Ministry of Health
Health policy unit – Hanoi medical school
Assessment of medical technology in vietnam
Case studies of computerized tomography
(CT), colour ultrasound and digestive
endoscope in 5 provincial hospitals in 2006
Hanoi, 1/2007
Research team
1
Nguyen Hoang Long
Vu Dien
Pham Duc Minh
Sarah Bales
Tran Quynh Anh
Do Thi Phuc
Nguyen Thi Thu Cuc
2
Table of contents
Error! Bookmark not defined.
List of Tables ........................................................................................................................6
List of Figures ......................................................................................................................7
1
BACKGROUND .........................................................................................................8
2
Objective of study .......................................................................................................9
3
2.1
Overall objective ...................................................................................................9
2.2
Specific objectives .................................................................................................9
Overview ....................................................................................................................11
3.1
Medical equipment and assessment of medical technology ................................11
3.1.1
Concept of medical equipment ....................................................................11
3.1.2
Assessment of medical technology .............................................................11
3.1.2.1
Basic information of doppler ultrasound ...................................... 12
3.1.2.2
(CT)
Basic information of technology of computerized tomography
13
3.1.2.3
Basic information of technology of diagnostic endoscope ........... 15
3.2
Policy for investment and development of medical equipment in provincial and
district hospitals ..............................................................................................................15
4
3.3
Policies related to investment and development of medical equipment .............17
3.4
Situation of investment in medical high technology ...........................................18
3.5
Utilization of high-tech medical equipment ........................................................21
3.6
Assessment of efficacy of utilization of medical equipment ..............................22
3.7
Shortcomings in investment in and utilization of high-tech medical equipment 26
Study method ............................................................................................................29
4.1
Study duration: From 6/2006- to 1/2007. ...........................................................29
4.2
Study location: in 5 following hospitals: .............................................................29
4.3
Quantitative study: ..............................................................................................29
4.4
Qualitative study..................................................................................................30
4.4.1
In-depth interview (with recording – Form 3).............................................30
4.4.2
Group discussion: A guidelines for group discussion (Form 4- recording).31
4.5
Pilot test: ..............................................................................................................31
4.6
Study team: ..........................................................................................................31
4.7
Data processing analysis .....................................................................................31
4.8
Ethics issue ..........................................................................................................31
4.9
Limitations of the study:......................................................................................32
5
Stuty results in current situation of investment and utilization of 3 types of high
tech-medical equipment in 5 provincial hospitals, 2006 ................................................32
3
5.1
General information of selected hospitals: ..........................................................32
5.2
Current situation of investment and utilization of doppler ultrasound machines 33
5.2.1
Current situation of investment in ultrasound machines .............................33
5.2.2
Current situation of human resource and training for using doppler ultrasound
machines 36
5.2.3
Current situation of utilization of colour ultrasound machines ...................36
5.2.4
Current situation of machine repair .............................................................38
5.3
Current situation of investment and utilization of CT system .............................39
5.3.1
Current situation of investment in CT system .............................................39
5.3.2
Situation of staff and staff training in use of CT .........................................41
5.3.3
Current situation of utilization of CT scanner .............................................42
5.3.4
Management, maintenance and repair of machine ......................................43
5.4
Investment and utilization of digestive endoscope ..............................................44
5.4.1
Current situation of investment in endoscope .............................................44
5.4.2
Current situationof staff and staff training in endoscope ............................47
5.4.3
Current situation of utilization of endoscope ..............................................48
5.4.4
Current situation of maintenance and repair of machine ............................50
5.5
Investment in 3 high-tech medical equipment of 5 hospitals ..............................52
5.5.1
Factors that decides on investment ..............................................................52
5.5.2
Process and forms of investment .................................................................52
5.5.3
Completeness in investment in medical equipment ....................................55
5.6
Assessment of effectiveness and equity in using 3 types of high-tech medical
equipment of 5 selected hospitals ...................................................................................56
5.6.1 Current situation of utilization ..........................................................................56
5.6.1
Cost-effectiveness in utilization of high-tech medical equipment ..............59
5.6.2
Current issue of equity in utilization of high-tech medical equipment: ......60
5.7
