and affordable for foreigners and rich Vietnamese, but not for the mass of poor or low income citizens: “Health care  is  only  improving  for  the  rich  people.  Not  for  the  poor  people,  not  for  the  general   public. So the general public still has to go through the crude medical system you have in Ho Chi Minh City versus major hospitals like FV hospital only caters to the rich and the middle class, upper  and  the  rich  people  in  Vietnam,  which  is  not  a  fair  system.” (Interview III, line number 156-159) One individual listed different criteria, which are needed to undertake improvements. Among them on first place she mentioned reforms that the government has to implement (Interview II, line number 125) and that great effort from the politicians is essential for a change. Furthermore, it needs awareness from the public and a better health care education. (Interview II, line number 152, 160-161).

4.5. Limitations As this paper is the result of only two months work of a single individual, it gives just a small insight into the health care demand of expatriates in Ho Chi Minh City. The results of this study will also not be compared to the findings of other works, because of the lack of existing literature in that field. That leads to the necessity of further representative studies to proof the results. Due to language barriers with some expatriates in Ho Chi Minh City, who are not able to speak and understand English and therefore could not participate in the surveys and the small sample size in the online survey, the results of the research may not have been representative for the whole  expatriates’   community in Ho Chi Minh City. However, this paper can be the basis for further studies, as well as for health care providers, who want to proof the health care needs of their own international patients resident in Ho Chi Minh City.

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Rebecca Mayer

5. Conclusion This paper has investigated the health and wellbeing demand of expatriates in Ho Chi Minh City. It concentrated on the current situation and how expatriates are feeling in Ho Chi Minh City, what types of medical treatments they are accessing and where they are accessing them. This study has found out that generally expatriates are accessing basic medical care in Ho Chi Minh City, but are more likely to leave the country in complex and dread cases. The majority of expatriates prefer to use foreign-owned private hospitals and clinics, followed by Vietnamese private hospitals. Public hospitals have a bad reputation and are shaping the negative image of health care in Vietnam. Mostly criticized was the bad quality of treatments, the low hygiene standards, medical staff lacking skills and the bad equipment, as well as the language barrier, which presents a major dread for expatriates. The findings of the study suggest that improvements on specialized care in the private sector and improvements on public medical care on the most basic level has to be done, to make expatriates feeling safer when accessing health care in Ho Chi Minh City. The study has furthermore found out that a way for health care providers to address and reach expatriates is the internet. Even more important than that is the personal contact with patients and the necessity to create a good brand image. Satisfied patients will then recommend the hospital or clinic and word of mouth is the most important source of information for other expatriates. Finally a number of limitations need to be considered. First, the lack of information on official statistic numbers about expatriates in Vietnam and Ho Chi Minh City as well as of other scientific papers on that topic. That means that a comparison of the results with other studies was not possible. Second, the sample size of the online survey was too small to be representative, so that caution must be applied, as  the  findings  might  not  be  transferable  to  all  expatriates’  communities  in  Ho  Chi  Minh  City.

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6. Appendix Appendix 1

Online questionnaire……………………………………………………………………………………….……. B

Appendix 2

Telephone questionnaire…………………………………………………………………………………….…. L

Appendix 3

Interview I – Transcript………………………………………………………………………………………….. R

Appendix 4

Interview II – Transcript…………………………………………………………………………………………. X

Appendix 5

Interview III - Transcript…………………………………………………………………….…………………... CC

Appendix 6

Interview If-Consulting – Transcript………………………………………………………………………. II

Appendix 7

Business cards interview partner If-Consulting…………………………………………………….… AAA


Rebecca Mayer

Appendix 1: Online questionnaire Health and wellbeing demand of expatriates in Ho Chi Minh City Thank you for taking the time to complete this survey. My name is Rebecca Mayer, I am a "Nonprofit-, Social- & Health Care Management" student and I am currently doing an internship in the health care sector in Ho Chi Minh City. The goal of this survey is to identify the health and wellbeing demand of expatriates in Ho Chi Minh City. With the results improvements on medical services can be done and health care can be adjusted to your need. To take part in the survey, you must be from another country than Vietnam and you have to have your current residence in Ho Chi Minh City. That ensures that the data collected is valid for the survey. The information collected from you in this survey will remain anonymous. Your name and contact information will not be collected for the survey.

Answering all questions will take approximately 10 minutes. Please answer each question to the best of your ability.

You can skip questions if  you  don’t  want  to  answer  them. Any questions marked with an asterisk (*) require an answer in order to progress through the survey.

If you have any questions, please contact me via email (rs.mayer@mci4me.at).

Click the Next button to continue to the next page. Click the Submit button to submit your survey.

Welcome to the survey! Thank you for taking part in it. There are 22 questions in this survey

B


Rebecca Mayer

General questions about your life in Ho Chi Minh City In this part of the survey you will be asked about your descision to move to Ho Chi Minh City and about the general view you have from the city. 1 [g1]What was your motivation to go to HCMC? Please choose all that apply: Work Good environment Healthy lifestyle New experience Studying a new language Partner/spouse is living/working in HCMC Access to good health care Well-developed infrastructure Good schools Other:

2 [g2]What are your major concerns/worries while living in Ho Chi Minh City at the moment? Please tick your top four concerns. Please select at most 4 answers Please choose all that apply: Work Food safety Hygiene standards Housing Leisure activities Health care Income Social life Freedom of religion Language barriers Child education Other: C


Rebecca Mayer

3 [g3]What do you think about Ho Chi Minh City (HCMC) as your current place of residence? Please choose all that apply: HCMC is a very convenient city The food in HCMC is delicious & healthy HCMC has an active nightlife Food security is a major issue Spa treatment is part of the lifestyle The health care situation in HCMC is bad People in HCMC are very friendly and helpful In HCMC are plenty of good doctors and hospitals to go to Other:

Health care in Ho Chi Minh City 4 [hc-hcmc1]In general, how would you rate your overall health? Please choose only one of the following: Excellent Good Fair Poor Very poor

5 [hc-hcmc2a]Did you get any information about Health Care in Vietnam / Ho Chi Minh City before you arrived in Vietnam? Please choose only one of the following: Yes No

D


Rebecca Mayer 6 [hc-hcmc2b]What was your source of information about health care in Vietnam / Ho Chi Minh City (before you arrived in Vietnam)? Only answer this question if the following conditions are met: 째 ((hc-hcmc2a.NAOK == "Y")) Please choose all that apply: Internet research Social media (Facebook, Twitter, Blogs, etc.) From my employer Travel agency Embassy of the country of origin Vietnamese embassy Friends or family Newspapers or magazines Television or radio Family physician / GP Other expats, who are living in HCMC Other:

7 [hc-hcmc3] Are you currently looking for information about health care and health care providers in Ho Chi Minh City? If the answer is yes, please mark the source(s) from that you are trying to get these information. Please choose all that apply: No Yes, through other expats Yes, through local people Yes, through family or friends Yes, through my employer Yes, through health care providers in Ho Chi Minh City Yes, through internet research Yes, through social media (Facebook, Twitter, Blogs etc.) Yes, through newspapers or magazines Yes, through television or radio E


Rebecca Mayer Yes, through my embassy (of the country of origin) Yes, through the Vietnamese embassy Yes, through a travel agency Other:

8 [hc-hcmc4]In which country do you access regular medical care? Please choose only one of the following: Country of origin Singapore Thailand Vietnam I never accessed regular medical care so far Other

9 [hc-hcmc5]In which country do you access emergency medical care? Please choose only one of the following: Country of origin Singapore Thailand Vietnam I never accessed emergency medical care so far Other

10 [hc-hcmc6]What is your regular health care provider? Please choose the one you use most often. Please choose only one of the following: Personal doctor/General practitioner Public hospital Private hospital Health Clinic Rehabilitation Clinic Other

F


Rebecca Mayer 11 [hc-hcmc7] Which source of care in Ho Chi Minh City would you prefer if you had following health issues? If I suffered from xy, I would prefer going to a... Please choose the appropriate response for each item: Public hospital

Private hospital

Medical practice

Diffuse discomfort Ability to see / vision is getting worse Continuous pain in the stomach Skin rash High fever

12 [hc-hcmc8] Is there any reason why you would not be able to use any of the health care providers mentioned in the last question? Please tick the box with the source of medical care you would not be able to use and explain in short words why you would not be able to use this health care provider. Please choose all that apply and provide a comment: I would not be able to go to a public hospital because...

I would not be able to go to a private hospital because...

I would not be able to go to a medical practice because...

G


Rebecca Mayer 13 [hc-hcmc9] In the following questions you can find statements about health care in Ho Chi Minh City (HCMC) in general and about public and private health care in particular. Please mark on a scale from "strongly disagree" to "strongly agree" how strong you agree to each of the following statement. Please read carefully. Please choose the appropriate response for each item:

Strongly disagree

Disagree

Neither disagree nor agree

Agree

Strongly Agree

Public health care providers in HCMC are reliable… Private health care in HCMC is patientoriented… Public health care providers in HCMC are overcrowded… Private health care in HCMC is shabby… You can receive a wide range of different treatments in HCMC... Private hospitals

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Rebecca Mayer Strongly disagree

Disagree

Neither disagree nor agree

Agree

Strongly Agree

in HCMC are providing good specialized care‌ The quality of health care in HCMC is excellent‌

Health care financing 14 [hc-f1]How much money, in U.S. dollars, do you spend on healthcare in a typical month? (Count all healthcare-related costs, including health insurance premiums, deductibles, copays, co-insurance fees, and any other out-of-pocket expenses for medical, dental, or vision services and medications.) Please write your answer here: If you don't know the exact number, roughly estimate the costs.

15 [hc-f2]How do you primarily finance health care expenses? Please choose only one of the following: Health insurance Private / out of my own pocket My employer pays for occurring health care costs Other

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Rebecca Mayer

Demographic Questions 16 [sex]What is your sex? * Please choose only one of the following: Male Female Other

17 [age]What is your age? * Please choose only one of the following: 18-24 25-34 35-44 45-54 55-64 65 or older

18 [nationality]What is your nationality? Please write your answer here:

19 [duration-living]For how long have you been living in Ho Chi Minh City? Please choose only one of the following: Less than 1 month 1-3 months 4-6 months 7-11 months 1-3 years Over 3 years

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Rebecca Mayer 20 [employment] Which of the following categories best describes your primarily area of employment (regardless of your actual position)? Please choose only one of the following: Education Economy / Commerce Health Care Homemaker Retired Services Student Tourism Unemployed Other

21 [income]What is your current annual income before taxes (gross salary) in U.S. dollars? * Please choose only one of the following: Less than 10.000$ 10.000$ - 19.999$ 20.000$ - 39.999$ 40.000$ - 79.999$ 80.000$ or more Prefer not to say

22 [end] Thank you for taking part in this survey and answering the questions! If you have anything to add about health care in Ho Chi Minh City or you want to give any feedback about the questionnaire, please use the following box. Please write your answer here:

Thank you for taking part in the survey and filling out the questionnaire. Please share this link with other expatriates in Ho Chi Minh City! K


Rebecca Mayer It will help me to get a representative sample.

Here is the link: http://mci-students.limequery.com/56946/lang-en

Appendix 2: Telephone questionnaire Health and wellbeing demand of expatriates in Ho Chi Minh City Interviewer: Date: ID number: General Introduction: Hello / Good afternoon / Good morning. I am Rebecca Mayer from Cao Thang Eye Hospital in Ho Chi Minh City. Am I speaking to Mr / Mrs _____________? I have your phone number, because you are a patient at Cao Thang Eye Hospital. We are currently working on a study to identify the health and wellbeing demand of expatriates in Ho Chi Minh City. We’re therefore  doing  a  survey  and  asking  questions  about  our  patients’  health  care  demand.  With  the   results we can adjust our health care services to our patients need. May I ask you five questions, which will take approximately 5 to 10 minutes?

If no: “All right.  Thank  you  and  goodbye.” No time now: “Could  I  call  you  back  later?  What  day  and  time  would  be  good  for  you?”  ______________ If yes: “That’s  great.”  (CONTINUE WITH INTRODUCTION SURVEY)

Introduction to the survey: I will tell you a couple things before we start. All your answers are completely confidential, and you are free to skip any question or to end the survey at any point. Cao Thang Eye Hospital will not release personally identifying information and your answers in the survey will not be related to your name.

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Rebecca Mayer

Questions: 1. What is your current place of residence? a. Ho Chi Minh City (CONTINUE WITH QUESTION 2) b. Other (POLITELY EXPLAIN, THAT WE ARE LOOKING FOR EXPATS WHO ARE CURRENTLY LIVING IN HCMC & SAY GOODBYE) 2. What kind of health treatments are you accessing in Ho Chi Minh City? I will now read a list of different treatments to you and you can tell me if you are accessing them or not. Are you accessing …    in  Ho  Chi  Minh  City? a. Regular health checks b. Basic dental care c. Cosmetic surgeries / cosmetic dental care d. Emergency medical care e. Vaccinations f.

