“In Vietnam, if you have money then you can find a good doctor, but if you don’t, then it’s really difficult,” said Tam, 32, who found specialty care a couple hours outside of her hometown, where the family could bring Tam’s mother for follow-up care after her hospitalization. “Normally, these [specialist doctors] people speak highly of do not work in the hospitals but instead run a private practice out of their homes. Because of that, you’re unable to use your insurance and must pay out of pocket.” Interestingly, cash rates can be much cheaper than rates at the hospital. For example, a doctor’s visit might cost a patient $2 privately instead of $8 at the hospital. Private doctors make most of their money not on the visit fee but by selling medications to patients.

As for calculating the overall cost to a person managing CKD/ESRD in Vietnam, we must consider that almost 90 percent of the population is covered by the social health insurance.² Government insurance pays for about 80 percent of medical expenses. However, patients report paying for approximately 20-50 percent, depending on which services and procedures are covered. According to Tam, for someone with ESRD in Vietnam, a single hemodialysis session costs about $75, which puts a patient’s out-of-pocket expense at about $5-$15, and a monthly out-of-pocket cost at $65-$195, on top of medication costs. To put this into persecutive, the average monthly rent of an individual living in rural areas of Vietnam is approximately $150-$250;³ so this can be a hefty expense for the average person.

Let’s compare this with the cost of living in the U.S. with CKD/ESRD. Dialysis and kidney transplantation costs are covered 80 percent by Medicare for individuals with ESRD as part of the Social Security Amendments of 1972. This was introduced to assist patients in paying for lifesaving treatments that would otherwise be financially infeasible for them to access.⁴ Monthly costs to the patient for dialysis are approximately $624 to $3,835.⁵ These costs are significantly higher, but we must consider the difference in per capita income and also the difference in resources and accessibility to the average U.S. patient.

Treatment and Access

Throughout the initial hospitalization and diagnostic work-up of Tam’s mother, Tam and her family decided to withhold the details of the diagnosis from her mother so that she could focus on her recovery. This was done with her mother’s best interest in mind but stands starkly in contrast to patients’ rights to information in the U.S. In a follow-up appointment with her specialist doctor a month after the hospitalization, Tam’s mother’s condition had progressed. Although she doesn’t need dialysis yet, this will be the eventual next step. This is when we really see the differences in access between the U.S. and Vietnam. Those in Vietnam have exceedingly more trouble accessing dialysis and kidney transplantation.