Management, maintenance and repair of high-tech medical equipment .............63
5.8
Proposed orientation for investment, utilization of high-tech medical equipment of
hospitals ..........................................................................................................................67
6
5.8.1
Improvement of surrent situation to use effectively the existing equipment68
5.8.2
Orientation for effective utilization of equipment .......................................68
Conclusion and recommendations ..........................................................................70
6.1
Conclusion ...........................................................................................................70
6.1.1
Current situation of investment in 3 types of high-tech medical equipment in
survey hospitals ..........................................................................................................70
6.1.2
Effectiveness of utilization of 3 types of machine ......................................70
6.1.3
Management for maintenance and repair ....................................................71
4
6.2
Recommendations ...............................................................................................71
6.2.1
To improve the situation and effective use of high-tech medical equipment,
hospitals should: .........................................................................................................71
6.2.2
Orient for effective investment in high-tech medical equipment, hospitals
should pay attention to: ...............................................................................................71
6.2.3
Propose some monitoring indicators in assessing investment in high-tech
medical equipment ......................................................................................................72
References ..........................................................................................................................74
ANNEX– Information collection tools .............................................................................77
5
List of Tables
Table 1 Current number of 3 types of high tech medical equipment in public hospitals of
Vietnam .................................................................................................................................. 19
Table 2 Nnumber of high-tech medical equipment in provincial hospital by region ............. 20
Table 3 Proportion of general hospitals undertaking SC scanning, ultrasound and endoscopy
techniques, 1998~2005 ........................................................................................................... 22
Table 4 Average times of undertaking CT scanning, ultrasound and endoscope per hospital
that have available equipment, 1998~2005 ............................................................................ 22
Table 5 Average test per high-tech medical quipment ........................................................... 23
Table 6 Average test using high-tech medical equipment/inpatient by level of care ............. 25
Table 7 Average times of performing diagnostic procedures per 10,000 people ................... 25
Table 8 General information of 5 surveyed hospitals ............................................................ 33
Table 9 Information of appoitment and use of colour ultrasound .......................................... 34
Table 10 Investment in ultrasound machines in 5 hospitalss ................................................. 34
Table 11 Information of colour ultrasound machines in 3 hospitals ...................................... 35
Table 12 Basic information of staff using ultrasound machines ............................................ 36
Table 13 Current situation of most used colour ultrasound machines in 3 hospitals ............. 37
Table 14 Repair, maintenance of most used ultrasound machines ......................................... 38
Table 15 Information of appoitment and use of CT scanner .................................................. 39
Table 16 Situation of investment in CT system of 5 selected hospitals ................................. 40
Table 17 Information of CT in 5 selected hospitals ............................................................... 40
Table 18 Basic information of staff working on most used CT ............................................. 42
Table 19 Current situation of utilization of CT in 5 hospitalss .............................................. 43
Table 20 Situation of maintenance, repair of CT system ....................................................... 43
Table 21 Information of appoitment and use of endoscope ................................................... 44
Table 22 Investment in endocope in 5 selected hospitals ...................................................... 45
Table 23 Information of endoscope in 5 selected hospitals ................................................... 46
Table 24 Basic information of staff using most used endoscope ........................................... 47
Table 25 Current utilization of digestive endoscope in 5 hospitalss ...................................... 49
Table 26 Maintenance and repair of endoscope ..................................................................... 50
Table 27 Proportion of machine used..................................................................................... 56
Table 28 Average number of staff per working machine ....................................................... 57
Table 29 Data of utilization of medical equipment ................................................................ 58
Table 30 Situation of maitenance of all machines in 5 hospitalss in 2005 ............................ 65
Table 31 Situation of repair of medical equipment in 5 selected hospitals ............................ 66
6
List of Figures
Figure 1 Total investment in medical equipment in 1999-2003 ............................................ 18
Figure 2 Total expenditure on Purchase of medical equipment for provincial hospitals, 19982000 ........................................................................................................................................ 19
7
1 BACKGROUND
In order for Vietnam’s health system objectives
towards equity, efficiency and development are to be
achieved, besides strengthening and consolidating the
grass-roots health network in order to ensure supply of
basic quality health services, investment in medical
equipment, application of science and techniques in
appropriate and effective diagnosis and treatment plays a
crucial role[20].
