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My Health Emerging Markets:
Vietnam
EXECUTIVE SUMMARY ................................................................................................................................................. 1
Methodology and data collection .................................................................................................................................... 2
Key findings........................................................................................................................................................................ 2
Demograhics ...................................................................................................................................................................... 4
Health .................................................................................................................................................................................. 8
ICT penetration ................................................................................................................................................................ 18
Healthcare informatics .................................................................................................................................................... 19
Attitudes towards mHealth ............................................................................................................................................. 20
Vietnamese start-ups in health apps devices ............................................................................................................. 29
Recommendations .......................................................................................................................................................... 30
Key findings in on-line survey ....................................................................................................................................... 35
Contact informationWise Consulting Finland Oy
Viinikankatu 1C
FI-33100 Tampere, Finland
Fax: +358-3-214 0020
Email: [email protected]
Web: www.wcf.fi
Wise Consulting Finland OY is a consulting company offering market entry services for internationalizing companies in Vietnam. Working closely with our network of experts, we conduct market research and strategic planning with a strong focus on result-oriented performance.
Tekes – the Finnish Funding Agency for Innovation Tekes is the main public funding organisation for research, development and innovation in Finland. 'Teke funds a wide range of innovative activities in research communities. These take place in industry and service sectors and promote cooperative and risk-intensive projects Tekes’ current strategy puts strong emphasis on the growth of SMEs
1
EXECUTIVE SUMMARY
Healthcare is becoming more and more precise. As a result of our better understanding of
the human genome as well as other personalized technologies, the industry will be more
predictive, personalized, participatory, and preventive in the future. A part of this trend is
personalized healthcare which is currently an emerging trend in many developed countries
in the world.
In Vietnam there is no defined eHealth infrastructure or management strategy, nevertheless,
the country does have a number of population health issues that could be somewhat
addressed by eHealth initiatives as has occurred in so many other similar countries. 70% of
the Vietnamese population live in rural areas. Therefore, most Vietnamese people do not
have proper access to healthcare from the existing infrastructure. The key problem is how to
develop and manage a sustainable eHealth strategy and implementation framework. A
number of significant barriers have been identified including a lack of infrastructure to
enable eHealth delivery, poor strategy development, a lack of co‐ordinated effort towards
defined goals, skills shortages in critical areas including health information management,
mobile technologies and security and a lack of cultural sensitivity by current research groups
and funding bodies. Although eHealth is a new concept in Vietnam, it is expected to grow
quickly. Vietnamese healthcare consumers have recently demonstrated their growing
healthcare concerns through the increase in sales of healthcare product.
A key finding of this report is that there are several potential markets in Vietnam for Finnish
healthcare related products and solutions in the coming years. However there are major
constraints, language and literacy are among the major challenges. There are also particular
cultural and geographical barriers among certain demographics in Vietnam. Vietnam’s
Government has made significant efforts to expand healthcare to reach out to rural
populations and improve the public healthcare system in general. Vietnam’s government has
also aimed to develop the private sector with transnational partnerships and increased
investment in infrastructure. In the context of innovative global healthcare trends in which
Finland has the potential to become a proactive provider of healthcare and personalized
medicine, Vietnam is poised to become a potential market for Finnish solutions in the
coming years.
This report provides information on Vietnam’s Healthcare consumers by highlighting the
demographics, behaviors and attitudes that influence their acceptance of new healthcare
products and services. The report specifically gives information relating to personalized
medicine in Vietnam in the future and opportunities for Finnish companies in the Vietnam
healthcare in the near future.
At a new healthcare facility in Quang Nam Province
2
Methodology and data
collection
Key findings
Data comes from the following sources in this study
• A July ‐ August 2015 online and field survey of 300 healthcare consumers in Hanoi, Danang,
Quang Nam, Ho Chi Minh City, Vung Tau, Vinh Phuc and Lao Cai provinces (across multiple
ages, ethnicities and professions). The respondents are chosen from diverse backgrounds
and geographical conditions.
• Interviews with Vietnam’s leading healthcare experts in Endocrinology – Diabetes;
Cardiology, Oncology and Gerontology.
• Interviews with healthcare officials, healthcare policy makers, healthcare IT experts.
• Interviews with Vietnam’s startups who conduct R&D in health tracking mobile apps.
• Focus groups of patients in government and private hospitals.
• Data collected from social media
• Photos in this report were taken by the research team before and during the field trips
Market drivers
Public Healthcare has improved recently as a result of investment in infrastructure.
More investment is required in rural areas where there is still a lack of basic
healthcare.
The per capita income has increased and stakeholders have demand for, and can
afford better healthcare.
Vietnam’s government has made plans for the intervention to enhance the
healthcare workforce by 2020.
These plans include strengthening regulatory practices, increased autonomy for
public hospitals and incentives for the private sector.
Vietnam has had a rise in Non ‐ Communicable Disease (NCD)
Vietnam has a diverse population with varying levels of purchasing power.
Increased health awareness has made consumers spend more on preventative
healthcare.
Vietnam’s ICT growth is the highest in the region.
The population has a high rate of acceptance of mobile technology. 22 million
Vietnamese own smart phones. As a consequence of the mobile trend, mHealth
adoption could be promised a tremendous growth in the future.
eHealth/mHealth is still at the early stage. Key decisions have been made at the
ministerial level to establish a foundation for the interoperability of eventual
healthcare IT applications.
3
Vietnam’s young population cares more about health issues. Early adopters of
health technology will find their way to influence and build up a bigger community.
One of the potential solutions for remote healthcare and home monitoring is an
application for the elderly so that their families can keep tabs on their health and
constantly monitor their medical regime.
Vietnam’s use of self‐medication is increasing due to the easy access of online
information.
Vietnam has a growing middle‐class and an increasing disposable income, which
means consumers are more interested in exploring healthcare options
The vast majority of Vietnamese respondents have not heard of the term
‘personalized medicine’ but react positively when someone explain what it means.
Field interviews show that personalized medicine has a high acceptance rate among
cancer and diabetes patients.
The majority of respondents show willingness to have diagnostic tests for
personalized prevention or treatment if it is recommended by a doctor.
Most of the respondents are excited by the potential benefits of personalized
medicine.
There is a high acceptance of wearable devices to monitor health and chronic
diseases.
Healthcare expenditure occupies a significant proportion in Vietnamese’s spending.
Therefore, they would be willing to spend on high‐quality self/wearable devices.
Challenges
Infrastructure:
mHealth still faces the challenge of a lack of integration with technology.
Despite the sharp increment in mobile growth, IT infrastructure in Vietnam
is still poor. Therefore, we still have to work out a solution for scaling up
and building a strong reputation. The healthcare system is growing but still
weak in infrastructure, a shortage of health workers, and an incomplete
legal and regulatory framework.
Language and Literacy, Geography Challenges:
There is a very low level (nearly zero of understanding and acceptance of
mHealth among ethnic minority groups (focus interviews collected in the
northern mountain of Vietnam). In Vietnam, the population who are most
in need of medical support have low levels of literacy. Among the Kinh
majority, the literacy rate is 95.9%, in stark contrast to the H’mong rate of
37.7%1. Having people with poor reading skills to access health‐related
1 https://vietnam.savethechildren.net/what‐we‐do/education
4
Demograhics
information on a mobile –based application is a daunting task. Population
fragmentation makes ubiquity even more difficult.
There are likely to be more cultural and geographical barriers in the
acceptance of mHealth among the ethnic minority groups because of the
conflicting traditional medicine rules and the low level of education.
Terrain, accessibility, and infrastructure implementation are all key
considerations.
Cost and accuracy:
There are some concerns over the feasibility of Personalized Medicine in
Vietnam. Some of the most critical concerns are the cost and ability of
institutions to provide personalized treatment. Other concerns include
about the accuracy of prediction (data from our focus group) and
resistance among rural healthcare workers in the adaptation of mHealth.
