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Healthcare investment requires intricate approach

Released at: 09:55, 16/12/2018

Healthcare investment requires intricate approach

Photo: Viet Tuan

Potential investors in Vietnam's mental healthcare sector must comprehend the longstanding barriers that have limited its development.

by Ms. Kyssha Mah, Associate / Vietnam Briefing, Dezan Shira & Associates

The mental healthcare industry in Vietnam is still developing. The government has established the National Mental Health Program (NMHP), but industry observers have noted that it only covers approximately 30 per cent of the country and uses a very narrow list of mental illnesses.

While the government estimates that approximately 15 per cent of the population requires mental healthcare services, independent research suggests that the figure is closer to 20 to 30 per cent. This is a major service gap for NGOs and foreign businesses.

International NGOs and foreign businesses that want to cover this service gap, and contribute to the healthcare system, need an intricate approach when entering the country. That begins with understanding the barriers that have prevented Vietnam’s existing mental healthcare system from developing its capacity.

Mental healthcare landscape

From the outside, developing a mental healthcare industry may not strike foreign investors with immediate appeal, since it requires facilitating a niche market on one hand and working within a low-cost environment on the other. However, the country’s rapid economic growth is largely driven by its demographic dividend, and there is an increased demand for all forms of healthcare, including mental healthcare services.

Conventional for-profit counseling services are likely to be a challenge for investors in the current market. With most low and middle-income earners working full-time jobs, they are unlikely to bear the costs of taking time off work to seek out psychological assistance. Other considerations to keep in mind are factors like social stigma and the undeveloped concept of for-profit healthcare, which can prevent affluent clientele from seeking services.

However, targeting the growing middle class with new internet apps and online services for a low price may be a feasible option, while wealthier segments may become willing to pay for higher-end services as the discourse around mental health evolves. It is important to note that the demographics of consumers willing to pay for quality service may change with time, as consumer spending is rising significantly.

Regardless of the service model, creating accessible options with confidentiality as the backbone of any new service is important for healthcare providers to keep in mind. Creating useful technology, like internet apps, can help people who grapple with acute social pressure to access support in the comfort of their own home.

Areas of concern

In 2014, Vietnam’s Psychiatric Association conducted a study to identify which of the ten most common mental illnesses affect the country the most. Of the formal list of mental illnesses in the country, the three most well-known issues were alcohol abuse, depression, and anxiety. However, further research to address these conclusions and to identify their causes is needed.

Beyond this, people who live in rural areas encounter their own unique challenges - particularly those left behind by the country’s economic boom. Traditional aspects of family life are undermined because of the country’s rapid economic development. Intergenerational households are changing as parents move to urban centers to find work, leaving their children with extended family or alone for long periods of time.

A study conducted by the UK-based The Young Lives Project found that poverty-related stressors compromise healthy child development. Across both urban and rural areas, vulnerable youths and women lack adequate resources for their concerns. Care is especially lacking for those living in rural areas that do not have accessible transport to major cities - like Hanoi and Ho Chi Minh City - where services are more widely available. However, the limited number of mental healthcare professionals currently working in the field are unable to provide the demand vulnerable segments of the population have, especially when resources are limited.

A joint study by UNICEF, the Overseas Development Institute (ODI), and the Ministry of Labor, Invalids and Social Affairs (MoLISA) surveyed the rural area of Dien Bien province in northwest Vietnam, and discovered that, of 333 attempted suicides in 2015, 140 were 19 years or younger and 16 of the 73 completed suicide attempts were children. Alarmingly, the survey found that suicidal tendencies are a pressing issue among Vietnamese youths within the province. Or, perhaps, an issue that was never given much attention. 

However, the spike in suicides is a newly-recognized concern, and more research is required to address the factors that cause adolescent distress in Vietnam.

Mental healthcare infrastructure

The World Health Organization (WHO) surveyed the country in 2014 and found that only 0.91 psychiatrists were available per 100,000 people. 

The figure is comparable to Vietnam’s ASEAN neighbors: Malaysia has 0.76 psychiatrists available per 100,000 people and Thailand has 0.87. However, Vietnam is far behind developed economies like Singapore, where 3.48 psychiatrists are available per 100,000 people, and the US, where 12.40 psychiatrists are available.

This suggests that foreign healthcare providers and NGOs will most likely encounter challenges recruiting domestic professionals to serve the population in Vietnam.

The Department of Psychiatry at Hanoi Medical University and the National Institute of Mental Health provide programs for psychiatrists in training. General medical students can choose to do a one-year specialization in psychiatry, though interest remains low relative to other medical fields.

Developing the mental healthcare infrastructure will require foreign educational institutions and professional training programs to strengthen Vietnam’s clinical capacity and skills. Collaborating with local institutions to enhance existing education or establishing independent training services can help improve the current situation.

The mental health network facilitates outpatient treatment and inpatient programs for psychiatric care. The psychiatric hospital system in Vietnam has 36 hospitals around the country. Clients in severe condition are given care in these inpatient hospitals and there are currently 6,000 beds.

The system delivers services through a network of State-owned hospitals. There are two National Psychiatric Hospitals: in the north in Hanoi and in Bien Hoa city in southern Dong Nai province. The remaining 34 provincial psychiatric hospitals are disseminated around the country.

Vietnam currently has 600 outpatient mental healthcare facilities available for local people who are looking for short-term care. Outpatient treatment offers psychosocial services for those in need, without them being admitted into hospital.

Further, while service is available through State-owned facilities, the consensus among international research is that there are no targeted facilities for children and adolescents; demographics that research suggests are highly vulnerable.

How to prepare for the market

The development of a successful mental healthcare industry will require active research and regional adaptation, with firsthand insight on evolving medical needs.

Businesspeople seeking to invest into the mental healthcare industry should familiarize themselves with local partnership requirements and the industry’s regulations. In Vietnam, regulations in the health sector are more restrictive, so it is important to be aware of the existing limitations as well as the lack of legislation for the industry.

Foreign investment up to 100 per cent are allowed for healthcare establishments and medical training units provided they can fulfill capital requirements set by the government. Businesses that intend to provide healthcare treatment have comparatively high capital requirements, while the capital requirements for medical training providers are based on the number of students.

Exploring public-private partnership (PPP) opportunities and partnerships with local NGOs may help foreign investors enter the market and contextualize international treatments and services more quickly.

“The main impediment will be on the regulatory side - taxation won’t be a barrier,” said Mr. Maxfield Brown, Dezan Shira & Associates’ Business Intelligence Manager. “Mental health is controversial in many societies and the way you go about teaching it, or approaching it, is important. Even if it is not regulated, it is culturally sensitive. But as Vietnam becomes a developed economy, these views and laws might change in five years’ time and that will change how companies can operate in the market.”

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