With investment from the Ministry of Health, local
authorities and international and private organizations,
hospitals at all levels have been upgraded and provided
with modern equipment. However, investment in and use of
medical equipment are varied across locations depending
on the functions, tasks and specific conditions of each
locality (finance, human...), which might seduce arising
problems:
First:
investment
is
too
scattered
and
asynchronous and inappropriate with levels of hospitals.
Second: although much investment has been made, its
effectiveness is not commemorating with the needs for
health care, thus leading to the abuse of services, waste
and posing heavy burden on the patients. Third: Medical
workforce and professional staff have not been trained
well in order to exploit full capacity and efficiency of
the equipment thus leading to waste. Four: there is a
poor inadequate management and maintenance of modern
equipment thus many of them have broken down... [12, 19]
There have been disasters caused by new technology,
including new medicine, in the past decades over the
world as the need for saving resources in the context of
high cost technology leading to inflation in medical
costs therefore assessment of medical equipment has
become a big issue in health care activities. In order to
improve the effectiveness of the health care system and
safety for the patients, assessment of medical technology
has been applied in the past 3 decades in developed
countries, and is going to implement in less developed
countries...
Assessment of medical equipment aims to determine
the appropriateness, effectiveness and use of medical
equipment in diagnosis, treatment, and prediction and
development of health policies to invest in high tech
medicine for different levels of care. In Vietnam,
assessment of medical technology is a new issue which has
been recognized recently. However, there are existing
difficulties from the concept to practice even within and
outside the health sector.
8
With financial support from Sweden Sida, the Health
Policy Component project undertook a study in 2004 on:
“Inventory and assessment of investment in diagnostic
medical equipment in provincial general hospitals” [12].
However, a number of questions have not been answered
satisfactorily, specifically: is it appropriate to invest
in and use medical high technology, how effective is it?
Which indicators have been developed to build management
databases and standards for medical equipment, trends in
investment and what equipment is being used? This study
selected 3 types of medical equipment scan, ultrasound
and endoscope in diagnosis in some provincial general
hospitals as case studies with a view to answering the
above-mentioned questions.
2 Objective of study
2.1 Overall objective
Describe the current situation of investment and use
of
medical
diagnostic
equipment
namely
scanner,
ultrasound machine and endoscope of some diseases in
certain number of provincial general hospitals in 2006.
2.2 Specific objectives
1. Describe the current situation of 3 types of high
medical technology in 5 provincial general hospitals.
2. Determine decisive factors, procedures and experience
lessons in investment in 3 types of high medical
technology in provincial general hospitals.
3. Describe current use and effectiveness of scanner,
color ultrasound machine and intestinal endoscope in
5 provincial general hospitals.
4. Describe the current management, maintenance and
repair of high medical equipment in 5 provincial
general hospitals.
5. Propose possible measures to improve the use of 3
types of current high medical technology in selected
provincial general hospitals.
6. Show evidence for policy formulation and investment
orientation and assessment of medical equipment in
Vietnam.
9
10
3 Overview
3.1 Medical equipment
technology
3.1.1
and
assessment
of
medical
Concept of medical equipment
The term “Medical equipment” – “Medical techniques”
–
“Medical
technology”
all
refer
to
instruments,
techniques, means for transportation, specialized and
common supplies in service of preventive, curative and
diagnostic activities of the health sector[5].
The following equipment is
MRI, accelerator, vein scanner,
Telegraph, Doppler ultrasound,
chemotherapy machine ….