(Preventive) Cancer screening

g. For women: Gynaecologist visits 3. What are the three most important requirements for you to choose a health care provider? I will now read out a list of different aspects. Please let me know which ones are most important for you. You can also add other aspects to the list. a. Affordability b. Accessibility c. No language barrier d. Hygiene e. Quality of care f.

Good reputation

g. Needs to be covered by my health insurance h. Other

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Rebecca Mayer 4. Let’s assume  that  you  have  two  health  care  providers  which  are  both  meeting  the   requirements you mentioned in the question before. If you need to make a final decision, which one you would you choose for your long term treatment? I will now read different cases to you. Please let me know which health care provider you would choose. a. Would you choose the health care provider which is …? a1.

More convenient to reach or the one with the

a2.

Better facilities

b. Would you choose  the  health  care  provider  with  (the)…? b1.

Better price or the one with

b2.

Doctors who are trained oversea

c. Would you choose the health care provider with …? c1.

More years experiences or the one with the

c2.

Greater variety of treatments offered

d. Would you choose the health care provider with …? d1.

Special offers (Health care packages etc.) or the one with

d2.

More flexible opening hours (late in the evening, Saturdays & Sundays)

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Rebecca Mayer

5. What general hospital or clinic instantly comes to your mind when you think about health care in Ho Chi Minh City? (DON’T READ  THE  ANSWERS) a. Cho Ray Hospital b. Franco Vietnamese Hospital (FV Hospital) c. Victoria Health Care International Clinic d. Family Medical Practice e. Columbia Asia Hospital f. g. None

6. Was health care an important issue for you at the time you were thinking about moving to Vietnam? a. Yes b. No

Please explain in short words why / why not:

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Rebecca Mayer

Demographic questions 1. For how long have you been living in Ho Chi Minh City? (DON’T READ  THE  ANSWERS) a. Under 3 months b. 4-6 months c. 7-11 months d. 1-3 years e. Over 3 years

2. What is your Nationality? ____________________________________

THIS PART CAN BE FILLED OUT BY THE INTERVIEWER:

3. How old is the interviewee? ___________________

4. What sex has the interviewee? a. Male b. Female

- END -

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Rebecca Mayer

Part for the interviewer to fill out

1. Did you have the impression, that the interviewee answered the question truthfully? a. Yes b. No

2. Did you have the feeling that the interviewee was in a hurry when you asked the questions? a. Yes b. No

3. Did you have the feeling that the interviewee was annoyed or bothered by your questions? a. Yes b. No

4. Did you have the feeling that the interviewee fully understood all the questions? a. Yes b. No ďƒ Which question might not be understood completely? __________

Q


Rebecca Mayer

Appendix 3: Interview I – Transcript Interview with Jin S. – 20th of March 2014 R: Rebecca – interviewer ; J: Jin - interviewee R: So. For the beginning you can just tell me a little bit about yourself like – just for recording – like what’s your  name  and  since  when  you’re  here,  since  when  you  are  in  Ho  Chi  Minh  City  and  what  you’re   doing here and why you came here. J: Ja. So, my nationality is Singaporian. 37 years old. My name is Jin S. and I resided from Ho Chi Minh from 2007 to 2011. Last held the position as a chief representative of the Singapore Tourism Board based in Vietnam. R:  Alright.  And  that’s  why  you  came  here?  That  was  the  reason? J: Yes. R: So when you moved to Vietnam. Was it like a quick decision or did you have time to prepare? J: We had time to prepare. It was a cured plan six months in advance. R: Okay, alright. And did you have any worries at that time. Did you worry about something or..? J: No, not really because  for  cooperate  relocation  I  think  it’s  quite  comprehensive.  They  would  put   forward some sort of a package including housing, medical, education – if you have kids – and your taxation issues. So these would have been communicated to you six months before and then you would take up a post thing upon the agreement of the terms that you have then shed with, so by a large relocation basis with a company that has looked into these factors, the individual does not have to worry that much. But if you are coming  here  as  an  entrepreneur,  you’re  coming  here  to  look  for  a  job   then  it’s  different.  Because  these  are  areas  that  you  may  not  have  considered  or  you  may  not  even  know   if you are back, if you are here in Vietnam. R: Okay, so you felt safe because you had the feeling you were well prepared from working site. They prepared  you  with  all  kind  of  information  and… J:  I  think  it’s  not  just  that  they  prepared  but  they  also  executed  many  of  these  things,  so  for  example   taxation issues: Do I pay tax in Singapore or do  I  pay  tax  in  Vietnam.  I  don’t  have  to  worry  about  that   because the office would have taken care about the tax in Vietnam. So they would have a separate team asking me for my documents and then working separately with the authorities here to make sure that I will pay tax in Vietnam, but I just pay the tax in Singapore. I would also have the support of the organization saying: Choose three houses that you think you wanna stay and then put the one that you’re  recommending  and  we  will  approve  that.  So  it’s  a  really,  ehm…  pre  plan.  So  you  don’t  have  any   surprises.

R


Rebecca Mayer R: Alright. And how did you expect it to be different to Singapore? Like: Did you have any idea what would be different for you when you move here? J: I think on two fronts there would always be difference. But I think these differences would not be overwhelming. The  first  front  is  of  course  workwise…  you  have  a  different  culture  to  work  with  and  I   think that can be resolved very quickly through establishing what you need to do and stuff. The second one is on a personal front. On a personal front being a single individual, I did not have any relocation issues with my family, because I was here by myself and given the earlier four points I mentioned: You know, the taxation, the housing, the health care: These have been really taken care of, so there was not much  of  a  readjustment.  It’s  quite  straight  forward.   R: Alright. I see. And have been living outside of Singapore before or was it your first time? J: It would have been my first time. R: Okay, alright. And what was your first impression of Vietnam or of Ho Chi Minh City? J: I think most Asian cities would have a similar view. I think Vietnam was similar in that sense. So it would be a traditional South-East-Asian  emerging  economy  city…  eh…  feeling.  It would not have been very different from Thailand, it would not have been very different from Malaysia, it would eh…Indonesia,  it  would  not  have  been  very  different  from  Myanmar.  So,  I  think,  they  are  all  quite   consistent in the way they portrait the image. R: Okay. When you remember back to your first weeks and your first month, maybe your first half of a year.  Can  you  describe  a  little  bit  of  your  personal  life,  feelings  you  had  during  that  time.  Would  you…   You said already like, that it was not so much difference to other cities, but like your lifestyle. Did it change to before? Did you have to build up something or..? J: Lifestyle would change in a better ply. Because it is like going to a new job, or going to a new school. So your sense of home is not…  eh…  your  sense  of  space  and  neighborhood  and  home  is  quite  different.   So I think the first weeks you focus more on settling into your home, looking for the kind of food and trying different kinds of food, so that you feel comfortable with. Concurrently you would be engaging on different  level  of  networking  with,  you  know,  eh…  your  professional  groups  as  well  as  your  country   groups, specific groups. So, I think this would be what happens in your first month or so. You would be meeting up with a lot of individuals, you will be meeting up a lot, you will trying different experiences. So  I  think  this  is  quite  consistent  for  any  relocation  you  will  go  through,  even  I  think  if  you’re  in  a  school,   or in company you do the same thing, you try to meet as many people, understand the company, many students understand the curriculum, so quite consistent. R:  Do  you  have  or  had  any  problem  with  feeling  healthy,  with  feeling  like…  or  having  a  good  wellbeing  or   was it something which came naturally and I would also be interest what you do for feeling healthy, for being healthy? J: I think food wise was one key to gonna beat the minon to your wellbeing. I think for food here. The initial difference would have been the fact that the food here tends to be a little bit like worth in South-

S


Rebecca Mayer East-Asia, meaning Thailand, Malaysia, Indonesia, Singapore. We have very strong curry base, spice base ingredients, which is absent from Vietnamese food. They tend to be a bit more brooke base, they tend to be sauce based. But all these are very like sauce; they are not cream, heavy, bavy-heavy. So that food was a bit different, but it was not tremendously affecting ones wellbeing. I think in terms of the other aspects like  access  to  recreational  facilities,  it  does  have  its  …  Because  I’m  staying in a service apartment, which has a pool, a gym and a tennis court, so it would not make me feel, that I had a lack of access to recreational facilities. I think your mental wellbeing would have to be evolving sequence of how you meet people and engage with people and again because working here on a professional basis, I was able to join and engage people very quickly. So again that was not an issue. So I think overall relocating to a country or city that is like Vietnam, maybe Ho Chi Minh to be specific, did not pause great challenge to ones wellbeing. R: Okay. Alright. I just one more time to be a little bit more detailed, a little bit more concrete. So was there anything you had the feeling, is missing, what you think would be good for your overall wellbeing? J: The short answer is no. The more elaborated answer would be: There are these certain areas of cleanliness that you would pay specific attention to. Coming from Singapore you would say, you know, have the spoons and the chopsticks been washed entirely before they are served to the next costumer, have  the  food  that  they  are  serving  been  kept  on  a  certain  temperature,  that’s  warm  and  hence  you   know, reducing the risk of certain bacteria multiplying. These would be the slightly kills that one would consider, but the short answer is still no, because you would feel that after trying it once, twice or three times  you  can  feel  comfortable  with  the  fact  that  what  you’re  eating  it’s  not  going  to  cost  you  severe   health poison. R: Alright. And what was or what is your impression of health care providers in Vietnam or especially in Ho Chi Minh City? J:  I  have  had  different  experiences  in  my  time  here.  I  think  as  I  start  to  understand  the…  the  market   better…  there  are  two  very  distinguished  groups:  The  international hospitals as well as then the local based hospitals. I think that health care here for expatriates in the initial status is the unfamiliarity of the language and the perceive inferior, you know technical skills that the hospitals or the staff may have here, which will lead to many expatriates using, you know, FV or Victoria, mainly because of the portrayal, you know the common use of English as a language and also the portrayal of having the medical crew from around the world. This gives a bit of a counterbalance to just Vietnamese specific doctor. But overtime I think you realize that the medical procedure as well as the medical knowledge and the equipment  is  not…  in  the  local  hospitals…  is  not  anywhere  worse  stuff  than  what  you  have  seen  in  FV  or   Victoria.  In  fact  on  most  cases  some  of  the  non  critical  treatments  would  have…  FV  or  Victoria  sort  of   leveraging, existing equipment from local hospitals to do the initial diagnostic. So the bottom line is, when you look at both, the local hospital and a foreign-run-one, the only difference  is  actually  the  language  and  the  other  aspects  of  you  know  the  technical  skills  that’s  are  more   or less similar.

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Rebecca Mayer R: May I ask where you accessed your medical treatment and how you found it there. What was your experience there? J: I  think  in…  I  mean  I  went  for,  you  know,  medical  treatment  both  in  local  and  I  think  it  was  FV  or  Family   Medical,  I  can’t  remember.   Quite honestly I enjoyed the local hospital a lot more, because I think the experience of having with and paying an extremely high premium at Family Medical or Victoria was unnecessary. The only benefit they brought of the table was an English speaking doctor. But when I went to the local hospital I surely realized that many of their senior consultants are able to converse in English. And if they continue to maintain not just a conversation in English, but a diagnostic in a bilingual, Vietnamese and English report,  I  don’t  think  it  would  be  very  far  factual  for  foreigner  to  choose  the  local  hospital  or  FV  or Victoria or Family Medical. R: Okay. So your health care experiences here were not so much different from what you experienced in Singapore? Or was there any difference you saw? J: There is of course a difference when you compare to your home country. I think the comfort of the language would be a big difference, so even though you are talking about FV, I mean you could be, you could  be  speaking  to  a  doctor,  that  can  speak  English,  but…  or  it  could  be  an  international  crew,  but  will   have very little understanding of you know maybe local issues or Asian-based symptoms and stuff like that. Where else Singapore doctors would already be very familiar with the kinds of medical trends, medical characteristics that you will have. If you say, that you have pain in  your,  in  your…  in  certain  parts  of  your   body, it could be a country specific risk, a country specific, you know, issue, maybe too much xyxyxy causes gout in a specific country like Singapore. There may be not such an issue in Vietnam, due to the dietary differences.  So,  there  is  a  difference…ehm…  on  the  consultation  side.  In  terms  of  the  cost   structure  there  is  also  a  difference.  In  Singapore  when  we  are…  we  are  subsidies  by  our  government.  So   the costs that we pay is relatively low, compared to what we will pay in FV hospital or Family Medical. It would be about the same price as what you pay in Vietnam in a local hospital. The difference is actually the  consultation  time  as  well  as  the  access  to…eh…  equipment.  So  taking  a  MRI  as  an  example  – in Singapore I would have to wait for two to three months. In Vietnam I only needed to wait for one day at the  local  hospital.  And  the  panel  of  the…  the  reviews  the  medical  MRI  in  Singapore  would  have  been  a   medical officer, which means an entry level doctor, but here I’m  getting,  you  know,  the  panel  surgeons.   So the quality of the software, in terms of the diagnostic aspects is a lot better in Vietnam for me, in my experience at the local hospitals, not necessarily at the foreign hospitals, then in Singapore, but this is a system  related…  full  of  events,  it’s  because  of  the  fact  that  Singapore  health  care  requires  you  to  first   get your diagnosis done by a medical officer before it is escalated to a panel of surgeons if you are there. Where else here they would have already the surgeons on standby, to advice almost immediately after the medical report is in release. R: Okay, alright. Is there any, any illness or anything you would go back or you went back to Singapore to get the treatment done there?