Vietnam is one of most the inhabited nations in the world with a population of 90,493,352
million (as of April 2014) in the area of 128,565 square miles. The country is crowded and has
a young population with approximately 42% under 24 years old. The country has a diverse
culture with 54 ethnic groups. The Kinh is the largest ethnic group, accounting for 86.2% of
Vietnam’s population.
Traditional values, customs, rituals and beliefs have been conserved through thousand years
of history. Yet, the “Flat world” has brought changes and modern ideas to the country as it
takes part in the global trade.
About three quarters of Vietnam's landscape is constituted by mountainous and hilly
regions, mostly in the northern and western borders Southern Vietnam is mainly made up of
lowlands and paddy fields. The highest point in Vietnam, or "the rooftop of Vietnam," is
Mount Fanxiphan which is 3,144 meters above sea level. The lowest point of Vietnam is the
South China Sea which borders the east coast which is at 0 meters above sea level. Vietnam's
two main deltas are the Red River delta in the north and Mekong delta in the south.
Vietnam has a remarkably diverse climate because of its location, spanning a wide range of
latitudes and altitudes. Although the entire country lies in the tropics and subtropics, local
conditions vary from frosty winters in the far northern hills to year‐round, subequatorial
warmth in the Mekong Delta.
Like other Asian cultures governed by Confucianism and Buddhism, Vietnamese culture is
characterized by a strong sense of collectivism, family‐orientation and emphasis on
interpersonal relationships. For Vietnamese people, age is seen as a social hierarchy, which
reflects both social status and rank. This hierarchy is highly respected and strictly dictates the
society’s norms and values. These cultural values have significant impacts on Vietnamese
healthcare consumer behaviours (e.g. information seeking behaviour, the purchasing
decision process, attitudes towards products and satisfaction/dissatisfaction) (Le& Jolibert).
5
Vietnamese culture according to 6‐D Model of Geert Hofstete.
Power Distance
Vietnam scores highly on this dimension of power distance, (a score of 70) which means that
people accept a hierarchical order in which everybody has a place. No further justification is
required in terms of these hierarchical orders. Hierarchy in an organization is seen as
inherent inequality. People at managerial levels are powerful, and, subordinates expect to
be told what to do and the typical boss is a benevolent autocrat. Challenges to the
leadership are not well‐received.
Individualism
The score of individualism in Vietnam is 20, which shows that it is a collectivistic society. This
can be seen in any long‐term relationship that requires high levels of commitment tofamily,
extended family or extended relationships. Loyalty in a collectivistic culture is of paramount
importance and overrides most other societal rules and regulations. Such a society fosters
strong relationships, where everyone takes responsibility for fellow members of their group.
In collectivistic societies, offence leads to shame and loss of face. Employer/employee
relationships are perceived in moral terms (like a family relationship), hiring and promotion
take account of the employee’s teamwork skills. Management is the management of groups.
Masculinity
Vietnam scores 40 on this dimension and is thus considered a feminine society. In feminine
countries the focus is on “work to live”, managers strive for consensus, people value
equality, solidarity and quality in their working lives. Conflicts are resolved by compromise
and negotiation. Incentives such as free time and flexibility are appreciated. People focus on
well‐being but not status An effective manager is supposed to support the employees.
Decisions are made through discussion and with the involvement of everyone.
Uncertainty Avoidance
Vietnam scores 30 on this dimension which shows that they are less likely to avoid
uncertainty. Low UAI societies maintain a more relaxed attitude in which practice counts
more than principles and deviance from the norm is more easily tolerated. In the societies
that have low UAI, people believe there should not be many rules and if the rules are
confusing or do not work they should be abandoned or changed. Schedules are flexible, hard
work is undertaken when necessary but not for its own sake, precision and punctuality do
not come naturally, innovation is not seen as a threat.
Long Term Orientation
Vietnam scores 57, making it a pragmatic culture. In societies with a pragmatic orientation,
people show the flexibility to adapt to the changing conditions, have a strong propensity to
save and invest, and thriftiness and perseverance in achieving results.
Indulgence
A low score of 35 on this dimension indicates that the culture of Vietnam is characterized as
Restrained. Societies with a low score in this dimension have a tendency towards cynicism
and pessimism. Also, in contrast to Indulgent societies, restrained societies do not put much
6
emphasis on leisure time or appreciate the gratification of their desires. People are
restrained from self‐indulgence as a social norm.
Urbanization in Vietnam
Vietnam has one of the fastest rates of
urbanization in the world. Almost half of
the country’s population is expected to be
living in cities by 2030. While more than
two‐thirds of the population still live and
work in provincial towns and villages, the
east‐coast cities of Hanoi, Ho Chi Minh,
Danang and Haiphong are growing rapidly
due to the employment opportunities that
have risen from Vietnam’s integration into
the global economy. Hanoi and Ho Chi
Minh City will remain the largest and most
important economic centers, but with a
growing population, cities and provinces
outside and Hanoi and HCMC are also
increasing in economic importance.
Key Figures
• Annual 3.2% growth in urban population
• 40% of the total population will live in urban areas by 2020
Source: WHO
7
The middle and affluent class (MAC) in Vietnam will double in size between 2014 and 2020,
from 12 million to 33 million. MAC consumers whose income is from VND15 million (US$714)
a month are also spreading out to other provinces and cities. By 2020, Vietnam’s average per
capita income will rise from $1,400 to $3,400 a year. For comparison, Vietnam’s MAC
population will equal to two‐thirds of Thailand’s MAC population.
8
Health According to the latest data from the World Bank, Vietnam is undergoing a rapid
transformation in terms of epidemiology. This results in an increasing number of cases of
chronic NCDs. The Rates of cancer and Type 2 diabetes are increasing, one in four people aged
over 25 now suffers from hypertension or heart disease. The World Heart Federation (WHF)
forecasts that up to 20 percent of Vietnam’s population will suffer from health problems
caused by cardiovascular diseases and hypertension by 20172. Chronic diseases are the major
cause of death in hospitals across the country. The mortality rate for non‐communicable
diseases in Vietnam is four times higher than for CDs diseases, accounting for 67.34 per cent
of deaths from illness, according to the Ministry of Health (MoH).
These challenges will become more serious over time. The development of physical and social
infrastructure is not keeping pace with the dynamics of demographic and cultural change.
Vietnam’s young population keeps growing but it will also soon become an aging population.
Catering for its needs will be an economic, social and cultural challenge for Vietnam. The
traditional family structure – three‐generation family with the eldest child looking after ageing
parents – is weakening, yet the culture has not yet opened to the concept of nursing homes
for the elderly. There are fewer than 3,000 geriatric care beds across the whole of Vietnam.
Mental healthcare is also likely to rise quickly. Vietnam has approximately 3 million Alzheimer
patients, however, the number will rise very fast in the coming years.
While there is a growing recognition of the burden of NCDs, the financial burden is the most
pressing. Therefore, it requires urgent action to help lower the costs of treatment. One
answer may be innovative technologies and solutions that facilitate prevention, conduct
timely and accurate diagnoses, and carry out the delivery of appropriate and cost effective
interventions and treatments. (Focused interview with Mr. Doan Van Tu, Deputy General
Director, Medical Equipment Department, and Ministry of Health)3
Healthcare
Vietnam‘s healthcare system is dominated by services provided by the government’, largely in
the form of public hospitals in urban area. Improved living standards have caused an
increasing demand for high‐quality health services in the main cities and provinces.
Remote and disadvantaged regions, however, have slower growth from a lower base and still
require the central government’s assistance to narrow the gap.
The most important focus of the government’s sponsored projects are district and commune
level facilities and hospitals in remote and disadvantaged regions,. These places are often
perceived to have the poorest facilities.
Below is the level of public health service delivery in Vietnam4. The referral path is normally
bottom up. This means that the commune level delivers most primary care services whereas
national level hospitals include specialized wards such as Oncology.