Medical equipment can be classed
regarded as high tech:
computerized tomography,
Digital X-ray machine,
into 10 categories: [1]
1. Image diagnosis
2. Electronic physiological diagnosis
3. Laboratory
equipment,
typically
spectrum,
cell
counter spectrum, centrifuge,
4. Emergency and resuscitation equipment, anesthesia,
operation room
5. Physiotherapic equipment
6. Medical optic spectrum equipment
7. Special measuring and treatment equipment
8. Indochinese medical electronic equipment
9. Common household electronic device
10.
Common equipment serving hospital performance
Apart from such a relative classification, to ensure
the unification the Minister of Health approved, on
26/04/1991, a list of medical equipment under management
of the MoH with 123 sets of basic equipment used in the
sphere of people’s health care and protection [1].
3.1.2
Assessment of medical technology
Assessment
of
medical
technology
in
general
or
assessment of hospital technology is a very large concept
and defined differently. According to the US Medical
Institute, assessment of medical equipment is process of
inspecting and reporting attributes (characteristics) of
any medical technology in terms of safety, productivity,
feasibility, appointment, cost and cost-effectiveness as
well as its influence in terms of social, economic and
moral views.
11
Assessment of medical equipment aims at many purposes.
This study concentrates on some aspects of the investment
and use of high medical technology in some central and
provincial hospitals. Such assessment is similar to the
situation where a health facility reviews how to make
investment or use of medical equipment effective while
ensuring that when the patients need the equipment, it is
available and in working condition. Through case studies
in ultrasound, computing scanner and endoscope it is
expected to bring about valuable recommendations for
other health facilities to take into account 3 above
mentioned types of equipment as well as other medical
equipment for hospitals.
3.1.2.1
Basic information of doppler ultrasound
The Doppler effect is a change in the frequency of a
wave, resulting from motion of the wave source or
receiver, or in the case of a reflected wave, motion of
the reflector. In medicine, Doppler US is used to detect
and measure blood flow, and the major reflector is the
red blood cell. The Doppler shift is dependent on the
insolating frequency, the velocity of moving blood, and
the angle between the sound beam and direction of moving
blood, as expressed in the Doppler equation.
In medicine, ultrasound was first used in diagnosis
in 1940 by Dussik – Austria recording the image of the
brain but the results was not what was expected. In 1950
in the US, ultrasound was used to probe bile duct by
Sonar, and since then it is used widely in the medicine
sphere.
Thanks to electronic advancement, today people
concentrate on improving the probe, transducer and
processor of electronic signals, feedback ultra wave type
A.B, trimention, Doppler ultrasound and Doppler power
ultrasound, black and white, color ultrasound…
Pulsed Doppler allows a sampling volume (or gate) to
be positioned in a vessel visualized on the gray-scale
image, and displays a spectrum, or graph, of the full
range (as opposed to the mean velocity, as in color
Doppler US) of blood velocities within the gate plotted
as a function of time. The amplitude of the signal is
approximately proportional to the number of red blood
cells and is indicated as a shade of gray.
Color Doppler provides a global depiction of blood
flow in a region and may be used as a guide for the
subsequent placement of the pulsed Doppler gate for
detailed
analysis
at
a
site
of
potential
flow
12
abnormality. Power Doppler, which is not routinely used
in arterial Doppler evaluation of the lower extremity,
depicts the amplitude, or power, of Doppler signals
rather than the frequency shift. This allows detection of
a larger range of Doppler shifts and thus better
visualization of small vessels, but at the expense of
directional and velocity information.
In Vietnam, ultrasound was first applied in the 80s
of the 20 century. Today, ultrasound machine is used in
both diagnosis and prognosis of the therapeutic process.
Black and white is the most common technique in all
hospitals in Vietnam, district level hospitals and
private clinics. However, the value of ultrasound results
still depends in the quality of the machine, generation
and experience of the doctor. Color doppler is a high
technology and has been applied in the past 15 years in
provincial,
central,
especially
in
diagnosis
of
cardiovascular diseases.