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Rebecca Mayer J: I think.... I have not done so. But if you are to ask me, the operation related unites where you will need rehabilitative period  of  either  occ…  eh  physiotherapy  or,  you  know,  support  of  your  family.  Those  I   would go back to Singapore, you know. That is one a psychological side from a practical aspect of looking for help, getting help, you know. For quick surgery, I mean not surgery, but quick diagnostic and stuff like that I can get it in Vietnam. I think one of the things that one might need to consider is also the insurance coverage. So for example in Singapore we have already existing insurance coverage. It does mean that inpatient or inhospitalisation related costs would be bound by the insurance. So even Vietnam relatively cheaper, but I might not be paying anything, if I do it in Singapore. So then I would choose Singapore, for the reason that I be closer to my support system and not having to pay anything. R: But here you also, you have the insurance through your employer, right? J: Yes, correct. But I think one would have to examine very quick, ah very quickly and very carefully whether or not the insurance that is covered by your employer covers simply outpatient or does it cover hospitalization? Does it cover, you know... physiotherapy related post-hospitalization kind of treatments or does it cover in hospitalization just the hospital state or does it covers the surgeons fees as well. So I think there is a categorization of costs, that you need to be cognizant of, so that you are not hot up to say that the insurance is sort of like a black head cover for all, you know, the insurance just covers outpatient,  it  may  not  cover  medical  evacuations,  so  and  so  far… R:  Alright.  Just  to…like…  ask  more  specifically:  Did  you  ever  go  to  another  country  for  medical   treatment? Primarily for medical treatment as a medical tourist? J:  No,  I  don’t  think  I’ve  done  that  as  an  individual.  Although  these  would  be  common  phenomenal  into   days context, where cross border travel and cross border treatment is so accessible. R: You mentioned many…  you  mentioned  a  few  things  which  are,  which  you  can  better  access  in   Singapore: Medical treatments. And you mentioned a few things which might be even better in Vietnam.  Is  there  anything  you  want  to  add  which  could  be…  like…  medical  treatment,  in  a  general view, which could be better in Vietnam than in Singapore? J: I can only share from my experience, what I would say is, not quite better, but objectively either cheaper because of the costs, so that would be like your MRI or your ultrasound. This sort of diagnostic, which requires equipment is relatively cheaper in Vietnam for the injuries that I have had, likewise for consultation fees of the doctors as well as appointments, these are a lot faster and cheaper in Vietnam compared to Singapore. To whether or not the operation would be better, to whether or not the diagnostic  is  going  to  be  more  accurate  in  Singapore…  I  think  there  is  bit  pre-mucher for me to comment,  but  at  least  the  first  opinion;  it  would  have  given  me  a  lot  of  comfort  in,  in…  with  the Vietnamese hospitals, for them they would have sent a senior doctor to look at some of these injuries and give the diagnostic. So all I know, I think, diet is cheaper in Vietnam, access to equipment, diagnostic,  access  to  senior  doctors…  is  also  faster.  But Singapore gives the comfort of being closer to home and if you need further treatments, if you need further health support there is the family network as well as the hospital network that you know, you can get access to very quickly as well.

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Rebecca Mayer R: Okay, alright. At  the  end  I  want…  maybe  you  can  share  one  experience  with  me,  one  very  concrete   experience you had in a hospital here. For example, I would be very interested; you said you visited both, private and public hospitals or health care providers. So I would be interested if you can tell a little bit more concrete the experience you had in the public hospital compared to the private hospital, in terms of like language barrier or language in general, in terms of cleanliness, in terms of the treatment itself. So what was your impression in terms of friendliness of the staff? J:  I  don’t  think  there  is  a…  I  don’t  think  there  is  a  lot  of  significant  difference  but  I  will  point  out  some,   which  I  felt  in  a  personal,  made  a  difference.  Eh…  In  public  hospitals  I  think the language used continues to be Vietnamese. These would be the main state, who I expected to change. Where else in private hospitals or the foreign-owned hospitals the language used, quite from the onset, is English. So, if you are unable to converse basic Vietnamese, you will find the public hospitals a little bit daunting, to even get your first treatment, so that means that people in their first or second year in Vietnam may not consider public hospitals, but people who are staying here after four to five years, who are speaking basic level of Vietnamese, would consider public hospitals, simply because they are getting the same stuff,  but  at  a  much  reasonable  price.  In  terms  of  cleanliness,  I  think  it’s  a  subjective  assessment.  So  I   would not think that there are significant differences between both the public and a private. I mean not private, but the foreign-owned one. I think that is function of number of people in a hospital, so obviously, if you go to a hospital which has higher public visitation, there will be a lot more noise and perceive untidiness, but to a private hospital you will see a bit more exclusivity, because of the higher price range which means only a limited people can go there. Does it mean that it is much cleaner? No. Does it mean  it’s  much  more  sterile,  in  terms  of  its  process?  I  don’t  think  so.   In terms of treatment again, my point is, I do not find a significant value at on from the foreign hospitals, mainly because I think they charge a premium for the language but not necessarily for the technical expertise. Many of the technical expertise in terms of diagnostic treatments and diagnostic inventory still goes back to the government hospital, which really has purchased equipment. So the three points I mentioned, I think captures the fact that, the Vietnamese hospitals to someone who has stayed in Vietnam for about four, five years, is a very attractive option and one does not have to go towards a, you know, a foreign hospital to actually get the treatment as well as the valuable. R: Did you ever considered – because  I’ve  heard  like  that  Ho  Chi  Minh  City  should  be  good  for  like  dental   treatment  or  now  I’m  working  in  an  eye  hospital,  so  is  quite  popular  for  eye  treatments,  did  you  ever   consider like to get any cosmetic surgery, cosmetic dental care or if you need cosmetic like eye care here in Ho Chi Minh City? J: The short answer is no and the reason is because I think this is very much typed to individual preferences,  especially  if  it’s  cosmetic.  For  dental,  the  short  answer  is  yes, I would have considered that, because the dental treatment is, technical treatment that you need, regular, you know, checkups, so those  are  very  much  possible  in  Ho  Chi  Minh  and  I  think  that’s  what  I  actively  considered. R:  But  you’re  talking  about  the basic dental care now or cosmetic dental care?

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Rebecca Mayer J: Basic dental care. I think area specific to cosmetics that becomes a personal preference. So the first other question is would you ever consider cosmetic surgery or cosmetic enhancements. And if the answer is no, than whether is Vietnam, Singapore or Thailand it does not matter. So my point is that my first other question is would I ever consider cosmetic enhancements. My answer is no. R: Okay, that would be my question. So if you have like anything to add about health care, about health care providers, then say it know. J: No,  I  don’t  think  I  have  anything  else  to  add  on  to  the  earlier  points  I’ve  made. R: Okay, thank you!

Appendix 4: Interview II - Transcript Interview with Trang N. – 24th of March 2014 R: Rebecca – interviewer ; T: Trang - interviewee R: All  right,  so  let’s  start.  First  of  all  I  would  like  to  ask  you  to  introduce  yourself,  tell  a  little  bit  about   yourself  and  why  you  came  to  Vietnam  and  what  you’re  doing  here. T: My name is Trang N.. I came to Vietnam about five years ago, five years ago, yes and I work as a consultant here in Vietnam. Yeah. R: Okay, all right. When you decided to move to Vietnam was that a quick decision or did you have time to prepare? Can you tell me a little bit about that? T:  I  didn’t  have  time  to  prepare.  It  was  a…  yeah,  a  very  quick  decision  actually.  I  didn’t  think  too  much   about it, because initially I only planned to stay for about year or two years. R:  Okay.  The  first  time  you  came  here  was  just  for  like  a… T: A short period of time. R: Okay. All right. Did you have any worry about anything at that time? T:  Ehm…  How  do  I  gonna  fit  in,  what  Vietnam  is  like,  you  know  culture  life,  business,  environment,  that’s   about it. R:  And  when  you  arrived…  you  arrived  in  Ho Chi Minh City, right? T: Yeah. R: What was your first impression?

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Rebecca Mayer T: Eh…  Too  many  people,  very  busy  city…  eh…  many  motorbikes.  And  yeah,  how  to  say,  the…  how  would   I  say  that,  it  is  a  developing  country,  it’s  just…  it’s  different  because  I  came  from  Sydney,  so… R: What was the biggest challenge? T: Business culture, I think. Assimilate into the business culture here. R:  Alright.  And…  ehm…  So  I  think  for  a  good  balance  it’s  important  do  something  for  your  wellbeing.  So  I   would  like  to  know  what  you’re  doing to feel healthy, to have a good wellbeing. T:  Eh…  Well,  I  suppose  to  go  on  exercise,  which  I  don’t  do  enough.  Off.  Recently.  Ehm…  But,  that’s  about   it. Eat healthy, but try to anyway. R: Did you find that difficult in your first weeks, in your first month? T:  Eh…  No,  it  was  okay.  Because  company  is  taking  care  of  my…  when  I  move  here  they  took  care  of  my   first few weeks, in terms of accommodations. And I came here, because I already have a job offer, right, so everything is taken care of, including my first few weeks, in terms of accommodation, I had health insurance already, so that was not a big deal. R:  May  I  ask  where  you’re  doing  the  exercise?  Are  you  going  somewhere,  or  are  you  have  it..? T:  Typically  it’s  just…  I  just  run  around  where  I  live  or  at  the gym. R:  Okay,  alright.  Ehm…  Is  there  anything  you  would  like  to  do  to  feel  healthier  but  you  cannot,  for  any   reason? T: Cycle is not a lot to do. Full stop. I mean I came from a place, where there is a lot of outdoor activities, you can just go away, there is parks, there is beaches, there is things to do and see. And you can just walk  around.  Can’t  do  that  in  Saigon.  Well  you  can  do  it.  Walk  around  the  park  here,  but  even  the  park   here  there  is  too  many  people,  there  is  just  a  lot  of  people.  Ehm…  And  in Saigon, unless you try to get out, like Bumthan, there is not a lot to do here. R: Alright. Okay. And I would also like to know what was your first impression of health care in Ho Chi Minh or in Vietnam in general? T:  Eh…  If  you  talk  about  private  health  care,  I  think  it’s  pretty  good.  Public  health  care  is  different.  Public   health  care  is….  Probably…  I  don’t  wanna  get  sick  here  and  don’t  have  a  private  health  insurance.   R: Have you ever been to a private health care provider? T:  Yeah,  that’s  all  I  go  here. R: And to a public health care provider? T: Yeah, hospital, local hospital. My mum was sick. R: Okay. Y


Rebecca Mayer T: So she was staying in a hospital in Vietnam for about three months. And she was in intensive care pretty much, for like half that time. So I experienced the health care here. R: Okay,  can  you  describe  me  a  little  more  about  that.  Like…  Maybe  like  quite  concrete.  When  you   entered the hospital what did you feel? T:  Is…  if  I  compare,  is  coming  from…  The  biggest  shock  was  that  the  family  members  had  to  take  care  of   the  patients.  From  turning  them  for  example,  cause  some  patients,  if  they’re  in  a  coma  or  they  cannot   move, you have to turn them, right? So pretty much everything from feeding them, changing their diapers,  if  they  are  unconscious…  the  family  members  had  to  take  care  of  it.   In developed markets, in our countries, everything is going to taken care of. The health staff they would take care of everything, they  wouldn’t  allow  patients,  like  family  members  to  touch  the  patient,  right?   Here  in  Vietnam  is  different.  If  you  don’t  have  money,  that’s  it.  So  is  all  like…  What  shocked  me  is,  I  have   to pay for an IV-tube,  I  have  to  pay  for  my,  they  washed  my  mum’s  clothes, the clothes she wear, as a patient I have to pay for that, for the washing of that clothes. So  coming  from  a  country  where  health  care  is  free  and  I  mean  it’s  just  world  class,  that  was  a  big  shock.   And you basically as family members, and you sit outside, the intensive care unit, and you had to sit there 24/7 just in case they need something from you. They need you to buy blood, I mean what the hell?  Is  that  …. You  need  to  buy  a  blade,  so  they  can  shave  your  relative’s  head,  so  they  can  have  an  operation. Right, that’s  just…  Put  it  this  way:  Very  simple.  Life  is  cheap  in  Vietnam,  if  you  don’t  have  money.  You  go  to   hospital,  and  I’ve  seen  it,  patients  going  in,  who  had  a  stroke  or  a  car  accident  and  they  can  tell  you:   Well, this person has 30% chance of surviving, you wanna ask continue, taking care and have surgery or you can take that patient home and let that person die, because the chance of survival, or the chance of surviving is 30%. I mean you put family or relatives in a very difficult position, because what is if they don’t  have  money.  Alright,  then,  what…  Do  I  pay  or  not  pay?  I  meant,  it’s  putting  the  question  to  the   family  and  the  relatives  is  a  very  difficult  situation.  And…  yeah.  What  is  if  you  don’t  have  money?  The   good chance to die, cause they  don’t…  And  the  bill  they  give  you  is  that  long  [shows  with  her  hand],   maximizes everything. Ah, jeah. R: Okay. Maybe in comparison, if you go to a private hospital here: What are your feelings when you go to  your  regular  health  care  or…? T: I mean health care is layout, I  mean  I  haven’t  been  to  hospital  yet,  private  hospital,  but  I’ve  been  to   clinic,  right,  health  care  clinic.  And  it’s  clean,  it’s  up  to  the  world  standard.  You  know,  you  have  doctors,   and  the  room  and  everything,  it’s  just  like  what  you’ve  seen  in  Australia  or  the  US. But  you  have  to  pay  a  lot  of  money  for  it  right?  I  mean  if  you  stay  overnight,  it’s  500$,  just  staying   overnight. Those facility. Later on you have to pay for all the medication as well. R: So you are accessing all your health care treatments here in Vietnam or is there any health treatments, you are accessing abroad? T:  Ehm…  I  haven’t  touched....  I  haven’t  come  across  that  situation.  I  mean  here  it’s  just  mainly  health   check.  Eh…  That’s  it.  I  haven’t.  I  think  some  of  the  tests, they have to send it to Singapore, so the health