2World Heart Federation 3 Interviewed Mr. Doan on July 31st 2015 4 Source WHO and MOH
9
Healthcare workers
Vietnam is facing a critical shortage of healthcare manpower. Currently Vietnam has 7.6
doctors per 10,000 people. There is a wide disparity in the doctor‐per‐people ratio. In cities
like Hanoi and Ho Chi Minh city, the rate is about 9 doctors per 10,000 people, but in remote
areas this number is as low as 1 per 10,000 people.5
Number of doctors per 10,000 people in Vietnam, 2013. Source: Ministry of Health (MoH)
5 http://vietnamnews.vn/society/275212/mekong‐sees‐medical‐specialist‐shortage.html
10
The staff from a provincial hospital in a rural area of Quang Nam province providing back pain
treatment for outpatients
A voluntary doctor from Hanoi Medical University is checking up on a child at Phu Thuong
Primary School, Vo Nhai, Thai Nguyen Province in a project partnered with Lumikello (a
Vietnamese‐Finnish volunteer group providing help to underprivileged kids). The area suffers
from a serious lack of healthcare workers.
11
Public healthcare
Healthcare can be provided through public and private providers. Public healthcare is usually
provided by the government through national healthcare systems. Private healthcare can be
provided through “for profit” hospitals and self‐employed practitioners, and “not for profit”
non‐government providers, including faith‐based organizations.
The hospital sector in Vietnam still faces significant room for improvement. Firstly, the
number of facilities is comparatively small which causes constant overflow of visitors.
Consequently, the hospital bed occupancy rate (BOR) exceeded 100% in 2011. In the same
year, Vietnam had approximately 1,040 hospitals, which accounted for only around 12
hospitals per 1mn inhabitants with approximately 24 beds per 1,000 inhabitants. Currently,
the number of hospitals in Vietnam has risen to 1,0636 (of which only around 12% are
private). However, together with the growing population, the estimated number of hospitals
per citizen and also BOR figures are currently even lower, at only 20.5 hospital beds for every
1,000 citizens and roughly 11 hospitals per 1mn of inhabitants. This is far below the ratio of 33
beds for every 1,000 residents, recognized as the minimum acceptable level by the World
Health Organization.
Aiming at alleviating the problem of overcrowding at state hospitals, authorities announced
that additional investment will be made in hospitals in urban centers to enable hospitals to
improve services. Sources from Ministry of Health revealed that some hospitals have been
operating at nearly 150% of capacity levels. To make the matter worse, a law effective since
2011 ‐ the Law on Medical Treatment ‐ allows state hospital medical officials to establish
private clinics and work overtime at these clinics. According to Business Monitor International
(BMI), the law encourages some professionals to neglect their duties in public hospitals and
shift towards the private sector due to the higher monetary incentives in private institutions.
In 2013, in bid to tackle overcrowding in central hospitals, the Ministry of Health announced a
satellite hospital program. By 2015, a number of satellite hospitals placed in additional
facilities are expected to perform most of the medical procedures carried out by central
hospitals.
Private healthcare
The Public health sector has limited capability to cover all the needs of Vietnam’s growing
population. Vietnam legalised operation of the private sector in health in 1999, and has
targets for private sector provision of hospital beds of 2/10,000 by 2010, and 5 beds /10,000
by 2020 (20 % of total hospital beds).
The growth of private hospitals is one aspect of the Government of Vietnam’s broader ‘social
mobilisation’ policy, which has also led to increased private investment in state hospitals. The
aim of this policy is to mobilize resources from society to invest in key public services, and to
allow all members of the community to access the benefits of these resources.
Private hospitals tended to provide a higher proportion of diagnostic and laboratory services
than expected from their proportion of beds, but rarely had reciprocal referral or transfer
arrangements with state hospitals.
6 2014 figure Ministry of Health source
12
Recent growth in private hospitals has contributed increased resources to hospital services,
but private hospitals still remain only a small contributor to total hospital services, and are
concentrated in wealthy and urban areas.
In order to increase and secure overseas investment, the Vietnamese government has
introduced a range of incentives for this sector. For example, foreign healthcare companies
have a corporate income tax rate of 10%, tax exemption over the first four years of a project
and a 50% subsequent tax break in the following years.
The majority of private hospitals can be found in developed metropolitan areas, typically
Hanoi, HCMC and Da Nang. Inevitably, due to the huge capital demand and the need for a
swift return on investment, foreign investment in the healthcare sector has been aimed
at the top‐end of the market, notably foreign workers based in Vietnam, abroad‐
employed Vietnamese citizens returning home for treatment, and local citizens with above‐
average incomes.
As the Vietnamese population reaches 90 million and the country’s economy is
developing, the demand for high‐grade medical services will inevitably increase. The
sector is now seen as a premium investment area for companies with a respective track
record in the healthcare industry.
French and US companies are the dominant foreign players in the hospital business, while
companies from Thailand (Bumrungrad Hospital Pcl), Indonesia (Lippo Group), Malaysia
(IHH Healthcare Bhd, KPJ Healthcare Bhd), Singapore (Chandler Corporation, Parkway
Holdings), India (Fortis Healthcare) and Canada (Triple Eye Infrastructure) are currently
setting up operations or have expressed an interest in establishing facilities. Domestic
organisations including Saigon Institute of Technology (SaigonTech) and VinGroup (owner
of VinMec hospital) are planning to expand their operations in Vietnam Healthcare service
providers also compete for patients with “healthcare tourism” destinations.
1008 1043
1260
121 157
568
0
200
400
600
800
1000
1200
1400
2010 2013 2020
Hospital growth: Public vs Private
Public Private
13
Pharmaceutical and medical devices market
According to the Vietnam Pharmaceutical Companies Association, 30% of approximately
1000 pharmaceutical firms operating in the country are foreign‐funded. Several
multinational pharmaceutical companies have recently entered Vietnam's market, partially
through joint ventures. Companies that are able to engage physicians (through their sales
forces), initiate differential pricing policies and launch various corporate social responsibility
programs are likely to be seen in a more positive light than those that fail to do so. Therefore
they are more likely to succeed in Vietnam.
While the pharmaceutical sub‐sector may grow at a double‐digit rate, not all foreign drug
makers will be able to capitalize on this growth opportunity. Doubts regarding quality and
counterfeiting are two reasons why trust plays a major role in developing markets like
Vietnam. Consequently, careful branding and marketing is a vital method by which firms
can capture market share in Vietnam as well as other developing countries.
Major foreign pharmaceutical manufacturers and domestic manufacturers in Vietnam
• Sanofi‐Aventis
• Bristol‐Myers Squibb
• GlaxoSmithKline
• Roche and United Lab
• HauGiang Joint‐Stock Co
• Vipaco and Vabiotech.
Medical devices
The government encourages the import of medical equipment because local production
cannot meet the demands. Imported medical equipment has low import duties and no quota
restrictions. However, medical devices are subject to regulation and licensing required by the
Ministry of Health. By regulation, only companies with a legal business entity registered in
Vietnam and those with an import license are eligible to distribute medical equipment in
Vietnam. To meet with this requirement, foreign suppliers often sell their products through
local distributors or agents. Good representatives provide immediate access to an
established marketing network and in–depth knowledge of pertinent regulations.
The best opportunities for medical devices in Vietnam are in cancer, diabetic, cardiovascular
disease diagnostic and treatment. Devices which will be a strong area of growth include
operating theatre, emergency equipment, imaging diagnostic equipment. About 95% of the
market is constituted by imported goods. The main sources are from US, Japan, Germany. In
addition, Taiwan, Italy, France and South Korea also account for a significant share. Local
production has extremely limited share. There are currently 50 domestic firms making
approximately 600 products officially licenced by the Ministry of Health. Products are
hospital beds, medical scissors, scalpels, and disposable supplies.
14
Geographically, there are two major medical equipment markets in Vietnam: Hanoi and Ho
Chi Minh City, which together represent 80 percent of the entire market. Although Ho Chi
Minh City has a larger population and more medical centers, Hanoi has the largest share of
purchase contracts. The Ministry of Health (MOH) based in Hanoi is often the decision‐
maker for large projects.