3.1.2.2
Basic information of technology of computerized
tomography (CT)
Computed Tomography (CT) imaging is also known as "CAT
scanning" (Computed Axial Tomography). Tomography is from
the Greek word "tomos" meaning "slice" or "section" and
graphia meaning "describing". CT was invented in 1972 by
British engineer Godfrey Hounsfield of EMI Laboratories,
England and by South Africa-born physicist Allan Cormack
of Tufts University, Massachusetts. Hounsfield and
Cormack were later awarded the Nobel Peace Prize for
their contributions to medicine and science. The first
clinical CT scanners were installed between 1974 and
1976. The original systems were dedicated to head imaging
only, but "whole body" systems with larger patient
openings became available in 1976. Since then new
generations of CT have been born with multi-probe machine
(from 6-64 arrays of probe).
The CT scanner was originally designed to take
pictures of the brain. Now it is much more advanced and
is used for taking pictures of virtually any part of the
body.
The scanner is particularly good at testing for bleeding
in the brain, for aneurysms (when the wall of an artery
swells up), brain tumours and brain damage. It can also
find tumours and abscesses throughout the body and is
used to assess types of lung disease. In addition, the CT
scanner is used to look at internal injuries such as a
torn
kidney,
spleen
or
liver;
or
bony
injury,
13
particularly in the spine. CT scanning can also be used
to guide biopsies and therapeutic pain procedures.
In Vietnam, in 1991 the first CT machine was working
in Viet-Xo hospital (now friendship hospital). After
that, CT was then provided for other health facilities
such as Vietnam-Germany hospital, Bach Mai Hospital and
most big health facilities throughout the country. In
2003, there are totally 89 CT systems (15 systems in
private sector), present in 8 socio-economic regions.
CT is used to diagnose multiple-structured images
and the body organs. For some diseases that need
diagnosis, CT becomes the best choice because the image
captured is clear, concentrated trimention with multiple
tissues that can be distinguished from normal X-ray.
Common diseases are subject to CT including:
 Diagnosis of sinusitis, bone fracture in cavity







Diagnosis of diseases in brain tumor, stroke,
and blood vessels
Diagnosis of abdomen diseases. A CT scan of the
belly can find cyst, abscesses, infection,
tumors, an aneurysm, and enlarged lymph nodes,
foreign objects, bleeding in the belly,
diverticulitis, inflammatory bowel diseases and
appendicisitis.
Diagnosis of chest (thorax). A CT scan of the
chest can look for problems with the lungs,
heart,
esophagus,
the
major
blood
vessel
(aorta), or the tissues in the center of the
chest. Some common problems a CT scan may find
include
infection,
lung
cancer,
pulmonary
embolism and an aneurysm. It also can be used to
see if cancer has spread into the chest from
another area of the body.
Pancreas. A CT scan can find a tumor in the
pancreas
or
inflammation
of
the
pancreas
(pancreatitis).
Gallbladder and bile ducts. A CT scan can be
used to check for blockage of the bile ducts.
Gallstones occasionally show up on a CT scan,
but an ultrasound test is usually used to find
gallstones.
Adrenal glands. A CT scan can find tumors or
enlarged andrenal gland.
Spleen. A CT scan can be used to check for an
injury to the spleen or the size of the spleen
14
3.1.2.3 Basic information of technology of diagnostic
endoscope
In the early 1900s, the first attempts to view
inside the body with lighted telescopes were made. These
initial devices were often fully rigid. In the 1930s,
semi-flexible endoscopes called gastro scopes were
developed to view inside of the stomach. Fiber-optic
endoscope was pioneered by South African-born physician
Basil Hirschowitz at the University of Michigan in 1957.
Widespread use of fiber optic endoscopes began in the
1960s. A fiber optic cable is simply a bundle of
microscopic glass or plastic fibers that literally allows
light and images to be transmitted through curved
structures. Fiber optic cables are also replacing metal
wires as the backbone of the world's telecommunications
infrastructure. This Internet page may have traveled
through a fiber optic cable as a stream of digital data
(bursts of light) on its way to your computer.
An endoscope uses two fiber optic lines. A "light
fiber" carries light into the body cavity and an "image
fiber" carries the image of the body cavity back to the
physician's viewing lens. There is also a separate port
to allow for administration of drugs, suction, and
irrigation. This port may also be used to introduce small
folding instruments such as forceps, scissors, brushes,
snares and baskets for tissue excision (removal),
sampling, or other diagnostic and therapeutic work.