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Rebecca Mayer clinic I  got  to,  they  send  the  test  to  Singapore,  to  collect  the  test,  because  they  don’t  have  the  facility.   But,  I  think  for  everything  else  I  might  probably  go  back  home,  that’s  probably  cheaper  and  safer  and…  I   would go back home. R:  Ehm…  And  for  me  like…  that  might  be  a  little  bit  weird  question,  but  did  you  ever  consider  if  you  find   a job somewhere else, to move if the health care would be better there, or why would you consider that? T:  Ehm…  No.  I think when you have family or children or  when  I’m  a  bit  older  that  view  might  change,   especially if I have children, that view would change, because there is more need to access health care, so  typically  it’s  the  age  where,  yeah,  you  gonna  get  sick  more frequently and you have, you know, children,  again.  But  if  there  is  no  need,  yeah,  it’s  okay. R:  Another  question  is:  Did  you  ever  consider  or…  no  not  consider,  but  did  you  ever  go  to  another   country to just have your health care treatments there, so like as a medical tourist? T: No. R:  Ehm…  Okay,  I  think,  that’s  it  already.  If  there  is  anything  you  want  to  add  about  like  health  care,   health care treatments in Ho Chi Minh City, your impression of the health care system. Anything you would like to say. T: I  think  in  Australia  that’s  not  new.  Everybody  knows  that,  proper  health  care  here  is  not  necessarily   this  good.  If  you  have  money,  if  you  have  private  health  care,  it’s  good.  If  you  need  specialists,  if  you   need specialist treatment, Vietnam might not be the place. You might need to go to Singapore or elsewhere.  Just  because  you  can’t  get  the  doctors.  And  health  care  in  Vietnam  is  not  big  enough.  Eh…  In   term  of  private  hospital  to  deal  with  many  cases,  right?  Ehm…  Public  hospital  is  a  different  story.  Public hospital there is huge, huge need. You know reform. The question is when. Because the demand is there, the need is there, but the policy, the  mechanism  in  terms  of  government  encouraging  foreign  investors  and  make  it  better.  It’s  still  a  long   way.  That’s  reality.  In  fact  some  of…  you  know,  we  have  good  doctors  here…  ehm…  but  again,  it  doesn’t   matter  how  good  a  doctor  is  you  have,  if  you  don’t  have  the  equipment,  you  don’t  have…  you  know.   Even if you go, you send the doctors to oversea training and they come back and the equipment is very outdated  there  is  no  way  the  doctors  here  can  utilize  the  skills  that  they  learned  abroad.  So,  first  it’s  to   improve,  it’s,  you  know,  it’s  an  effort  within  the  government,  as  well  as  the  people  itself.  And  again,  this   is not new, but you know, if you go to a good hospital, you have money then, they take good care of you. The doctor gets paid so low, that everyone has a clinic at home because they make more money at home.  So  it’s  also  a  question  of  ethics  as  well.  You  read  more about it, you will see there are many, many issues about, you know, ethical standards of doctors, you know health care, like health service staff in Vietnam, like I said to you, like you know, a nurse in Vietnam would not take care of a patient. They just go and they just, you know, give a shot to the patient, but they would not clean the patient, they would not bath the patient, they would not do what a nurse is supposed to do, simply because officially the salary, the wage is crap, very, very low. Right?  And  it’s  a  very  pressure  job.  All  the  stress,  

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Rebecca Mayer right? So,  yeah  there  is  huge  need,  huge  reform  is  required.  When  it’s  gonna  happen?  Be  questionmark,   right? R:  Okay,  so,  since  I’m  here  I  learned  or  heard  many  times  that  Ho  Chi  Minh  City  might  be  famous for, like…  because  I’m  working  in  a  eye  hospital,  might  be  famous  for  some  eye  treatments,  LASIK   treatments, that Ho Chi Minh City is also famous for dental treatments and maybe cosmetic dental treatments and cosmetic surgeries. So, I would like to know if you heard about that as well and if you consider doing such treatments here instead of going back to Australia and do it there? T: Dental, yeah. I mean dental is known. And the reason it is cheap, is that labour is cheap. Again but you have  to  do  it.  It’s  cheap  relatively  compared  to  developed  countries  because  I  think,  the…  professional   indemnity  cost  is  lower,  right?  So,  again,  cosmetic  surgery  you  have  to  have  money.  It’s  cheaper,  but  it’s   not  cheap  for  local.  But  it  is  relatively  cheap  and  it’s  not  high risk. Cosmetic surgery is a popular thing, because  everybody  feel,  you  know  lack  of  confidence  or  they  wanna  look  better  they  wanna…  So,  is  a   boom.  It’s  a  booming  industry  in  Vietnam.  And  in  fact…  it’s  a  booming  industry,  because  the  rich  people     here, the rich Vietnamese want to access that, the same with health care, is that only the rich Vietnamese that can access that sort of service. Is not that at all about middle income, low. No. So,  investors  who  come  to  Vietnam…  I  know  a  friend  who  come  to  Vietnam as an investor and at the end of the day he tried to open a clinic, a serial clinic, provide you know affordable health care to middle income earner, you know. And there is so many right tay, you  know  so  many…  and  the  return  of   investment is so low. Later on he decided maybe to go into cosmetic surgery as a business. Because again  it’s  always  about  making  money.  So  the  rich  people  would  take.  Or  he  just…  I  think,  recently  he   just bought another hospital, to get into the market, right? So, yeah, I mean is know. And dental is developed.  Is  know,  is  cheap  and  it’s  relatively  safe.  Do  it  here  and  yes  it’s  fine.  There  is  no  issues  there.     But  again,  if  it’s  coming  out,  even  if  you  say,  it’s  famous  here,  it’s  famous  because  because…  is  not   necessarily affordable  for  the  local.  It’s  affordable  for  the  expats  and  rich  Vietnamese.  Yeah,  it’s  still   relatively cheaper than if they do it in their home country. R: Could you imagine that in the next 5, 10 years, that health care improves a lot in Vietnam? T: I hope so. I think, of government is willing to change and compromise and listen to the private invest…like  the…  If  they  make  the  policy  more  attractive  to  foreigner.  If  they  willing  to  reform  the   industry: Yes. That takes a lot of effort. But the government is the key. They have to set the standard, they have to set the standard, they have to enforce that standard. Vietnam is many virigoul in laying down the standard, right, if you looked at standard they have everything. Enforcement is the problem. Right? So, go out and you actually vigorously checking and making sure that the clinic out there, you know, is providing proper health care. You  know,  not  sure  if  you  heard  about  the  doctors  case,  where  he  didn’t  have  his  license,  but  he  bought   his license to do cosmetic surgery and basically he killed someone and throw that body into the river and  till  now  they  cannot  find  it,  right?  So,  in  Vietnam  they  need  to…  and  I  think  also  people  awareness   here and it takes education, right? Because here the Vietnamese is when it comes to health care, is very easy.  Oh  yeah,  I  know  that  doctor,  I  don’t  need  to  know  if  he  is  good  or  not.  Just  gets  word-mouth, he is really  good  and  they  blindly  believe  it.  They  don’t  think  of  service,  health  care  service.  Classic  example  is:  

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Rebecca Mayer They get a prescription or I feel sick and get a prescription and you know self diagnose. Next time I get sick with the same symptoms, instead of going to the doctors I will use the same prescription and go to the pharmacy and purchase the same. Same kind of medication. So self-medicate themselves. So, awareness also. And to do that, is the government is also asked xyxyx. Is the minister of health is doing that. So,  ehm…  And  then  reform  and  pay  the  doctors  probably.  You  know  a  doctor,  I  think  a  graduate   doctor, after studying for six years, I think they get paid maybe 200$ a month, in terms of official salary, how can? I mean average in Australia a doctor would get, fresh graduate, not even specialist yet, he works in a hospital, the salary at least 60.000$ / 70.000$ a year. You imagine that? Yeah, so there is a lot to be done in the next five years, I hope so, because there is demand, but it need to change from the government perspective, in terms of policy making. Hope so, I hope so. R: Okay, alright. Thank you very much for answering the questions. T: You are welcome!

Appendix 5: Interview III – Transcript Interview with Chamira E. – 28th of March 2014 R: Rebecca – interviewer ; C: Chamira - interviewee R: First of all I would like you to introduce yourself, tell a little bit  about  yourself,  what  you’re  doing  here   in Vietnam, since when are you living here? C:  Chamira  E.  I’ve  been  living  here  for  the  last,  almost  last  three  years.  Working  first  as  an  RMIT  Student   and then as a teacher at a high school. R: And how old are you? C:  Me?  Eh…  Older  than  25  [laughing]. R: Okay, so when you decided to move to Vietnam. Was that a quick decision or did you have time to prepare before you came to Vietnam? C: It was actually a quick decision. Because if I prepared, I would never have made it here. I mean coming to Vietnam is not economically a rational decision. It took a lot of income. So,  it’s  yeah  more  of  a   quick decision, but I know it was probably the right one to make. R: Okay, at that time when you started or decided to move to Vietnam. Did you worry about anything, about your life here or about anything?

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Rebecca Mayer C: No,  no,  not  at  all.    No,  because  Vietnam…  I  had  been  in  Ho  Chi  Minh  City  before,  so  I  know  the  life   here is pretty easy going. But yes, I was always worried about the unknowns like, see, what will I do after I finish school, will I get a job, will I stay, and all that information. But things usually work out, so on and so on. R:  Okay,  alright.  And  when  you  arrived  in  Ho  Chi  Minh,  it  was  not  your  first  time,  but  it’s maybe your first time you live here for longer, right? So, what was your first impression of Ho Chi Minh City, of living here as a long term resident? C: I think Ho Chi Minh City is a great place to live on a short term residence, but long term residence I’m   not  quite  sold  on  that  idea,  so  I  think  it’s  a  great  place  for  a  short  term.   R: What do you think, why is it not good to stay here for longer? C:  Ehm…  Healthcare,  job  safety,  political  situation.  Those  things  doesn’t  have…  and  especially  the  rule  of   law,  right?  It’s  a  different  system  to  what  I’m  used  to,  so  yeah,  so  I  don’t  see  myself  here  in  a  long  run.   But  in  the  short  run  it’s  an  awesome  place.  It’s  an  awesome  place  in  a  short  time. R: In which aspects? C: The life itself. You gonna get to enjoy your  life,  go  out.  Even  your  work,  but  you  don’t  have  to  work  so   hard, so at the same time you balance it with the social life here. R:  So,  it’s  easy  to  have  a  social  life  here  and  the  work-life-balance in general is very easy? C: Correct. R: Okay, so I want to go a little bit deeper into health care. You said it might be a problem here or it might be a problem for a long term stay. C: Exactly. R: Can you please explain me why? C:  In  Canada  health  care  is  free,  so  I’m  a  health  conscious  person.  So,  I  usually go for medical checkups and everything and I do it according to the book. But here there is no accountability if you go to any hospital  or  any  doctors.  There  is  no  accountability.  So  you’re  not  quite  sure,  whether  are  you  getting  the   right advice, because  they  don’t  have  accountability.  If  they  give  you  wrong  advice  or  they  treat  you   define,  if  they  make  a  mistake.  So  that  aspect…  for  example  I  would  be  scared,  if  I  brake  my  knee,   because the process of getting a surgery, recovery, I would trust more of the medical practices in the US and  Canada.  In  Canada  there  is…  people  who  does  it,  they  have  accountability.  So  here  they  don’t.  But   here health care cost is much cheaper than in Canada. I mean that would be in the US, because in Canada  it’s  free.   R: To what kind of health care provider are you going here in Ho Chi Minh City?