Medical Devices registration Process
Ministry of Health determines the guidelines for medical device purchases for the health
system in Vietnam. Within the Ministry of Health, the Department of Medical Equipment
and Health Works is in charge of medical devices. The Ministry of Sciences and Technology
performs some regulatory functions for medical devices produced domestically. There is a
list of selected medical devices that require import licences in order to be imported and sold
in Vietnam. Application should be sent to the Department of Medical Equipment and Health
Works under the Ministry of Health for synthesis and submission to the Ministry of Health’s
Science and Technology Council for consideration. The results will be available within 15
working days after the full receipt of valid dossiers.
Used and refurbished equipment are strictly controlled by the Government. They mainly
enter Vietnam through donation projects.
Buyers of medical equipment can be grouped into four categories:
Government‐funded hospitals, clinics, and healthcare centers purchase the largest quantity of medical equipment. With financial support from the government, they tend to look for advanced and brand name equipment.
Foreign‐owned and joint‐venture hospitals, clinics, and health‐care centers are big buyers, but they usually procure directly from their sponsoring country
Private hospitals are emerging, thus the future needs for equipment will be huge.
Medical education and research institutions are open to experimenting with new and innovative methods and systems.
Source: MOH
176195
225
8,6 11,7
56
0
50
100
150
200
250
2010 2013 2020
Hospital bed (thousand)
Public Private
15
A growing healthcare sector
The new analysis from Frost & Sullivan finds that market expenditure stood at US$12.9
billion in 2014 and is estimated to reach US$27.48 billion in 2020 at a compound annual
growth rate of 13.4%7.The government has been giving hospitals more autonomy. This has
gradually reduced the degree of centralization in public healthcare.
Demand growth for foreign healthcare solutions is driven by the incapability of local players
to meet with the growing demands. The perceived shortfalls in local resources and expertise
have encouraged a number of foreign companies to target the country’s healthcare sector.
Vietnam’s hospital development strategy focuses on the improvement of the hospital
facilities and healthcare workers in the provinces. The Ministry of Health Decision 774
(period 2013‐2020) gives guidance for the development of “satellite” hospitals to upgrade
facilities and improve medical techniques to meet with the central hospital standard. They
also encourage the application of Telemedicine in all “core” and “satellite” hospitals.
Insurance
While providing coverage to 70% of Vietnam’s population, Vietnam’s public insurance
scheme requires that a patient obtains lower‐level hospital referrals in order to get
treatment at higher – level hospitals (provincial or central hospitals). Otherwise, the patient
is not entitled to a full reimbursement of treatment expenses.
As the infrastructure and heath‐worker skill at the district level are low, many patients skip
district and commune facilities to get treatment at provincial and central hospitals without
referrals. Patients have to bear significant costs to travel and purchase accommodation
altogether the high costs of treatment
Facility level Commune District Provincial National
Reimbursement
without hospital
referral
100% of
treatment
expenses
70% of
treatment
expenses
60% of
inpatient
treatment
expenses
40% of inpatient
treatment
expenses
The Law on Health Insurance that took effect on January 1, 2015 promises practical benefits
for the public, especially for the health insurance participants and poor and ethnic minority
people. “The Supplement Law to the revised Law on Health Insurance brings more benefits
to poor and ethnic minority people because 100% of hospital fees will be paid by health
insurance. Poor and ethnic minority people in disadvantaged areas will also be paid for
treatment at both local and central hospitals”.8
7 https://www.frost.com/p887 8 Pham Luong Son, Head of the Health Insurance Policy Department, Vietnam Social Insurance agency
16
Insurance coverage types (for basic medical care services)
100% 95% 80%
Specialized technical officersPersons on pensions or
monthly working allowance
Other categories of
the insured
Specialized technical
non‐commissioned
officers
Capacity loss allowance
Professional officers People on monthly social
welfare allowance as
prescribed by law
Professional non‐
commissioned officers
Officers of the People's
Public security
Poor household members;
ethnic minorities living in
areas with difficult or
exceptionally difficult socio‐
economic condition
Meritorious persons &
children under 6
Source: A Health Financing Review of Viet Nam. World Health Organization Report
In summary, the applicable insurance benefits depend largely on the category of the insured.
Limited benefits received from the public health insurance also drive people to use private
clinics. Transportation costs are also covered by the health insurance when patients need to
be transferred to another hospital with a higher technical level.
Cases that are not eligible for health insurance coverage in Vietnam
1. Cases in which costs are paid by the state budget
2. Convalescence at sanatoria or convalescence establishments
3. Medical check‐ups
4. Prenatal tests and diagnosis for non‐treatment purposes
5. Use of obstetric supportive techniques, family planning services or abortion services,
except for cases of discontinuation of pregnancy due to fatal or maternal diseases
6. Use of aesthetic services
7. Treatment of squints, short‐sightedness and refractive defects
8. Use of prostheses including artificial limbs, eyes, teeth, glasses, hearing aids or movement
aids in medical examination, treatment and function rehabilitation
17
9. Medical examination, treatment and function rehabilitation in the case of occupational
diseases, labour accidents or disasters
10. Medical examination and treatment in the case of suicide or self‐inflicted injuries
11. Medical examination and treatment for addiction to drugs, alcohol or other habit‐forming
substances
12. Medical examination and treatment of physical or mental injuries caused by law‐breaking
costs
13. Medical assessment, forensic examination, forensic examination, forensic mental
Examination
14. Participation in clinical trials or scientific research
15. Work injuries within the payment scope of employers according to legal regulation on
work
16. Traffic accidents due to breaching of the law and others traffic accidents that are covered
by work injury scheme
17. Extra medical service costs (include medicines, medical materials, medical service) upon
request of the patient
Source: A Health Financing Review of Viet Nam. World Health Organization Report
A mother and son at a mountain hospital in Quang Nam province.
18
ICT penetration
Source: MOH
As evident in the chart above, Vietnamese are spending more and more on their health.
Different sources state different levels of total healthcare expenditures (%), ranging from 45‐
60%. In essence, Vietnamese are increasingly likely to spend more on their health from out‐
of‐pocket.
Vietnam’s ICT industry grew substantially during the period of 2008‐13 and the total revenue
in 2013 reached US$39.5 billion, representing a year‐on‐year increase of 55.3 per cent9. The
government has identified ICT as a key sector contributing to the country’s development and
has devised a Master Plan on Information Technology, which specifies targets for 2020 and
aims at turning Vietnam into an advanced ICT country10.
Telecommunications contributes to about a quarter of the total revenue of the ICT sector. It
employs 15 per cent of people working in the ICT industry. Mobile telephony generates
nearly 90 per cent of the subsector’s revenue and thus plays a leading role in the rapid
development of the telecoms sector11.
According to Vietnam’s Ministry of Information and Communications (MIC), as of 2013,
Vietnam has about 105 million telephone subscribers, 88 million of which are mobile phone
subscribers and 17 million landline phone subscribers12 . Vietnam has nearly 32 million
internet users (accounting for approximately 35 per cent of the population, 4.8 million of
which are broadband users) and almost 16 million users of 3G13. Key decisions have been
made at the ministerial level to lay a foundation for the interoperability of eventual
healthcare IT applications, and increase usage of healthcare.
9 Source: Ministry of Information and Communications White Book on Information and Communication 2014, Oct 2014). 10 Source: Ministry of Information and Communications, IT Master Plan approved, 26 Dec 2011) 11 (Source: BMI Research, Vietnam Telecommunications Report, Sep 2014). 12 Source: U.S. Commercial Service, Vietnam Market for Telecommunications Equipment and Services, Jun 2014). 13 (Source: Open Technology Fund, Internet Access and Openness: Vietnam 2013, Jun 2014).
19
Healthcare informatics
Together with the growth of the Internet, ICT applications in the medical field, also known as
eHealth in Vietnam has gained a lot of public attention. Statistics from 2014 show that
computer software applications are used in 100% of central hospitals, 68 % of provincial
hospitals and 61% of district hospitals14.