Endoscopes may be used in conjunction with a camera or
video recorder to document images of the inside of the
joint
or
chronicle
an
endoscopic
procedure.
New
endoscopes have digital capabilities for manipulating and
enhancing the video images. The technique has been
developed and expanded to other specialties such as
digestive system, respiratory, ENT, obstetrics and
neurontology.
In Vietnam, application of endoscope began in 1957,
soft tube endoscope was conducted in Bach Mai in 1966 of
Nguyen Khanh Trach and Bui Xuan Tam in 1991 in the
Military Medicine Institute 108. Today, the endoscope
technique has been used in also most all hospitals of
provincial and central levels.
3.2 Policy for investment and development of medical
equipment in provincial and district hospitals
Medical equipment includes machines, instruments,
supplies and specialized means of transportation for the
15
protection and care for people’s health [5]. Some high
medical technology including CT, colour Doppler and
endoscope have their own regulations related to the
trading, import, export and use of the machines [9].
In
order
to
ensure
a
consistency
of
medical
equipment, Decision 490/Q§-BYT of the Ministry of Health
dated 26/4/1991 issued a list of medical equipment for
all levels of care. Decision 1419/1996/Q§-BYT promulgated
medical equipment list under the management of the MoH
with 123 types of essential used for the protection and
care for people’s health [1]. One of the purposes of this
Decision is to strengthen the state management role in
the area of medical equipment and ensuring investment
effectiveness.
By 20/02/2002, the Ministry of Health issued Decision
437/Q§-BYT covering a list of medical equipment used for
district and provincial general hospitals, regional
polyclinics and commune health centers. This list of
equipment is divided by level of care and by specialized
departments and regarded as a criterion for investment in
medical equipment.
The digital colour doppler ultrasound of the
essential medical equipment list belongs to the image
diagnosis
department,
and
functional
exploration
department at provincial level but in the district level,
only black and white ultrasound is required.
The CT system attached by optics resistance pump is
included in the list of essential equipment of the MoH
but it is not incorporated in the district list.
Diagnostic endoscope is more popular equipment as it
is present in the list of both provincial and district
level of care. At provincial, as regulated the hospital
has a separate department of endoscope. Apart from the
required list of essential equipment, other departments
also need endoscope machine. The essential endoscope
machine at provincial level is the set of soft-tube
endoscope of bronchus, amnion, and hard-tube endoscope of
bronchus,
soft-tube
endoscope
of
large
intestine,
stomach, duodenum, bladder, nose larynx, esophagus and
bile duct. The remainder of the endoscope is used for
treatment and surgery purposes. At district hospital,
there exists endoscope for stomach soft-tube endoscope of
rectum, anus and amnion in obstetrics department.
16
3.3 Policies related to investment and development of
medical equipment
To realize the objective of industrialization and
modernization in the health sector, improving quality of
care and meeting the growing needs for health care of the
people in the new situation, the Vietnamese Party and
Government has, in the past years, passed many statutory
documents as a legal corridor for the investment, use and
management of medical equipment and technology in
Vietnam. Below are some of the policies.
 Decision 35/2001/Q§-TTg of Prime Minister dated
19/3/2001 on approval of the Strategy for the
protection and care for people’s health during 20012010 [20].
 Decisions 88/TTg- 1995, 139/TTg-1997 and 890/TTg2000 approving the Program of development of high
tech health centers in Hanoi, HCM city and the
central region with investment in 13 units. The
objective is to develop intensive health centers,
gradually modernizing the sector in order to keep
abreast with medical advancement of some regional
countries and over the world [21]
 The Ministry of Health has issued many documents:
Circular
10/BYT-TT
dated
26/5/1994,
Circular
08/1996, Circular 03/2001/TT-BYT, Circular 4428/BYT
dated 5/6/2002 on guidelines for Purchase and
investment in medical equipment.