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Rebecca Mayer C: Usually  just  go  to  a  normal  doctor,  if  I  get  sick.  And,  so… R: So to a local hospital or is it a private doctor or the clinic? C: Actually, the last time I went to a local clinic, but had to wait too long, so then they opened up the private clinic, so I had to spend a whole lot of money. Close to more than 1.000.000. R: So was it a Vietnamese private clinic or a foreign-owned one? C:  Yes,  it  is.  It’s  a  Vietnamese  private  clinic,  yes. Not the FV hospital. I have been to FV hospital to get some... FV hospital has good products for injuries, like if you have safety items. You can buy at FV hospital. Then a local place. R:  Could  you…  Because  now  you  like…  you  have  seen  three  health  care providers already: The public hospital, the Vietnamese private hospital and the foreign private hospital. So for me it would be very interesting if you could compare them a little bit, like what you experienced there, what your feelings were. C: If you go to a local clinic, the cost is quite low. But you have to wait for long. You have to wait in the line for much longer, but even in the local clinics if you pay certain additional fee, you can cut in front of the  line  and…  but…  the  results  of  your  blood  tests and those things takes longer. But when I went to the local hospital private clinic the results of the blood test, everything was amazingly fast. I think it came back within 30 minutes or something like that. But if you have gone to a local clinic, it would have been the next day, but I wanted the results right away, because I was worried it was dengue fever. So if it was dengue  fever  I  didn’t  want  to  pay  the  chance,  so…  I  am  a  cost  conscious  person,  but  at  that  time  I  wasn’t   cost conscious because I was  more  worried  about  my  health  and  to  make  sure  I’m  safe  versus  taking  the   risk  of  waiting  another  day  or  two,  if  I’ve  gone  to  a  local  clinic.  And… But  most…  even  the  local  clinics,  or  even  the  private  clinics,  they  don’t  speak  English  much,  they  had   these…  even  the  doctors  hardly  speaks  English. R: Did you find that was a barrier to go there? C: Not at all, because I went with my Vietnamese friends, who speaks English fluently. So they helped me out on the translation part. R: And if you would have to go there alone. Would you choose another hospital or would you choose the same? C: Just the same hospital, because through my experience here, language has never been a problem for me,  even  if  they  don’t  speak  English,  I  just  find  a  way  to  communicate  with  them what I want and then they would still help me out. But that would have taken longer, longer time to let them know what I want.  If  I  had  a  friend  it’s  much  faster. R:  Since  you’re  living  here  in  Vietnam,  did  you  ever  access  health  care  abroad? C: No, no, no.

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Rebecca Mayer R: Okay, so you access all your health care needs here in Ho Chi Minh City. C: Yes, yes. R: Would  there  be  any  reason…  would  you  consider  to  access  health  care  abroad,  if  there  would  be   certain reason? C:  Ehm…  The  only  time…  Like  if  I  had  a  major  surgery or something. I would not do it in Vietnam. I probably would go back to do the surgeries. R: To Canada? C: Yes. If I would break my knee and I need a knee surgery I probably would go back home to do it, although  it’s  quite  cheap  here.  The  surgery  is quite last. But I would rather have somebody who is responsible, something was wrong. R: Can you like tell me some of the aspects why you would go back to Canada. You said already the responsibility you have, maybe in Canada is better, maybe is cheaper. Are there any other aspects? C:  Oh,  I  think  it’s  a  better  quality.  Like,  I  wouldn’t  trust  somebody  with  my  body,  cutting  and  chopping   unless I know they are well qualified for that position. And from my knowledge none of the Vietnamese doctors would be qualified to practice medicine outside of Vietnam. So, I mean except in Cambodia and Lao.  I  think  those  are  the  only  places  where  Vietnam’s  qualifications  are  accepted.  So,  if  they  would  go   anywhere outside, their qualifications are accepted. So, that probably tells me something is wrong with the  medical  schools  here,  the  quality  of  the  medical  schools  here.  So  I  would  not  want  to…  take  the  risk. R: In general what are you doing to stay in a good health condition, to feel well and good? C: Eat healthy, exercise, watch how much sweets I eat, be careful with the sweats I consume because I have  a…  one  of  my  weaknesses  is  sweet.  So  I  try  to  limit  that.  Replace  that  with  more  vegetables  and   with healthier alternatives. R: Did you find that easy or difficult in Vietnam? C:  Eh…  About  the  same,  it’s  about  the  same.  Yes.  Because,  actually  I  would  say  the  cakes  are  better  in   Viet…  ah  in  Canada.  The  cakes  are  much  better  in  Canada  that  in  Vietnam.  Like  chocolate  cake,  cheese   cake. R: Ah, okay, so you think maybe here you have the risk to eat more sweets? Or in Canada? C:  In  Canada  is  higher  risk.  Because  the  cakes  are…  I  find  the  quality  of  the  cakes  are  much  better.  The   bakery is much better in Canada, so you would have a higher rate of craving for that than in Vietnam because  the  quality  of  the  sweets,  the  bakeries  are  not  so  high  as  in  Canada.  So  then  it’s  easier  to   remain  healthy.  And  also…  One  of  the  biggest  advantages,  when  it  comes  to  eating  healthy  here  is,  the   access to fresh vegetables here is amazing, is amazing. Like in Canada, like unless you go to the local

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Rebecca Mayer market during  the  summer,  pretty  much  can’t  fresh  vegetables.  Everything  comes  from  Costa  Rica  or   Mexico. R: Have you ever been before to a country just to access health care there? As a medical tourist? C: No, never. R: Would you consider that? C:  Eh…  No,  not  really.  I  have  no  medical  condition  that  would  require  me  to  look  for  overseas  medical   attention,  which  pretty  much,  almost  all  medical  facilities  in  Canada  is  efficient  enough.  I  don’t  need  to   go outside. R:  Was  there  any…  Or  maybe  you  can  just  pick  any  experience  you  had  with  the  hospitals,  with  the   doctors  here  and  you  can  tell  me  a  little  bit  either  if  it’s  more  a  bad  experience  or  a  good  experience.   Just pick one which is remarkable, you want to share. C: The last time I was sick, I actually been to a local clinic the wait was so long so they opened up the private  clinic  just  for  me.  And  the…  like  everything  was  super  fast.  Like…  everything  was  super  fast.  They   took the blood, all the result came out, they analyzed it right away. Everything was done in like less than 30  minutes  to  an  hour.  But  if  you  go  to  Canada  you  don’t  have  that  option.  That  is…  you  don’t  have  the   private medical option. Everybody is treated equally. So you are treated based on priority.  So  doesn’t   matter how rich you are, how poor you are, you are all treated the same, depending on your medical condition.  So,  that’s  one  advantage  here  that  if  you  have  money,  you  can  buy  pass-the-line and get treated  better,  but  if  you  don’t,  you  are  kind  of  out  of  luck,  to  better.  Quality  align  that’s  really  bad  for   the  poor  people  but  then…  since  I  can  afford  to  buy  pass-the-line,  it’s  an  advantage  for  me.  So,  yeah,  if   you have the money, you get really fast medical service here. R: So, Ho Chi Minh City is also known for cheap cosmetic surgeries, would you consider getting any cosmetic surgeries or any cosmetic dental care here in Ho Chi Minh City, instead of going somewhere else? Or would you consider at all? C:  Cosmetics  means  like…  eh…  normal  dental work or something you would do outside of regular dental work? R: That you would do outside of necessary dental work. For example bleaching the teeth, whitening the teeth… C:  No,  I  wouldn’t!  I  don’t  like  the  cosmetic  dental,  but  in  Ho  Chi  Minh  City  I wouldn’t  hesitate  to  do   normal  dental  work,  general  dental  work.  I  would  not  think  it’s  important  enough  to  go  oversea  for  that.   I think Ho Chi Minh City has enough probabilities for that. R: So in general cosmetic surgeries is nothing you would consider at all? C:  Exactly.  Yes,  yes.  Because  I  think  it’s  just  only  temporarily,  because  people  do  cosmetic  and  then…  the   reason  you  need  cosmetic  is  you  already  had  bad  habits  and  if  you  do  it,  it’s  only  a  temporarily  thing,  

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Rebecca Mayer because you reverse back to your bad habits, which brought you to that place anyway. So, I think I would rather prefer to change my bad habit, to make change, than getting a cosmetic surgery. R: Okay, this would be my questions. But if you have the feeling anything is missing about health care providers in Vietnam, in Ho Chi Minh City, anything about health care. C: I  think  health  care  comparing  to  how  I…  my  impression  to  first  time  I  was  in  Vietnam,  I  was  in  Ho  Chi   Minh  City,  it’s  improving  drastically.  Like  conditions  and  level  of  the  health care providers are increasing drastically and the quality is going up. But then the other side of the quality aspect is, is only for the rich people. Health care is only improving for the rich people. Not for the poor people, not for the general public. So the general public still has to go through the crude medical system you have in Ho Chi Minh City versus major hospitals like FV hospital only caters to the rich and the middle class, upper and the rich people in Vietnam, which is not a fair system. R: So,  just…  I  want  to  know,  if  I  understood  right.  You  said  health  care  is  increasing,  is  getting  better? C: Yes, the quality of health care is improving drastically. R: In every section? In public and private hospitals? C: Private. Just in private. R: So you don’t  see  that  in  public  hospitals? C:  No,  no,  no.  I’ve  been  to  like  some  private  hospitals,  I’m  sorry,  public  hospitals.  The  conditions  are  not   even  reasonable.  I  won’t  think  it’s  an  acceptable  level. R: What conditions are coming to your mind? C: I think  cleanliness,  eh…  availability  of  modern  equipments,  modern  technologies.  I  don’t  think  a  poor   person can afford a CRT, a catscan or an MRI, right? So like one of my friends he broke his leg, but the doctor  just  fixed  his  legs,  he  didn’t  do  a  surgery,  but if he had the option he could have taken an MRI and then  he  knows  that  yeah…  there  is  no  need  of  a  surgery.  But  yeah  they  let  him  heel  on  his  own,  but  so…   If you have money you can take another option, but if you have not, you are stuck within; you have to take the risk of making sure that everything is alright. R: Okay, alright. Thank you very much! C:  You’re  welcome!

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Rebecca Mayer

Appendix 6: Interview If-Consulting – Transcript Interview with Viet and Claudio from If-Consulting – 21st of March 2014 R: Rebecca – interviewer ; C: Claudio- interviewee, V: Viet - interviewee R: So, first of all maybe you can introduce yourself a little bit, like what is your name, how long you've been working for if-consulting and how long you have been in Vietnam. C: Okay. You want to start or? V: Okay, for me it's easy. I am Vietnamese origin, as you can see. And I am working for IF three years and a few months now. It's quite a long time. And I came back in Vietnam four years and a half already. So I don't know what to say... R: And before you were where? V: In France. R: Ah, in France. Okay. I see. C: So me, I'm born in Finland, grow up in France and came to Vietnam the first time five years ago. I work in IF-consulting two years now, in the marketing department. So, a lot of things to do… Not really something interesting, but we're expanding Asia now. So we have been focusing in expatriates in Vietnam for mostly before. Let's say 80%, 90% of our clients are medical insured in Vietnam. R: Okay. So that would be my next question. Like, can you tell me a little bit about IF-consulting, like the rough... like what you're doing and how this business works and how many clients you have, how many clients you insure or put for the insurers? C: IF-consulting has been here for, let's say 20 years, more or less. Starting in 1994. So, it will be 20 years this year actually. About clients, let's say roughly we have around… over 1500 medical insurance clients. People as we insure, that can be groups, that can be individual. Well, I can't give the exact... I can't give it because it's quite confidential, of course. R: But this is the number at the moment? C: That's it. 1500, I would say roughly. Around that. That's how many lives we have here insured. Then of course we have the house, the cars, all that, that might be roughly 200 non-medical people who are insured. That can be factory also, but I guess we're focusing on the medical, right? For your needs? R: Yes. II


Rebecca Mayer

C: So, ehm... V: What we are doing in medical actually, we can pursue it, we does SNACK. C: So we do the SNACK, that is how we serve our clients. We have a SNACK series. The “S”  is like SELECT. So when you come here you have a lot of insurer, Vietnamese offshore, onshore. You never know… There are many things you don't know about the insurers and especially Vietnam regulated insurer. You’re supervising in Europe you cannot increase price individually, Vietnamese insurers they can. They make by personally loading. So select the right insurance depending of your needs first of all, first... Then years after years we will  renew… your needs will probably change. Maybe you will get married, maybe you will get older, maybe we have some new products here. So we will also select if there is something better. When you're getting retired you don't have the same budget, as if you are working. You will probably need something with more detectivel, or something like that. V:  …new on the market as well. So we can introduce somebody’s  best. C: So how we do that: We have a pool of,  let’s  say,  three, four, five insurers that we will put on a comparative code and we will explain which one the client should choose and why. We cannot say that one insurer is better than another one. If you ask me today: Who is the best insurer? I cannot answer it. Because it will depend of your needs. Some insurers are better for families, some are better for individual, some are good for younger, some are good for older people. Ehm... Than we have what we call NEGOTIATE. This is the second part of our series. Negotiate can be as well on the price. Of course we don’t…  our prices are the same  as  the  insurer.  We  cannot…  we don't have, the insurer they pay us introduction commission. We cannot discount on them if they don't allow to give discount, the only way to do that is if you're in a group or family discount. Negotiate can be negotiate also, you can have exclude, you know, something like that, for example you have the pre-existing-deal. That can be something that the insurer don't want to cover. But if it's something that we see that it's don't really, like you get an operation on your arm, 30 years ago. You can say, hey, come on after 30 years you never need anything to fix your arm again. They can cover. The risk is almost zero. That's called the negotiating. V: Because of our portfolio. Either you are an individual and you don't work with us then you are alone to negotiate with the insurer. Or if  you  work  with  us,  we  can  say…  we can ask the insurer to make exception for example. Because otherwise we can say: Okay, you are not a really good insurer because you are not doing that and the other can, how does it come. And then we can tell our 1000 something clients won't go with you. We have more power from negotiation with them. R: You also have travel insurance, right? V: Yes.