According to figures from the International Data Corporation (IDC), information technology
(IT) expenditure in Vietnam’s health sector in 2014 stood at $18 million which represents a
12.5 % increase compared to 2013. Hardware saw the highest spending of 69.1 %, followed
by IT services of 20.5 % and software of 10.3 %.
Spending was focused on hospitals in Northern Vietnam’, including the National Hospital of
Obstetrics and Gynaecology, the Vietnam National Hospital of Paediatrics, and Ha Tinh
General Hospital Under the Instruction No. 02/CT‐BYT dated February 25, 2009 from the
Ministry of Health (MoH), the application and development of IT in the health sector is
planned to accelerate. Certain hospitals in the south, such as in Long An and Tra Vinh
hospitals, have made investment in IT applications in order to improve the management of
hospital operations. Private hospitals also invested heavily in IT solutions to improve the
management.1516
Despite the above mentioned factor, the paper based process is still the main mode of
operation at all levels of the health system. Large hospitals at the central level have deployed
some electronic administrative management software such as Medisoft, which is considered
one of the standard Hospital Information System packages that includes Patient
Administration Discharge and Transfer Information and hospital reporting systems. There is
still no standardization of databases or patient records even though they are needed for the
exchange and sharing at hospitals in both regional and national levels.
Elements of teleradiology, teleconsultation, telediagnosis and video conferencing have been
deployed in public and private hospitals as well as remote island clinics. However,
14 Nhan dan Newspaper 15 http://www.fis.com.vn/en/news/expansion‐fptehospital‐hoan‐my‐medical‐corporation 16http://ictnews.vn/cntt/nuoc‐manh‐cntt/fpt‐ehospital‐co‐mat‐o‐80‐benh‐vien‐lon‐126954.ict
82,4
12,9 15,8
90,9
39,8
128,6
0
50
100
150
Population Internet users Mobile subscription
Changes in Vietnam from 2005‐2014
2005 2014
20
Attitudes towards mHealth
developments in telemedicine are facing challenges due to the high investment and
inefficient networking systems.
Currently, the MoH is implementing the pilot project of Electronic Medical Records and
hospital management systems in six hospitals: The National Hospital of Paediatrics, Thanh
Hoa Hospital of Paediatrics, The National Hospital of Obstetrics and Gynaecology, The
National Hospital of Traditional Medicine, Ha Tinh General Hospital and Thua Thien Hue
General Hospital. These hospitals will focus on upgrading software for hospital information
management with a view to providing better service s for both doctors and patients. In
addition, the health sector has been planning to issue Electronic Health Insurance Cards in
2018 with the purpose of reducing cumbersome procedures as well as saving time and
increasing treatment efficiency17.
There is a strong emphasis from the government to implement an Electronic Health Record
system, according to Mr. Nguyen Hoang Phuong, Deputy Head of the Information and
Technology General Department. MoH. Healthcare authority is currently working on creating
appropriate conditions necessary to introduce an Electronic Health Record system in
Vietnam. Taking into consideration the four levels of the healthcare system and the fact that
nearly 70% of the population are living in rural areas, they are aware of the technical
challenges they will face, considering. Key decisions have been made at the ministerial level
to lay a foundation for the interoperability of eventual healthcare IT applications.
Vietnamese population has a high rate of acceptance of mobile technology. The proliferation
and advancement of cell phones and smart phone will continue to push mHealth to become
an integral part of healthcare delivery. As a consequence of the mobile trend, mHealth
adoption in Vietnam will potentially have a tremendous growth aligned with the future
trends.
Currently, mHealth in Vietnam is still at an early stage. In most parts of Vietnam, the
population who are most in need of medical support also have low literacy. Besides the
technological and infrastructure challenges, language and literacy challenges are needed to
be addressed. Among the Kinh majority, the literacy rate is 95.9%, in stark contrast to the
H’mong rate of 37.7%18. Having people with poor reading skills to access health‐related
information on a mobile –based application is a daunting task.
There are likely to be more cultural and geographical barriers in the acceptance of mHealth
among the ethnic minority groups where traditional medicine rules and the level of
education is low. Terrain, accessibility, and infrastructure implementation are all key
considerations. Focus interviews in the northern mountain of Vietnam show low level of
acceptance of mHealth among ethnic minority groups.
Disparities in social, economic, culture and infrastructure between rural and urban areas
have resulted in the different attitude towards mHealth. Urban consumers have greater
expectation of mHealth.
17 Hanoimoi Newspaper 18 https://vietnam.savethechildren.net/what‐we‐do/education
21
According to our focused interview, 60% of respondents say mHealth will change the way
they manage their medication and their chronic conditions. 70% of respondents say mHealth
will change their information seeking and the communication with doctors.
Urban vs rural Healthcare workers’ attitude towards mHealth
An Informal survey carried out in 108 Central hospital, Hanoi Endocrinology Hospital, K
hospital ( Oncology) (Hanoi), Binh Dan Hospital (Da Nang) Tu Du Hospital (Ho Chi Minh City),
Ba Ria Hospital (Vung Tau city) 19shows positive attitude of healthcare workers towards
mHealth. Most of the interviewees say they do not see new technology adoption a
constraint. Many of them use online source to update health knowledge. The most favourite
online source is www.ykhoa.net. Some of them have concerns over the possible
uncompensated workload due to higher volume of information and patient communication.
While the level of interest in mHealth is high in central hospitals where the physicians have
better access to health information, the resistance to change is found among healthcare
workers in the rural area. Our informal survey found out that healthcare’s adoption is low
and they are less likely to acquire knowledge or change their behaviour towards accepting
the new technology. Many of them feel anxious or uncomfortable about using computers or
technology and find them not very practical and helpful.
Healthcare executives’ attitude towards Big Data and Internet of Thing (IoT)
According to the Vietnam C‐Suite Barometer Survey 2015 from IDC which interviewed senior
executives in the healthcare sector on “the role of IT in medical institutions in Vietnam from
2015 to 2016”, 50% of respondents said that IT spending increases productivity and
optimizes business processes, while 17% said that IT helps create opportunities and new
market penetration.
The survey also showed that ‘Big Data’ is a key interest in Vietnam. It receives the greatest
concern from hospitals that want to enhance their competitive position in 2015‐2016, as
answered by 50 per cent of respondents, followed by the Internet of Things (IoT) and
Mobility and Security/ Risk Management/ Data Governance.
19 These hospitals are at central or provincial level
22
Healthcare executives' appreciation of key technologies in enhancing competitive
position 2015‐2016
Source: IDC
Healthcare trends in Vietnam
The profile of Vietnam’s consumers 2011, 2012, 2013, and est. 2016 (in thousands of
people)
2011 2012 2013 2016
Babies/infants (aged 0‐2) 4,344 4,289 4,228 4,025
Kids (aged 3‐8) 8,332 8,438 8,534 8,627
Tweens (aged 9‐12) 5,218 5,263 5,309 5,522
Teens (aged 13‐17) 7,642 7,163 6,822 6,526
Young adults (aged 18‐29) 21,199 21,304 21,240 20,208
Middle youth (aged 30‐44) 20,161 20,547 20,965 22,233
Mid‐lifers (aged 45‐59) 14,249 14,705 15,117 16,309
Later—lifers (aged 60+) 7,549 8,021 8,443 9,843
16,70%
16,70%
50%
16,70%
Mobility
Internet of things
Big Data & Analytics
23
Population: National
estimates at January 1st 88,792 89,730 90,657 93,293
Male population 43,906 44,388 44,862 46,211
Female population 44,886 45,343 45,795 47,082
Urban population 27,536 28,407 29,289 31,999
Rural population 61,256 61,323 61,368 61,294
There is growing demand in the area of food safety, due to the short food supply chain
among urban consumers. Hygiene is a hot issue after many public health scandals.
