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

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

Rebecca Mayer

Table of Contents 1.

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.

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

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

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

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.

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

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.

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 expatriatesâ&#x20AC;&#x2122; 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).

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

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.

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).

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

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.

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.

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

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

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

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...

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

Rebecca Mayer Strongly disagree

Disagree

Neither disagree nor agree

Agree

Strongly Agree

in HCMC are providing good specialized careâ&#x20AC;Ś The quality of health care in HCMC is excellentâ&#x20AC;Ś

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

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

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.

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

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)

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:

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 -

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 ď&#x192; Which question might not be understood completely? __________

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.

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-

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.

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?

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.

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?

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?

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

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,

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:

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?

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?

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.

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

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,

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!

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.

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 clinicâ&#x20AC;Ś 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.

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.

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.

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...

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

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?

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?

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…

Rebecca Mayer

Appendix 7: Business cards interview partner If-Consulting

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