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Rebecca Mayer R: Is this a big part of IF-consulting? Or a smaller part? V: Travel, it belongs to the, how do you say, to the personal life. So it's a smaller part, right now. It's like our main clients they are medical and then if they need anything, because they are travelling around they would ask us for a travel. But it’s  really  a  small. R: But also the expats they are asking you for the travel insurance? Not people from outside coming to Vietnam for travelling in Vietnam? C: No. V: Well depends, they can do that as well, but it's rare, because usually the travel insurance you take it before you come here. So, does few insurers can except, but in like one week time, you need to write, you need to purchase one travel insurance doing this. C: Let's say, nowadays in Europe, you buy your flight tickets or something like that, or you travel package on the internet. There is always that option, that it stick ready for you, do you want travel insurance. Let's say more and more people do have already that. Once they come here and they already here it's usually quite hard to find a product for them. V: You have one, but only within first week, otherwise you can't purchase it anymore. R: Okay. C: Usually travel insurance needs to be taken before, so... V: The reason is that you can't take the travel insurance to make it like medical insurance. It's not the same thing. C:  That  is  actually…  I  think  that’s  good to know. There is a lot… nothing against Australians or something like that, but usually using a travel insurance as a medical insurance to save money. Ehm... We see a lot of expats doing that. But travel insurance, unless you have private confirmation from your insurer, but you may not, and then if you renew it, that's fine, as long as you have flight back to Australia and you can proof that to the insurer. Because the day you are on the road and you have motorbike accident. They will use that, that reason, if you don't have the proof that you have been in Australia back in the middle for example. They have the very good reason they  don’t pay your evacuation and not to pay your treatment. So that's something. So we do travel insurance, but it's a small series. R: I see. C: Then part of our snack: We have the ADMINISTRATION. We call: Administrate. So, you know the hassle paperwork, you have for running insurance. You have to fill that. And then every year you have be KK


Rebecca Mayer sure you don't miss the renewal date and then you have to send that to the insurer. We make it easier for the client. You come here, you sit with us, you fill it, we do all the paperwork. You say what is okay, what is not okay. At the end you get just okay your premium, you're insured under this condition. The premium is this. Are you okay with this? That's it. You have nothing to do. And then again, we’ll  send  all   that, we make sure they receive the premium. Once we have the card, we call the client: You want to come to pick up your card? Administrate is part of… individual is interesting, but moreover for groups, because what is insurance for companies. We do that. And that's lot of, lot of time to do that. Ehm... I mean, receiving the application, make sure that they’re okay and all that, but most of the companies they have something else to do. So that is something what is quite valuable of course for individual, but even more for companies. R: Can you provide with a number: How many companies are using your consulting? C: Ah, approximately right now... R: How many people are insured over their employer? V: That's very important, actually. C: That's hard to say. V: Because we have schools and we have as well private companies... I can't say exactly... C: I would say that around 50% of our clients are companies. Probably. Of course we focus on examine, we don't want to have big companies, large cooperates, for a simple reason, that for larger cooperation all the decisions are made from the head quarter or CRER office. So most likely cooperates in Singapore or the US or anywhere. We used to have many big companies, when they started here, but as soon as they grow and let’s  say for example coca-cola, we had them, but then the US headquarter they said okay, for everybody it would be that insurance. Then we have no room to negotiate anything here. It's like that, that’s  a cooperate decision. That’s  it.  That's why we don't do the large corporate. But let's say there are some competitors they are using aofficy.org or the word, so it's easier for them. We are not that player, we take every client personally, we are not a client number. We know each client; just two days ago we organized a big party for our clients for example. We go to meet them, we know them personally, that's our strongest... Where we are really strong is, to know the people and we know their needs and we know specifically what's happening most of the time in their family, where are the confident. That's something important. Then CLAIM: Claim is a big part, especially often with the Vietnamese insurers. V: Well we have a small department would take care of the Vietnamese claim. This is... We do as well claim, but usually what we tell our clients is that if we have any problem and you don't know what to do, you can come and we will help you. But normally we don't have the right to ask you for the medical information. This is completely confidential. But in any case we are here to tell you, what you need to LL


Rebecca Mayer know, for example you can go to see your doctor. Well the doctor would say: How long do you have that symptom. You don't know, but you think that you have this like three or ten years ago. So it can be previous thing, what the insurer does not cover and we would tell you, well this was three years ago. But the thing is, right now, you have your elbow, your elbow is insured, but three years ago it was this one [the other on]. Nothing related. And the insurer can just base on the medical report, what the doctor said. You had that before. So we are here to provide them this kind of information. And as well if in case as the insurer or the clinic‌ well sometimes we intervene as well. It can be clinic and insured problem, it can be client and insured problem, it can be as well client and clinic problem. So we are here to help. C: Yeah, the claim is... The claim are... [phone ringing] V: It can be to take back the 10.000$ for evacuation. Because the insurer didn't want to pay it first, because the client organizing everything, because he was so afraid for his son, so he organized everything. And it can be the limit, because the clinic usually depending on what kind of clinic you go, it can be too expensive for the area, so the insurer say: No, no. We cover for no more than the charge. So we negotiate and we have the outcome. C: Well, sometimes the claim are on an unfair basis and in that moment when we see it's not fair, the denial of the claim, we will... we have a base of clients with which we are quite powerful. And the insurer they know, that if we come, and it's unfair, most likely they would pay for the simple reason: If they don't pay something that they have denied unfairly, okay what do we do: We send them to the whole basis of our clients, that they shouldn't buy your insurance. We have more power, because we have more clients. That's what, that's very... I mean for the client, for an individual if you try to fight against your insurance company. I could say: Good luck. Even in western countries it's a hassle. But in Vietnam it's even more. Then the clinic of course, when you go to the clinic and they deny, the clinic is also in a position, that's really, really hard for them. On one side they want to get the money for the series provider. On the other side they don't want to lose the client. Because they have to say to the client: Now your claim of 7000, 8000$ have been denied, so now you need to pay. At that moment the clinic they call us, most of the time, and they say: Can you help us. And there is the client, we will help them, we will solve it out, that everybody get out of the situation in a happy. So most of the time of course the insurer is the one who is most unhappy in this. They just cash out some money. But it's, let's say, it's kind of a game of power between the insurer, us and the clinic. But everybody tries to do their best and at the end we work together so everybody is happy. Because, of course, if the insurer doesn't pay, the client first of all, they are living in a world where information spreads quite fast, let's take facebook, take linkedin, take all social media and the expat community in Vietnam is very small. The expat community in Ho Chi Minh, in Hanoi is a delage, everybody know each other. Information goes very fast. The insurer, they don't want to lose their reputation. The clinic doesn't want to lose the client, because of course you have the position what the client will say about the clinic: The clinic they want my money. They charge me, they didn't blablabla... So they are. MM


Rebecca Mayer So we are…  most of the time we are in the middle, actually. We are the, how to say that, the referee, the referee in a football game. And we have to keep that everybody… stays, how to say that... it doesn't go insane. That's a big part of the job also. R: May I ask, did you work in the insurance business in Europe before? C: Sorry? R: Did you work in the insurance business in Europe before? C: No, no, no. R: Ah, so it's your first time in that field?! C: I didn't work in insurance before, but for two years you learn quite a lot [laughs]. Then: KNOWLEDGE. We share our knowledge. As we say, we read fine prints 365, 24 hours a day, 7 days a week. So... V: And because we are working for the insurers, so we know which is in which field. And who can do what and why they can do it. This is what Claudio told you, that few insurers in Vietnam they have the right to increase your premium next year. You have …  A  big  fluctuation  is  here.  For  example we have hospitalization which costs like 100% of your premium, they can increase your premium next year. This is experience loading. And no international insurer can't do that. But then Vietnamese insurer...Vietnam based insurer they can. So this kind of information is written nowhere. This can belong to the government. C: That's why we share. We know the insurers, we know their habits, we know their own psychology, how they work, we can advise which is the best insurer for a long term expatriate. Probably Vietnamese insurer is not the best choice for you, because you will be moving to another country, then the Vietnamese insurer cannot support you. Ehm... V: It will be completely depending on your needs. How is your profile.... Really. We can't just say, okay this is the best insurer, because it's the most expensive one, because each one is different. C: But then knowledge also the fines prints. So you're not used to read the fine prints, so  you  don’t  want   to read 20 pages of fine prints for your medical insurance. But we read it. We know where are the traps, where are the tricks, where are holes. And all this actually... The insurer they have their own language also. And you don't speak the language of the insurer. There are all these little words, for you they doesn't mind, even you  don’t  see  the  problem. But, for example, a simple term as “usual” and “customer” of course that can be a big mess. Putting that into a fine prints that can mean all and nothing at the same time and the insurer can hide behind that, protect themselves from pay. So that's something when you're individual, it's very hard actually to NN


Rebecca Mayer understand fine  prints,  it’s  written  by lawyers, by advocates, they have a medical e-book, doing that with xyxyx. It's very well packed for the insurer to be as safe as possible, to  don’t  have  to  pay  these claims. R: For me it would be very interesting to know what profiles the expats you insure have? Like in which age group are they, which jobs do they mostly have, because in my survey I found out that some might be insured and some might be not, so... Are there different types of expats which are insuring over ifconsulting, that would be interesting for me to know. V: Well, what kind of expat then. Eh... What do you think, Claudio? Because, what we have right now is the flow of expats right now is young, they are really young, they need insures that for the basic cover. And because they are young, so they are moving around, they can stay here for two years and then they are moving to Thailand or Cambodia or India. So  this  is…this can be, like... C: Let's say that before in Vietnam there were a lot of expat packages, where you have the housing, the school and that. Eh... With economy downturn, the world would have or in the past five, six, seven years, especially in Vietnam, Vietnam is country where you produce a lot to export, for incompanies, there we can see that there is less and less of that expat package and so the people have to buy by themselves the insurance, so before it was a top insurance with all everything included, the maternity, the dental, the optics, all. And so there’s people sometimes the companies say: Okay, we don't pay anymore that insurance and they come to see you and they ask: Hey, we want to renew it. And you say the price and then: Really that's the price of my insurance. Ehm... So, there is a, let's say, there is a... more and more people, that they try to cost control the premium of their insurance. So having the maternity do you really need it when you're over 40. Maybe not. You never go to the doctor, but you have the outpatient treatment. That almost doubles every time your premium. And then of course you have foreign patients, you can detectivo, more and more product their purpose detectivo, because the price of medical insurance are really going up, going up, year after year, between 8% and 12% medical inflation.Each year. So, people use more and more that detectivo, of course. And then you have some insurers that are developed just for South-East-Asia. Because of course when you are in South-East-Asia you don't need a simple and the cost of the treatment, like in Thailand are much cheaper than in Europe, but the quality is almost the same. So if you agree to go to Thailand, instead of Singapore, which is most of the time the people are trying xyyx. For example Bumrungrad looks like a five-star-sheratonhotel. It's not a problem. And the medical, the doctors are really good. So what happens, people choose more and more the South-East-Asia package. Then of course, we have some high-end people, working for big companies, or not even big companies, but who are the Good-Dolce product and then we sell of course, this high-end insurances, but the tendency is to lower the premium and people are really looking more and more after the price. There is a survey that say in Asia 26% of the people they think they don't have the right insurance for themselves. So one people out of four who have an insurance they are not sure, is that fine. Maybe I can get something cheaper, something better, that's where our services are really something valuable for them,  because  it’s  totally  free  of  course.  