Consumers are putting a lot of pressure on the local authority to strictly regulate food
hygiene. At the same time they find their own way to self‐protect their family by finding
reliable sources of food supply, mostly through online stores. Consumers, especially in urban
areas, are willing to pay more for better quality food. The health awareness of consumers,
according to a study by Vietnam Post and Telecommunication (VNPT), is impressive with 98
% of survey people care about their health. 84% care specifically about blood pressure and
63% about blood sugar level.
Traditional street food stalls near Dong Xuan Market, the oldest and biggest market in Hanoi.
According to several shop owners, customers are becoming more and more demanding
about food hygiene.
Vietnam has a diverse population structure with varying levels of purchasing power. The
rural population mostly relies on Government support while the middle class pay for some
extent of their healthcare by themselves. The high income category tends to be the first
adopters of technology services and private healthcare.
Vietnam’s young population is growing and a burgeoning urban middle class is driving big
change in consumption patterns. Higher consumption of foreign products and mid to high
range product consumption has taken place in modern consuming trends, especially in urban
areas. In a recent survey by the Boston Consulting Group, Vietnam was found to have the
24
fastest growing middle class in Southeast Asia. By 2020, the country is expected to have 30
million middle class consumers. Vietnam’s per capita income is expected to increase to US$
3000 by 2020 from its current level of US$ 1,960. Vietnam’s young population is very
connected to the outside world. Smartphones are everywhere, so is Wi‐Fi. Social media use
is also ubiquitous; it is also a key information source for healthcare questions. The unusual
level of internet access20 (top world 20 in Internet access) has increased the rate at which
consumers gather information about drugs and medical devices. Google is a powerful tool
that assists the young and old in Vietnam in finding information pertinent to their health.
Hanoi students at a youth event
Online Health forums are increasing in number and size. Webtretho, a forum initially opened
for young mothers to exchange information about healthcare and children, has expanded its
members to nearly 2 million including unmarried young females. For the Vietnamese,
children are families’ top priority; their well‐being and future success is a key source of
happiness for parents and grandparents. Healthcare companies benefit from the forum by
influencing the decisions of consumers towards new healthcare products. Thuong thuong, a
marketing manager of Ha An Phat Company which is the exclusive distributor for the
Microlife brand (Blood pressure monitor and Thermometer), told us that the company’s
sales volume has exceeded the 2014 targets, and likewise for 2015, thanks to its successful
online marketing through health forums. Thuong also pointed out that when she observed
the trend, she did not only see an increase in number but an increase in diversity of ages and
backgrounds using the forums.
20 Source Netnam.vn
25
Vietnam has experienced a rapid decline in fertility rates in the past two decades (at 1.89)21,
with the increasing affluence and fewer children per family. The demand for children’s
products including healthcare are growing rapidly.
Mr. Do Tat, a retired professor of Chemistry in his 80s, carefully typed into Cốc Cốc , the 2nd
most popular web browser in Vietnam with 5.4 million daily users22 the keyword:
hypertension. He enjoyed his new toy, an old laptop given to him by his niece the previous
week. The conventional methods of searching for health related information (i.e. in books,
journals or newspapers) has been replaced by a click, which immediately offers a library of
health information. On his left side was a table covered in preventative medicines, blood
pressure monitors, glucometers, and a notebook with a comparison of daily blood pressure
measurements.
When asked about his willingness to buy a wearable device that can monitor health around
the clock “ I see no obstacles in wearing a monitoring health device, it could be a bit uneasy,
I guess, during the hot summer time like today (smile). But if I’m wearing it for better health
and a longer life, why not?”23
21 CIA World fact book 22 source Comscore April, 2015 23 Interviewed at Mr. Do’s apartment on August 5th 2015
26
Mr. Do spends 2 million VND
(approximately 89 USD)24 per month,
financed by his children, on his
preventive medication – both in
traditional and Western methods. He
had his medical check, out of his own
money, including periodical blood
tests, at a private clinic: MEDILAB. Mr.
Do was scared off the public hospitals
due to the overcrowdedness. He
added “I will only go there if I am
hospitalized.”
Mr. Do represents the changing
attitudes towards healthcare among
the elderly middle class in urban
centers of Vietnam. He joined
retirement group with weekly
activities including classic dance and
health information exchange.
Increasing wealth has contributed to
the demand for better healthcare
services. People with motivation to
live longer and healthier lives have paved the way for lucrative businesses in the provision of
home healthcare devices, food supplements and preventative medicines.
Traditional medicine also plays an important part in the consumer’s healthcare preferences.
For many years, traditional medicine has been the premier choice when it comes to the
prevention and treatment of illness. The eldest in the family could be considered as the
family doctor and has the herbal treatment secrets. In many parts of Vietnam, especially in
the remote rural areas, this practice is still maintained. Cases have been reported by nurses
in central hospitals that in – house patients, especially those from the remote areas of
Vietnam, refused to take medicines or simply hid them under the mattress. The explanation,
when asked, was that they were told by elder people in their villages that Western medicine
was toxic.
However, the above cases do not represent the growing trend towards the harmonization of
traditional medicine and modern medicine in Vietnam. Getting better access to health
knowledge has paved the way for healthcare consumers to demand more evidence based
treatment while still using traditional medicine as a parallel or complementary medicine. Our
informal survey at the Oncology Hospital in Hanoi showed that the majority of patients use
False Ginseng and Lingzi in parallel with other Western medicine prescribed by doctors. In
rehabilitation in particular, it is very common to have both methods applied.
Resistance to herbal traditional medicine is also recorded within certain groups of health
consumers. Our research about traditional medicine among office workers showed a high
24 https://www.google.com/webhp?sourceid=chrome‐instant&ion=1&espv=2&ie=UTF‐8#q=exchange+rate+vietnam+dong+to+usd
A traditional medicine shop in Hanoi.
27
level of concern for the poor hygiene and chemical substances found in many products in the
Vietnamese market. To address this problem, many herbal medicine manufacturers process
traditional products into capsules and obtain a hygiene control certificate from the relevant
authorities to give consumers the peace of mind.
According to Ms. Thanh Thuy, a Pharmacist in Xuan Dieu, Tay Ho, Hanoi, her 20 sqm2 store
welcomes an average of 150 customers daily and approximately 30% of them purchase
preventive medicine, mainly for heart disease and blood glucose control. There are an
increasing number of customers who care about anti‐aging products and health
supplements. Thuy said that the customers tend to have more and more information for
their purchases due to the increase in available information on health forums and the
internet.
Another informal survey at the Gerontology Institute from August 15th to August 22nd
showed that out of 95 elderly (from 60 years old onwards, both in Hanoi and the
surrounding provinces), 80 of them owned a blood pressure monitor at home (From the
brands Omron, Microlife, and Medisana). Many of them owned the latest Microlife BPA 200,
valued at 100 USD, while also owning older models which are still functional. When asked
about the reason for the change, some responded that the latest model had all the data
stored which could be retrieved electronically. It means that they don’t have to take notes
by hand. Some simply answered that their children bought it for them. When asked about
the willingness to pay for the home health device, the elderly‘s preference was to go for
more affordable alternatives while their adult children who often made the purchase for
them, would go for the expensive, Western brand with a good reputation. The fact that most
consumers are very young offers a lot of time to raise awareness about diseases and
corresponding treatment. Positive attitudes towards Western brands should lead to many
successful marketing campaigns and outreach efforts.
Healthcare expert’s attitude towards Personalised Medicine and Wearable devices
Our interviews with leading healthcare experts in Non Communicable Disease (NCD) shows
strong belief of personalized medicine‘s future in Vietnam’s healthcare. According to
Professor Pham Thang, a country’s leading expert in gerontology, in the field of geriatric
care, personalized medicine would greatly contribute to early diagnosis thus give hope for
better treatment and lowered treatment costs in the long run. In early diagnosis of
Alzheimer’s disease, there are 5 different Biomarkers on which the method of testing
cephalorhachidian fluid has an effective result. However, both doctors and patients are
looking forward to using the Non‐ Invasive Biomarkers to support the diagnosis of
Alzheimer’s disease. The cost of testing human genomes may be the main hurdle as there is
a lack of insurance coverage. However, the genetic test delivers more value to patients and
helps to control overall healthcare spending. Therefore, insurance company should look into
it as part of the future investment. It may take 2 to 5 years to see growth in this area.
