Calculating care: the valuation of medical routes while health seeking in Vietnam

ABSTRACT

Vietnam has implemented reforms in how health care is financed to provide patient financial risk protection. However, out-of-pocket payments remain high and insurance use is low relative to the country’s high population coverage rate. In this article, I argue that health insurance was not a pre-requisite for obtaining health care in Vietnam; rather, paying for care through health insurance was but one among many ‘medical routes’ for obtaining treatment. I develop the notion of 'calculative practices of care,' which I define as the repertoires of value scales patients employ as they navigate Vietnam's increasingly stratified public-private health system. The findings contribute to ethnographic research on health financing, particularly how patients practice valuation while health seeking.

KEYWORDS:

• calculation
• care
• insurance
• Vietnam
• value
• finance

Acknowledgements

First, I would like to thank my interlocutors for the time and warmth they showed to this curious ethnographer. Thank you to Erik, Maia, and Sibel for inviting me to be part of this special issue and organizing the wonderfully supportive and fruitful discussion of papers over Zoom. When I was struggling, the Aunty Way Writing Retreat helped me pull through the finish line – I thank Michelle Jacob and the Anahuy network for their fierce kindness and support. Quinn came into my life during this project and has been a beacon of joy and motivation.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Although insurance was not a pre-requisite to obtain care, people without financial means often had to borrow money or sell off land to pay for care.

2 Public hospitals in Vietnam also have a traditional medicine ward. I count these as part of the health insurance.

 

Additional information

Funding

This work was supported by Nippon Foundation; Cal Poly Pomona – RSCA; National Science Foundation [grant number DGE 16-44869]; Weatherhead East Asian Institute, Columbia University.

Notes on contributors

Amy Dao

Amy Dao is an Assistant Professor of Anthropology at Cal Poly Pomona. She is interested in the social and structural factors that shape health and care.