OO


Rebecca Mayer R: And do you have a specific target group, like people you want to reach, you address in a specific way? Or is it just very general, like expats here or do you have the feeling you can reach a certain group better through your service? C: Sorry, can you..? V: A certain group? Because normally all of them can be our client. The thing is how you reach them. This is  like  a…  how  we  do  our  marketing  most  of  the  time.  We  used  to  work  like from word to mouth and after that we started the… how  to  you  call  that…  the content of the marketing. C:  We  have  a…  so,  ja… V: And then the emailing of course. The emailing we can get it from xyxyx groups, neighbor, ask neighbor, most of them are expats. Well, I think all kind of  expat  can  be  our  clients,  so  we  don’t  have  a specific target group. R: So, I can imagine like for example clients from Europe you can address very easily because you speak French. Might that be a target group? V:  It  helps.  It  helps.  Because,  I’m  in  charge  of  the  French  clients  here.  Anyway,  well,  it’s  easier  for  them.   Because usually  French  people  they  don’t like speaking English. They can feel more comfortable if they can speak French with somebody. Because insurance is quite complicated, so if we are speaking another language,  well… C: That’s  something… you feel of course somehow more comfortable talking in your mother tongue about something like insurance, because you want to feel safe, sicker that something happens. You are really xyxyx. And you feel very comfortable to have a number where you can call and you can speak the language that you want. Of course we can do that for French, I speak Finish, I can do that for Finish, a little bit Spanish and all that, but most of time we do that in  English.  Mmmm…  Concerning  marketing:   We have probably one third of the people today they come from referral of happy client, we have one third that comes from clinics, so the clinics they know our professional, so they send us people, because they know that we will advise a good insurance for them. You know, when you are at a hospital you don’t  want  your client  to  come  to  ask  you  if  you  have  an  insurance,  you  don’t  want  just  purchase  an   insurance, because  if  it’s  not  good  for  him  …  Ah…  that’s  somewhere  like. You know, you want that him to  come  back  to  your  hospital  to  get  treatment,  you  can’t  purchase  anybody  that  insurance  and  then   next  time  he  comes  to  your  hospital  and  says,  I  don’t  know,  but  you’re  insurance  does  not  cover  this, they  don’t  want  that.  And then we have one third that come from marketing, like that can be networking, like face-to-face-meeting with people around the city and then it can be internet-marketing. We’re  trying  to  do  more  and  more  that  internet-marketing. Well,  it’s a tendency for people to buy insurance on the internet. People are mobile. People are international, people are moving all the time. They need to have, to feel safe to have somewhere on the internet, you know, to check fast, this, this, this. That for example we have a skype account, where ten of our consultants are ready to answer that. PP


Rebecca Mayer Any client or insured member, they ask us something, we advise  them  to  go  on  insurance…  on  skype   insurance question, to ask that. Because most likely, we have ten consultants, there will be somebody connected or ready to answer. So we try to work all together, work on information. You’ll  have a question,  we  will  work  together,  we  don’t  just  work  by  ourselves.  Most  likely  our  target is to be xyxyx. Xyxyx. To your question. R: So, you already quickly mentioned, but maybe you can go a little bit deeper inside. The kind of insurance  you’re  selling  very  often,  what  kind  of  medical  insurance  is  it?  What  does  it  cover?  Like  one   very popular one. C:  That’s  hard.  We  can  draw  you  how  actually  the insurance work. I would say, hard... V: I can write you like three kind of insurer. So... Well... C: The first and cheapest level is emergency cover, which will be inpatient with evacuation, Vietnam also... Let’s  say:  There is of course every hospital which has inpatient. V: So this is the plan. You need to have Xyxxy rather than thekind of insurer. What I mean is you have all of them, of course we have BaoViet, BaoMinh, those are Vietnamese insurers, so they we would not suggest them to foreigner, simply because in their terminent condition they say, we have the right to cancel the policy within 30 days of notices. This is not good at all. And then you have the second level of insurer which are those, because they are based here inVietnam, so they can use the experience loading, what the other insurer would not do. What  we  would  call  the  offshore,  like  those,  I’m  not  naming  them,  but  you  know.  And  then  regarding   the plan, we have like, three level of cover. The first one, what is the basic one, which would cover the hospitalization and evacuation. This is what Claudio was mentioning, this is the fist thing that you need, because if anything happens, it can be really, really expensive. And then the second level would be, what we call the outpatient visit, visit to the GP, specialist, medicine. [writes down]. This normally, I think family with children they would choose this one, because the kids they are sick most of the time and then the third level you have the maternity, dental and optical. R: So that would be... The first level that would be the insurance for an young individual to come here? V: Well, it depends. Because we... It depends really on their kind of lifestyle, for example us, we would be here [pointing on the first level]. Because we would  not  go  to  the  doctor.  Simply  because  I  don’t  have   time. If I have something I would go to buy medicine, like, I only have  flu  or  symtom.  So  I  don’t  want  to... So we would see what kind of lifestyle they have. If they go to see the GP often, if they go to see a specialist often. And we can caluculate based on the premium and the differences between this [pointing on the first and second level] and we can see: You need to take this one and this one [poiting on the third level] is really specific. If you need it you can ask us and we can say, you need to be here to take this.

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Rebecca Mayer R: I see. But what is like the feeling, what kind of lifestyle do most expats, maybe except families, the individual... An individual comes to you: Do they mostly say like, do they mostly have the lifestyle just for emergency case they need the insurance. Or is it really so different? V: So different. C: I would say we probably have 50%-60% of the client here [pointing on the first level] and 30%-40% here [pointing on second level]. V: Because the tendency is here [pointing on first level], because of the cost saving. Ehm... C: The thing is that Vietnam is not a country were there is a lot of rich expats. The tendency is really to be here, in the minimum cover. Ehm... Not necessarily cheaper, cheapest, but you know from here to here you double the price, from the first to the second level. V: So, you really need to ask them, this is such [pointing on first level] and this is double [pointing on second level], so do you really think you need to go and see your doctor often because you can either pay out of your pocket or... They decided really quickly, because they can see what they have. R: Okay. C: Most of the time here [pointing on second level] its families. It tends to be families who have that. V: Just,  individual  as  well,  but  because  they,  I  think,  they  don’t...  First thing is that they  didn’t realise that they  don’t  go,  they  don’t  really  need  that.  So  they  will  take  this  [pointing  on  the  second  level]  for  the   first year and then they would decrease it. Normally. Except if they have family. R: And most of the expats are getting the insurance when they in Vietnam or do they get it before they come to Vietam? C:  We  are  focussing  only  on  the  people  who  come  here  and  don’t  have  it. R: Who are here already? C: Ja. R: I see. C:  Because  if  they  do  it  before...  ehm…  Most  likely  it’s  a    xyxyx. From time to time we have some people who ask before coming here. But the people they usually they come to a country or the people who have  really  think  about  it,  they  have  the  big,  expensive  insurance  already  before.  They  don’t  think   about... If they really think about that,  I  think,  they  already  pay  a  lot  and  ehm…  They  ask  around, RR


Rebecca Mayer another friend or something like that. Otherwise it’s the company they will do, otherwise they would check the insurer that the know. The Americans they know  some…  they  check on internet, they will find some American insurer and they will come with let’s  say  AXA or UNION’s plan or something like that. V: So usually they are already here. Our clients are already here. Either they already, they are already insured  on  a…  So if they are already insured, they know that we can advise them for a better, cheaper or depends on what kinds of need they have,  so… R:  I  don’t  know  if  you  can  provide  me  with  numbers,  but  how  much  is  like  the  first  level  insurance  a  year,   roughly? V: Well, it depends on... We are talking about expatriates, so around 27 years old, the first level can vary from two let’s  say  350$  up  to  1000$,  depends  on  insurer  of  course.  The  second  one  is  double,  so  you  can   just double. This one is more expensive [pointing on the third level]. R: So,  that’s  the price a year, right? V:  Yes,  it’s  the  price  a  year.   R:  Okay,  but  you  don’t  have  any  numbers,  like  how  much  your  clients  spend  like  average  for  health   insurance a year. C: No. Something with xyxy, approximately… V: I think 700$. R: Might be a rough average? V: Yes. 700,800… C:  It’s  quite  hard,  because  you  cannot  say,  that…  We  could  calculate  it,  if  you  want,  but  we  have…  I  have   no number right now. We have to take the first deciles, the last deciles off, so we have to concentrate on the 80% expats and take the medium of,  of  course.  But,  that’s  a  good  question. R:  I  am  just  asking,  because  that’s  also  one  part  of  my…  of  my  study,  a  little  bit,  to  find  that  out.  The   online survey is not a representative number of people, who did the online survey. I asked them also, how  much  they  think  they  spend  a  month,  so  I  could  calculate  a  year,  so  I  can  compare  and  see  if  it’s   like… C: I could roughly tell you. Wait, let me take a calculator.

SS


Rebecca Mayer V: Yeah, as you can see for the first level. I think I replied to your survey but when I clicked on send, it turned black. So I couldn’t… R: Pardon? V: I answered your survey. C: I would say that the average premium must be something like 1300$. Per person, per year. R: Okay. V: So this xyxy. So  they  are  all… C:  All  of  them.  But  I  cannot  say…  For  each  level,  I  cannot  say. V: Because really, the client can take this one. 350$ only, because he is really young, 26 years old. Or it can be dad and daughter, they are taking the high-end one,  10.000$  per  year.  You  know,  so...  if  we…  just   like  that,  I  don’t  know. R:  Yes,  sure,  alright.  Ehm…  Maybe  you  also  speak  with  your  clients  before,  right?  So,  for  me  it  would  be   also interesting to know, like what concerns and worries the clients share with you, regarding their health, regarding their wellbeing here? What are like common concerns they bring to you? V:  They  usually  say:  Wow,  the  motorbike.  I  don’t  want  to  have  any  motorbike  accident,  so  I  want  to  be   insured at least for the hospital. This is the basic one. C: You have tried to cross the road, you have tried the motorbike. Medical evacuation to Thailand is between 5000$-35000$.  They  say  I  don’t  need… V: We will tell them that: Did you try Vietnamese hospitals? All of them? Are you happy with them? And they  will  say:  Okay,  don’t  like  this  hospital. And we will say: This is the best hospital in Ho Chi Minh, so if something happens you need at least have evacuation to go to Thailand. And then they would say: Wow, okay. So I think their concern  is  that  here  we  don’t  have  so  many  good  facility. C: It takes time usually. For the younger expatriates it takes time to have one accident by motorbike and then  they  come.  Most  of  the  time  they  are  likely,  yeah  I  don’t  need,  I  am  superman,  they  have  one accident,  lucky…  most  of  the  time  they  are  lucky,  they  get just… V:  No,  they  don’t  have  accident,  they  heard  about  their  friend  who  had  one.  And  then  they  say:  Oh  my   friend just had this accident. So...

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Rebecca Mayer C: Some scarves and bruises sometime, but of course you have some people who are stuck in Vietnam. They are in Vietnamese hospital,  because  they  don’t  have  an  insurance.  The  problem  in  Vietnam  is  like   brain surgery, nerve surgery. There is no blood bank. You see that overtime in the expat community: Hey,  we  need  blood  for  this,  we  need  blood  for  that.  Because  in  Vietnam  they  don’t  have…  Even  FV   hospital…  You  think  FV  hospital  is  the  top  of  the  top.  But  that’s not true. Most…  They’re  good,  but  they   don’t  have  brain  surgeons,  they  don’t  have micro surgeons and all that. When you have very small bones  to  repair,  I  won’t  go  over  there.  I  better  fly  to  Thailand  or  Singapore, where you have the building they have ten floor of micro-surgeon. R: So traffic is one of the major concerns? V: Traffic for those young and all they need the basic. For those really the facility counts. Or they want to go to Thailand or Singapore. R: So they want to have the better facilities? V: Yeah. R:  They  say:  Here  we’re  afraid  that here the facilities are not good enough. V: They would be looking around to see if they can find something, or if they have this kind of disease if they are children, this kind of disease, they will see where they can go to, they go to Thailand. They would look around, even in Europe. So, I think this case would be the facility problem. R: What is their concern about the facilities? What is what they are missing in the facilities here? V:  Eh…  Usually… Well it depends. There are lots of cases. It would be an example then. For example a heart surgery. Went even to see in Switzerland, to see if there is a good surgeon, even in Singapore. And then they end up at Bangkok hospital, because they say, that there they have the best surgeons. Because  the  surgeons  there…  he  had  seen so many cases, and he had so many operations already compared  to  Singapore  and  compared  to  Switzerland.  So  this  is  one  case.  Another  case  would  be…   well…  In  any  case  they  would  look  around. Our clients they usually look around. They would ask around, ask friends and everything. And then they wdo come and ask  us  as  well.  And… R: So you mentioned the experience of the staff and then the knowledge, like in specific areas, like the micro… C: Yeah, the micro bones. V: Not only. Because our work is to go, to meet clinics and to know exactly what they have, like specialists,  what  they  are  doing,  what  they  are…  In  which  field  they  are  good  or  not.  And  usually  those  