According to him, solution for remote healthcare & home monitoring and wearable devices
could be a great option for future elderly care. Cultural resistance among Vietnamese to
nursing home is still very high. However, the gradual change in the social and family pattern
could pave the way for future adoption of day care centre as the first step. Doctors also still
hold a significant influence on healthcare consumers.
Another leading Endocrinologist‐Diabetologist, MD, PH.D Vu Thi Thanh Huyen shares the
concern of the readiness on the population’s genomics. Scientists in Vietnam have just
28
completed the sequencing and analysis of a Vietnamese human genome. However, it will
take a long time to reach the readiness level. Dr. Vu Thi Thanh Huyen participates and speaks
in many international symposiums on Endocrinologist‐Diabetologist and frequents Karolinska
Institute in Sweden. She believes in the effectiveness of Personalised Medicine as future
solution for chronic disease prevention and treatment. “By 2020, Vietnam will have 5 million
diabetes and another 50% has not been discovered. Personalised medicine is promising, but
healthcare will be expensive. Who is going to foot the bill?”
Wearable/Quantified Self devices in Vietnam
There is also an increasing awareness of wearable devices in Vietnam, which is slowly but
surely picking up speed. The urban population has begun to buy these products for their own
use and as a luxury gift.
What the early adopter say: Mr. Hong Le is an early adopter of wearable technology. He got
a Polar Loop activity tracker when it was first launched. The motivation behind his purchase
was to keep track of his daily activities.
Hong Le is one of the active members in the Paragliding Club and they have weekly practice
in different locations outside Hanoi. The sport requires good physical body for mountain
climbing so maintaining regular daily exercises is important. The Paragliding community in
Vietnam is growing very fast and it is diverse in professional background. More and more
members are interest in activity tracker and are looking for solutions that fit their pocket.
“This is like the early days of the IPhone” said Dzung, an Apple reseller who owns a shop in
Pho Hue Street, Hanoi. The interest is growing. Common interested groups are people who
exercise regularly or Apple fanatics as well as fashion trend setters, or simply just those
looking for luxury gifts”
“I bought 2 Apple Watches during my New York trip last month for my business partner” said
Ms. Phan, an entrepreneur. “What else do you expect to buy as a gift, especially for men?
“Owning a wearable device
gives you a feeling of task
completion, it helps change
your attitude towards
exercise. Since I started
wearing it, my life has
changed ever since”
29
Vietnamese start-ups in health apps devices
Now they all have iPhones, iPads. I don’t know if they will use them or not or for how long, I
just feel like my travelling duty is fulfilled”.
Sony Vu, the CEO and co‐founder of Misfit, the big name in activity tracking, thinks that
Vietnam market is still relatively small to wearable devices25. Misfit products are not
manufactured in Vietnam and the products have not yet sold in Vietnam market. His
Vietnamese employees do the software development like new Link app that lets user do
things like controlling the music on their phones or taking selfies by pressing the button on
their Misfit devices.
Under Finnish Innovation Partnership Program, Zinmed is a Vietnamese startup that aids
diabetics in managing their treatment.
According to Chu Duck Hoang, CEO of Zinmed, the company is operating under the coaching
of Innovation Partnership Program (IPP) from Finland.
“The coaching from IPP program benefits us in designing new innovative thinking and
entrepreneurship approaches to cater to the diabetes community in Vietnam and 350 million
diabetics worldwide. The program has enabled us in extending our network to Vietnamese
experts and receiving important reviews from them. Behaviour changes towards the ways of
doing and thinking are important for us to integrate into the future international market and
our mentors have been doing a great job!”.
25 http://www.cnet.com/news/misfit‐ceo‐sonny‐vu‐on‐vietnams‐modern‐day‐success‐story‐q‐a/
30
Recommendations
Growth in average annual healthcare spending between 2014‐2018 is expected to be around
11% of GDP in ASEAN but with highly varied rates among the countries: Vietnam has the
highest of 6.6% and Myanmar has the lowest of 1.8%26. Vietnam is also experiencing an
increase in demand for private healthcare in boosting investment. The government offers
generous incentives such as reduced income tax rate and tax exemptions, to foreign
investors in this sector. ICT will offer valuable opportunities to provide cost – efficient
solutions for healthcare delivery. The government will use big data in the future to advance
national health and cooperate with different healthcare players to allow surveillance of
health risk factor. Medical equipment supply will be a potential opportunity as Finland has
been well‐known for high technology equipment
Opportunities could be found in several current projects. Such as:
1. Bach Mai Hospital Project ( facility 2) in Ha nam province
2. Viet Duc Hospital Project (facility 2) in Hanam Province
3. Nhi Dong Paediatric Hospital Ho Chi Minh City
4. Oncology Hospital Ho Chi Minh City, facility 2
Bach Mai and Viet Duc hospitals are the current biggest central hospitals in Vietnam
(location 1 in Hanoi). The government has recently invested in two new locations
for these two hospitals in Hanam province which will be the country’s biggest
hospitals by the time of its completion in 2017. Total investment for these hospitals
is 10,000 billion dongs (455 million USD). Vk Belgium was selected to be the design
partner and the construction started in December 2014. It is expected that these
two hospitals will be in full operation in 2017. Opportunities for Finnish companies
for Medical equipment, ICT are potential.
Nhi Dong Paediatric Hospital has the investment of 4,500 billion dongs (205 million
USD) and the construction also started in December 2014. Oncology Hospital
(Facility 2) with the Government’s investment of 250 million USD is expected to be
completed in 2017.
The findings from our research show the higher possibility that there will be the potential
market in Vietnam for Finnish new health related products and solutions in the coming
years.
Recommendations below should be taken into consideration when planning the Vietnam
market entry for Finnish companies:
Vietnam’s external environment and complex healthcare system can be difficult to navigate.
Evolving legal framework has frequent changes to laws and regulations – There are
numerous ‘grey areas’ in Vietnamese laws. This may cause difficulties in interpretation,
application and compliance. It’s worthwhile finding a local partner early on who can help you
understand and deal with the market, regulations, permits and laws.
To gain a competitive advantage it is vital to visit the market to shorten the learning curve of
business operations in Vietnam.
26 Medicine outlook through 2017. IMS institute for healthcare informatics
31
Do your research and plan carefully – As most of other emerging markets, the level of
bureaucracy can be challenging. This impacts many businesses when considering business in
Vietnam. Do your research beforehand. Get an understanding of the most critical permits
you’ll need. Ensure you fully understand how to comply with all the local regulations.
Be patient – It’s important to be patient when dealing with Vietnamese people. Negotiations
can take some time, and most of the decisions have to go through group consultation. The
processing of official documents and permits can also take a long time.
Understand etiquette – When someone disagrees with you, they’re likely to remain silent.
This is a cultural trait typical of several Asian countries that’s meant to help the parties ‘save
face.’
Relationships are important – Relationships are critical to successful business partnerships in
Vietnam. Invest time in building solid relationships based on both personal and business
lines. Eating and drinking together is an important part of business.
32
Online survey on attitudes towards Personalized Medicine and Wearable devices
Survey form (formatted and translated to English from original Vietnamese survey)
1. Gender
Male
Female
2. Age
19 – 35
36 – 55
56 – 60
Above 60
3. Occupation
Administrative offices
Businesses
Agriculture
Others
4. Have you ever heard of “ Personalised Healthcare” before?
Yes
No
(Definition of Personalized Healthcare is given to the respondents in a pop‐up /
handout)
5. What is your opinion after reading the the above definition of “ Personalised
Healthcare”?
