English - CEDAW Southeast Asia

A Gendered and Rights-Based Review of Vietnamese Legal Documents through the Lens of CEDAW
which provides that children aged less than six years are entitled to no-cost primary health
care, including free medical examinations and treatment, at public medical establishments. 584
The Decree on Children Law provides that: (i) children aged less than 6 years will be granted
medical examination and treatment cards for free medical examination and treatment at public
medical establishments; (ii) in cases where the medical examination and treatment cards have
not yet been granted, the birth certificate can be presented; (iii) it is mandatory for public
establishments to receive and provide medical examination and treatment for children aged
less than six years. 585 Nevertheless, there is some evidence, though, that health-care
providers discriminate against people who have free insurance cards. 586
This should be viewed in the context of the Decree No. 10/2002/ND-CP of January 16,
2002 on Financial Regime Applicable to Public-Service Units with Revenues (Decree on
Financial Regime), which grants powers to revenue-raising public agencies, including
government health facilities, to manage the revenue and expenditure accounts and to exploit
alternative revenue sources and its detailing circular. 587 The Decree on Financial Regime also
reflects the Government policy to spend less on public services to shift the burden to the
consumer. 588 This resulted in a number of practices that hinder access to health care,
especially by the poor, such as ‘patient skimming’ where hospitals pay more attention to
patients who are easy and profitable to treat, which results in the very sick and the poor being
referred elsewhere. 589
In view of the way that health-care is being financed in Viet Nam, it is obvious that,
without appropriate safeguards in place, access to it by the poor and ethnic minorities in
remote and mountainous regions will be severely affected. In most cases, women will suffer
disproportionately. It is suggested that more research be conducted in this area, especially into
the impact of the Decree on Financial Regime and Decision on Health Insurance on women,
to enable legislative reform to improve gender equality.
Recommendations: The impact of legal documents, in particular the Decree on
Financial Regime and Decision on Health Insurance, must be further looked into,
especially their effects on the disadvantaged sectors of society and revised
accordingly. Data must be sex-disaggregated to enable an analysis of the gender
issues and impacts. To ensure that appropriate standard of care is given to patients
regardless of their gender and economic status, protocols on appropriate treatment
and handling of patients must be drafted. Legal provisions that clearly prohibit and
penalize direct and indirect forms of discrimination against disadvantaged groups in
the field of access to health care, including those with health insurance cards, must be
stipulated. These include: (a) patient skimming; (b) referrals when treatment and care
can be reasonably provided by the health-care establishment; (c) refusal of treatment
when able to do so; and (d) providing less than the minimum standard of care.
261
584
Law on Children, Article 15
585
Decree on Children Law, Articles 18(3)(a), 18(4)(a) and 18(4)(b)
586
UN Discussion Paper No. 6, p. 8
587
Circular No. 25/2002/TT-BTC of March 21, 2002 on guiding the implementation of the Government’s Decree No.
10/2002/ND-CP of January 16,2002 on Financial Regime Application to Public service units with Revenues
588
UN Discussion Paper No. 2, p. 12
589
UN Discussion Paper No. 6
Health (Article 12 of CEDAW)