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Rebecca Mayer clients, they  would  ask…  they can ask us where to go and see a dentist, not too expensive, because they don’t  have  insurance.  And  we  can  tell  them,  because  we  know  who  is  working  and  how  much  it  will  cost. R: Okay. But this are the very specific... This I very specific health care fields, right? I would be interested if like basic health care. What are the concerns of the expats there? Like not if they have the specific difficult  bone  fracture  or  they  need  a  heart  surgery.  But  the  basic  health  care.  In  like…  Do  they  have  any   concerns if they come to you regarding their basic health care providers here in Ho Chi Minh City? V:  What  do  you  mean  with  the  basic  health  care?  You  mean… R:  They  are  just  like  getting  sick,  getting  cough  or  getting  flu  or  they  having  high  fever… V: Oh this. I  don’t  think  they would care too much. They would either go to FV, Columbia or CMI or Victoria  and  they  can  see  which  is  best  and  this  is  like,  if  it’s  the  basic  visit  we  can’t  tell  them  because   every doctor is different. Maybe they can trust this one, but  not  this  one.  Everybody…  I  can  go  to  this   doctor.  And  I  would  advise  Claudio…  And  Claudio will say: I would prefer my doctor. Because I know him for  a  long  time.  So… R: But we are in basic health care, there is no concern that you cannot get access here? That you cannot find a good hospital or doctor here? C:  It’s  more  like  specific  and  complicated  surgery.  All  the  basic  health  care  is  fine.  And  I  told  you,  it’s   better  to  go  here,  because  the  tropical  disease,  in  Europe  they  don’t  know.  They  never  seen a tropical disease. The doctor here they know much better their symptom. They working everyday in that scale, it can be malaria, it can be dengue, it can be all this. In  Europe  it’s  so  rare… V: Dengue fever? C: Yeah. Dengue fever or malaria. No for the basic health care is okay, but you know you cut your arm, you want it to work after your accident. I will not give my finger, if I have the nerve wire cut or something like that, I will not go to the first doctor here. I would fly somewhere and check that. Or I would choose the first aid-surgery here, just close it that it  does  not  bleed  all  the  time.  Then  I  go  to… you cannot…  you  don’t  have… How  to  say…  you  don’t  have  the  room  for  mistake.  Especially  then that comes with the children for example. Your children is still broken. And he fell down and broke his arm. You want  him  to  have  the  best  support.  You  don’t  want  him  to  have  any  xyxy for the rest of his life. For seventy years you have to live after that. You know that they are just scared and you know that Vietnam cannot provide to them the best care for some specific condition. Of course they will not take the kid and fly to Singapore for a flu. That is not very common. Sometimes you can have that also. You start to have... you go for a flu and you need to go some blood  check,  they  cannot  find…  At  the  end  you  can…  I   have  some  people…  I  have  some  friends  who  are  insured,  and  they  tried  and  tried  and  the  doctor  didn’t   find. They were thinking about an angina. Finally he went back to France and they found out that it was a  very  bad  bacteria  that  he  had.  But  just  they  miss  it  for  the  blood  test  and  all  that,  but  it  hasn’t   VV


Rebecca Mayer sometimes… But  most  of  the  time  you  can  get  good  health  care  in  Vietnam  for  some  basic.  But  once  it’s   more complicated better to fly  somewhere.  And  that’s  very  normal.  You  have  the  building  with  ten  floor   of  I  don’t  know…  cardiac surgery. In Ho Chi Minh you have three. And on the 10th floor you have 20 cardiac  surgeons.  Of  course  you  will  have  better  care  with  that.  That’s  most  likely  it  is  very  normal.  So…   V: Does it answer your question? R: Yes, yes. Thank you. And do you have the feeling, that the health care need of you clients change overtime?  Like  when  they  stay  here  for  longer.  Let’s  say  they  first  arrive,  they  get  the  insurance here. After 5 years, after 10 years does their health care need, does their lifestyle changes so they need other insurances? C:  Sure,  it  changes,  but  there  it’s  something,  that’s  why  it  is  quite  important  to  choose  the  right   insurance because select is very important. Because once you choose for example Vietnamese insurer and you need change, but in that time you have a motorbike accident, you have a broken arm. When you will go to see the new doctor, sorry, the new insurer , you have to fill that medical form, you have a broken arm xyxy.  So  it’s  better  to  take  a  product  that  is xyxy and can have many level of cover and will not  have  apply  for  them….  Because  most  of  the  people  they  would  say,  if  they  are xyxyx, I would just shift to another xysy. You  can’t.  It’s  too  late.  You  have  the  xyxyx condition. So, of course there need will change. V: Because they will get married, they will have children. They will change work, anything can happen, they will change the company, or the residence. Everything.  So,  yes  they…usually  our  clients,  when  they   stay  with  us,  they…  We  can  see  them  changing  from  this  insurer  to  this  insurer  to  this  insurer.  We  can…   depending  on  cases…  we  can  see,  okay  he  changed  because  of  this,  he  changed  because  of  this.  So,  yes,   of course  the  situation  will  change.  So,  the  insurance… But like Claudio said, the best is to have the solid one if you will stay in Asia for a long time you will take a solid one and if everything happen this will keep you covered in any case. R: Do you have the feeling, that some of the clients, even if they have the insurance here in Vietnam and evacuation in Thailand, that for some treatments they go back to their country of origin? Can you follow that up or can you see that? V: Well, is not exactly that we follow it. For example, one of our clients choose the basical one, this one. I’m  not  sure  if  I  am  answering  the  question…  but  yes  they…  there  are  expats  who  are  deciding  to  go  back   to  their  home  country…  country  of  origin  to  have  treatment  there.  This  woman has cancer and of course the  insurer  covers  it,  but  the  thing  is:  She  went  to  FV,  the  best  here  in  Ho  Chi  Minh  and  …  the  hospital   said: Okay, you need to cut everything, because you have breast cancer. Everything. Then she was so afraid, that she went back to France to get treatments, not paid by the insurer because she got back the social security and then they just got like two cut, so she is still well. Well this is the differences. Because normally they would go back to their home country, because they think the treatment is way better. WW


Rebecca Mayer There is… R: For very severe cases?! V: Yes. C:  Of  course  it’s  more  comfortable  to  be  in  your  home  country,  for  example  for  xyxyx, if you have breast cancer.  It’s  easier  being  in  your  home  country  than  being  abroad, especially for expatriates here who don’t  really  have  family  here.  They  are  here  alone.  So  the  cancer  ….  Xyxy fly back to their home country and receive proper treatment over there. That happening in a lot of countries. For example for French it’s  very  easy, or for Europe in general I would say. You go back to your home country, the governmental security  social  system  will  accept  you  and  take  you  back,  they  can’t  say  no.  If  you  go  to  the  US,  you  have   to apply for a new insurance, or they are changing now with their new government, but you have to apply  for  an  insurance,  so  some  people  they  don’t  have  really  the  choice.  That’s  depending…  And  then   some  people,  they  don’t  necessarily  want  to  go  back  to  their  home  country,  because  their  treatment  in   their home country is even worse than in Vietnam. That happens sometimes. V: This is why the plans, we have the evacuation cover or you can choose the pre-evacution cover, to back  to  your  home  country.  So,  there  are  plans  for  everything… R: Okay. And this, because you mention it: I want to ask regarding psychological help. Do you have the feeling  that  there  is  a  need  at  all?  Do  you  have  the  feeling,  that…  Vietnam  has  psychological  providers   for expats? Is it any topic at all? C:  For  the  moment  it’s  quite,  say…  there is no psychological health care in Vietnam, most likely. V:  We  have  specialists…  we  call  them  psychologists. C: But  probably  in  another  country  for  treatment… V:  We  have  so  many  clients,  we  need  that  kind  of…  But  few of them are asking of course. Always. C:  In  Vietnam  we  don’t  really  have  anything.  No  health  care  center  for  that,  so… V:  It’s  a  specialist.  You  go  for  a  visit and you are talking with the psychologist. C:  Yeah,  it’s  more  outpatient  treatment.  So,  it’s  a  day  patient  you  just  go  to  see your psychologist. Xyxyx, that’s  it.  But  if  you  need  it  to  be  in  a  hospital,  they  can  be  taken  care  of  you. V:  So,  we’re  talking  about  the  inpatient  or  the  outpatient.  Outpatient  is  just  the  visit,  inpatient  is  if   you’re  admitted.  Is  that  what  you  ask? The admitted?

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Rebecca Mayer R: No,  just  very  in  general,  because  that’s  maybe  a  field,  a  also  very  difficult  field,  which  like  if  it’s  not   your  language,  even  many,  many  Europeans,  they  can’t  speak  their  mother  language  with  their  health   care provider, right? Especially  with  psychological  help  it’s  quite  difficult.  And,  I’m  not  sure…  That’s   actually  why  I’m  asking,  how  much  this  field  is  already  established  in  Vietnam  and  if… V:  So,  I’m  not  working  in  a  hospital,  so  I  don’t  know  exactly.  But  I  have  one  friend:  She  is French speaking, English speaking and Vietnamese speaking. She is psychologist. So she told me that she has three kind of nationalities. Not only three but speaking languages. R: So she has patients who xyxy. Patients will go to her? V: Yes. R: Alright. C:  But  that’s  once  again  outpatient.  You  cannot  go,  stay  in  a  …  like  in  Western  Countries  you  have  proper   treatment  centers… V:  Ehm…  But  this  is  serious.  The  cases  I  think.  We  haven’t  seen  this  kind  of  cases  before. C: No, no. V: At least in our experience,  we  didn’t  have  any  kind  of  expat  here… R:  Okay,  maybe  I’m  asking.  Another  field  is  the  rehabilitation  field.  How  like…  is  there  rehabilitation   clinics in Ho Chi Minh City or in Vietnam in general? Or do you also send your patients to Thailand or go they back to their country of origin to get rehabilitation? V:  Oh,  that’s  a  good  question,  because  usually  we  have  to…  rehabilitation  is  post-hospitalization. Is that? R: Yes, right. After the surgery and you need to find back, to use your arm again or whatever try to use it again  and  slowly  get  used  to  your  daily  life  again  with  the  surgery  you  had  or… V: In my experience there is only the visit to the GP or the specialist after the hospitalization, but not a center…  not  exactly  the  center.  Or  it  can  be the resort. But it usually would be outside of Vietnam. How about  that,  but  not  in  Vietnam.  We  can  check…  rehabilitation  center…  I  don’t  think… R:  In  Germany  it’s  common  after  you  had  a  surgery  or  you  had  for  example  back  problem  and  you  need   to get some  treatment,  and  you  have  the  artificial  knee  or  the  artificial  hip  or  whatever…  And  then  you   need  to  get  used  to  handle  your  life,  right?  And  so  you… C:  So  you’re  talking  about  medical  prosthesis,  right?  

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Rebecca Mayer R: Yes,  that  would  be  one  form.  But  it’s  also  if you just have like back problem and then you get some treatment  and  then  you  slowly  need  to  learn  how  to…  what  is  healthy  for  you  and  how  you  need  to  live   with that. So you go for about one week or two weeks or three weeks to a rehabilitation clinic or it can be on a daily basis, you go there every day again or you stay there overnight. So there are two different forms. C: I would say the doctor,  xyxyx,  or  something  like  that  job  … V: So this is the visit. C: But that you really  have… I  don’t  think  so   V:  We  didn’t  see  it.  We  can  ask,  maybe  there  is  a  room  for  that.   C:  No,  normally  the  problem  in  Vietnam  is,  that  health  care  is  so  basic,  they  even  have  a…  do  you  know   the children hospital, next to Trinh Treng Trong. You have that children hospital where you see people go there. So rehabilitation center is not the priority in that town. Of course. I never heard about that. The  alcoholism  for  example,  we’re  talking  about,  that  the  alcoholism…there  is  nothing  for  that…That’s   sure. The drugs neither. V: It’s  not  covered  through  insurance.  It’s  not  covered  by  an  insurance.  It’s  not  covered  by  the  insurance   anyway. R: Alright. V:  Okay,  but  what  we  can  say  is  that,  it  takes  this  insurance  plan,  but  here  in  Vietnam  we  didn’t  have  in   here xyx. C:  it’s  like  home  nursing.  You  have  that  in  your  plan,  but  it  doesn’t  exist.  It’s  not  like  in  Western   Countries  where  somebody  comes  home  and  takes  care.  I  don’t  know.  You  know  most  of  the  time  when   you’re  in  Vietnamese  hospital,  you  have  to  cover  the  food, you have to pay more or less the doctor to do their work, before they would come to your home to take care of you. Xyxyx. R: Okay, this are my questions. But if you have anything to add, which I should put into the report or into the transcript. You want  to  say  anything…

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Rebecca Mayer

Appendix 7: Business cards interview partner If-Consulting

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Report health and wellbeing demand of expatriates in Ho Chi Minh City  

The findings of the study suggest that improvements on specialized care in the private sector and improvements on public medical care on the...