Positive‐Good
Negative
No idea
6. Are you interested in further information of Personalised Healthcare”?
Highly interested
Low interested
Not interested
7. Do you recognize the benefit of Personalised Healthcare”?
A. Life enhancement
Big benefit
Small benefit
No benefit
No idea
B. More active in disease and sickness prevention and treatment
Big benefit
33
Small benefit
No benefit
No idea
C. Socially healthcare cost reduction in the long run
Big benefit
Small benefit
No benefit
No idea
D. Efficiency and accuracy improvement in diagnosis
Big benefit
Small benefit
No benefit
No idea
E. Avoid side effects in treatment
Big benefit
Small benefit
No benefit
No idea
F. Avoid invasive methods in treatment
Big benefit
Small benefit
No benefit
No idea
G. Enhance treatment result for patients
Big benefit
Small benefit
No benefit
No idea
8. If you are advised by doctor(s) to carry out diagnosis for personalized prevention or
treatment, will you take it?
Certainly
Maybe
No
9. Do you have any wearable device(s)?(for example: smartwatch, bracelet, etc.)
Yes
No
34
10. What kind of information do you expect to get with the wearable device(s)? You can
select more than one answer
For better sport practice
For health check
Better diet
For home appliances control
For entertainment channel access
For social network connection
11. What information by the wearable device(s) you would prefer to share among
family and friends? You can select more than one answer
I’m not interested in sharing information
Sport practice level
Health
Mood
Weight
Diet portion
Sleep quality
Daily medicine routine
12. Which price range of wearable device(s) are you willing to pay ( Convert from VND
to USD)?
45 USD
90 USD
150 USD
250 USD
450 USD
900 USD
13. What concerns you most if you decide to buy wearable device(s)?
Security safety
Price
Aesthetics, convenience
Quality
14. Is it an obstacle when the data and indicators in the device(s) are in English?
Yes
No
35
Key findings in on-line survey
Question 1: Have you ever heard of the term “personalized medicine” before today?
Reaction after reading the definition of Personalized Medicine
Are you willing to learn more about Personalized Medicine?
What did respondents say?
Ngoc Hoa Ho, a 45‐year‐old businessman from Ho Chi Minh City, said:
I follow health news regularly, especially from the Medicine Association of Ho Chi Minh. I saw an article about the definition of Personalized Medicine.
Ta May, a member of the Dao Ethnic Minority group, Sapa, Lao Cai province:
I do not understand anything. Even after reading the definition. This is beyond my knowledge.
Respondents’ reactions were mostly positive. After reading the description of Personalized Medicine, 83.6% said their reaction was positive, 3.2% said negative and
13.2% did not know.
66.1% of respondents want to learn more, 25.9% are less interested and 7.9% are not interested at all.
Consumers have not embraced personalized Medicine in large number but they react positively when reading the description.
35 out of 189 respondents (18.5%) have heard the term before. The surveyed ethnic minority groups found it very difficult to understand even after the definition was explained, as their vocabulary and technical terms like ‘genomes’ does not exist in their languages.
36
Attitude towards the benefits of personalized Medicine
Benefit 1: Improvement of Quality of Life
Benefit 2: Personalized medicines’ capability to take an active role in illness prevention and treatment.
Benefit 3: In the long term, Personalized Medicine saves costs for public healthcare
What did respondents say?
Mr. Nguyen Van Tai, 60 years old, Vinh Yen City, Vinh Phuc Province:
I have not heard of the personalized medicine before but after reading the explanation I am overwhelmed with hope for future cures for cancer and diabetes. I am 60 years old and hope I still have time to benefit from new health technologies. (Focus group interview). Anonymous doctor: (Focus group) There are concerns about the accuracy of prediction as well as the cost. Shifting the traditional role of the doctor cannot be seen as a minor hurdle.
77.8% of respondents believe Personalized Medicine offers an improvement in quality of life. 10.1% think it’s a minor benefit and 0.5% thinks it has no benefit. Most of the interviewed focus group thinks that by improving the quality of healthcare, this already guarantees an improvement in the quality of life.
81.5% of respondents believe that personalized medicine has a major benefit while 9% think it has a minor benefit.
The majority of respondents believe this is a major benefit while 10.6 % think the benefit is minor.
What respondents say?
MD, PHD Professor Pham Thang:
In the long run, Personalised Medicine could help decrease the pressure on public healthcare cost. For example, chronic disease is a big burden on society and by having better and accurate prevention as well as treatment, thanks to Personalized Medicine, the cost of treatment will be greatly reduced.
MD. Hung Quoc:
The investment cost will be huge for every stakeholder; it’s hard to say when the cost level will be affordable by healthcare consumers.
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Benefit 4: Improving the accuracy of medical diagnoses
Benefit 5: Avoiding side effects
Benefit 6: Improve treatment results
Benefit 7: Avoiding invasive treatment methods
Would you follow your doctor’s advice to have a diagnostic assessment for personalized prevention and treatment?
79.4 % believe that the improvement of accuracy in medical diagnosis is a major benefit.
74.1 % believes the benefit of avoidance of side effects from medicine is a major benefit.
79.4% believes the improvement of treatment results is a major benefit
63.8% believe the avoidance of invasive treatment methods is a major benefit
What does respondent say?
Doctor Binh:
When it comes to spinal tap, there are always big fears and resistance from patients
and their families. The non‐invasive treatment method, for sure, will be a major
benefit.
57.1% of respondent says they definitely would follow their doctor’s advice. 38.6%
may follow their doctor’s advice and 4.2% say they would not.
Patients today proactively ask about treatment
choices, advantages of
Oncologist, K Hospital.
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Do you own a wearable device? (For example: Smartwatch, smart wristband, Google glasses)
What information would you expect to receive from wearable devices?
19, 6% of respondents say that they own a wearable device
What do respondents say? (Focus group)
Mr. Nguyen Van Tai: I trust Doctor’s prescription, if they say I have to wear a
device to monitor my health, surely I will do it. Who says elderly men don’t like
high technology? We do.
Mr. Duong Hoai Thuy, a 63 year old former government official, suffered from a
stroke though he showed no signs of high blood pressure or diabetes before. “I
feel very positive, I do not know how much a device that can monitor my health
risks will cost, but I have seen life and death myself. Having a little portable
doctor with you would be a great experience.”
Ms. Dang Trinh, a 52 year old entrepreneur: I think it will not be comfortable for
me to have screen on my wrist. I would rather have my jewelry . It does not fit
with my daily outfits.
Mr. Dao Hoang, 35 years old: I am an electronic engineer for a Korean
company. I do not have time to exercise daily so I do not have plan to buy any
wearables now. But who knows, in future it is possible.
Kieu Trang Nguyen, 22 years old. It’s cool. With my Fitbit, exercising is much
more fun. My boyfriend sent it to me from the USA. It’s hard to wear it the
whole day as it does not go with my outfits especially when I go to events.
35, 7% of respondents say they want to collect and track health information.
21.1% want to have ‘smarter exercise’
22.8% want to eat more healthily
8.4% want to plug into social media
6.7% want to control home appliances
5.2% want to get access to entertainment
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What kinds of information would you want to share with family and friends?
Acceptable price level of wearable devices
Constraints on the purchasing decision
Is wearable device indicator in English a disadvantage?
30.5% of respondents want to share health information
17.6% of respondents want to share the level of exercise.
13.8% don’t want to share any information
10.3% want to share their mood
9.2% want to share their weight
8.4% want to share dietary intake
7.0 % want to share sleep pattern
USD 45 : 29.6%
USD 90 : 23.3%
USD 150 : 22.8%
USD 250 : 17.5%
USD 450 : 5.8%
USD 900 : 1.1%
What respondents say is the most important:
Quality of wearable devices: 64% of respondents
Aesthetic look, user friendly: 42.3%
Price: 40.2%
Privacy: 24.9%
41.3 % of respondents think that a wearable device indicator In English is a disadvantage.
58.7% of respondents do not think that this is a disadvantage