 Decision 130/2002/QD-TTg dated 4/10/2002 was issued
by Prime Minister on approval of National Policy on
medical equipment during 2002-2010[19]. The overall
objective of this policy is “To ensure sufficient
medical equipment for different level of care as
regulated by the Ministry of Health. To gradually
modernize medical equipment in order to improve
quality of health care for the people, trying to
reach, by 2010, an equivalent level in medical
technique with other advanced countries in the
region; To train a contingent of technical staff to
be able to exploit, maintain, repair and audit
medical equipment; To develop an industry of medical
equipment in order to increase the proportion of
locally-produced goods towards exportation.
 Directive
01/2003/CT-BYT
dated
13/06/2003
of
Minister of Health on strengthening management of
medical equipment.
17
3.4 Situation
technology
of
investment
in
medical
high
Report from the Department of Medical Equipment of
MoH reveals that funding for Purchase of medical
equipment comes from different sources.
 Government budget in annual allocation.
 Preferential loans from international organizations
and countries
 Grants from international organizations,
and Non-Governmental Organizations
countries
 Mobilization from community (socialization fund)
Statistics
from
National
Health
Account
(NHA)
(Figure 1) show that total social fund procuring medical
equipment varies overtime, especially in 2001 and 2002
when the fund dropped sharply. However, the earmarked
fund from the public purse for procurement of medical
equipment seems stable and tends to increase from 1999 to
2002. However, in the trend of socialization and
development of private sector, mobilized funding for
equipment
from
non-government
sector
rose
up
significantly (in 1999, 2000, 2003), but also plummeted
(in 2001, 2002) (see Figure 1). Decentralization process
is also reflected in the data of investment in medical
equipment. In 1999, funding from central government
budget holds 53% of total government budget for Purchase
of medical equipment but it declined to 40% in 2003.
2000
1800
1600
VND billion
1400
1200
Non Gov budget
1000
Local Gov budget
800
Central Gov budget
600
400
200
0
1999
2000
2001
2002
2003
Figure 1 Total budget invested in medical equipment during
1999-2003
Source: National Health Account 1998-2003 [14]
Investment in medical equipment aims to strengthen
quality of care and create opportunities to seek for
profits. This practice is true in private health
18
facilities and also a source of funding from hospital
staff and other investors to procure more medical
equipment for these health facilities. These issues will
be touched upon in the result analysis section.
In terms of investment and Purchase of medical
equipment in provincial hospitals, hospital inventory of
the Treatment Department shows that expenditure on
Purchase of medical equipment in 61 provincial hospitals
was high in 1999. In 2000, although investment seemed to
slow down but it was still higher than in 1998 (Figure 2)
[4].
25000
22021
19115
VND billion
20000
15000
10000
7606
5000
0
1998
1999
2000
Figure 2 Total expenditure on Purchase of medical equipment
for provincial hospitals in 1998-2000
Source: Hospital Inventory 2000 [8]
High-tech medical equipment is invested by the
program of development of high tech health centers in
Hanoi, HCM city and the central region with investment in
13 units of total approved budget of VND 2,352,204
billion during period 1995-2005 [13]. In this investment,
the project has procured a system of CT for 7 hospitals,
colour doppler ultrasound for 7 hospitals and diagnostic
endoscope for 8 hospitals.
Within 5 years, the number of high-tech medical
equipment has doubled. On every 100 hospitals of all
kinds, there are 112 ultrasound machines (in 2000) and
rose to 158 machines in 2005, 19 set of endoscope
increased to 36 set of endoscope in 2005 and 3 CT
scanners rose to 6 CT scanners in 2005. (See Table 1).
Table 1 Current number of 3 types of high tech medical
equipment in public hospitals of Vietnam
Medical equipment
Total ultrasound
machines
In 2000
Available
In working
condition
920
833
In 2005
1388
19
Colour ultrasound
Equipment/Hospital
Endoscope
equipment
Equipment/Hospital
CT scanner
Equipment/Hospital
72
156
25
62
1.12
126
NO DATA
1.58
315
0.19
24
0.03
0.36
58
0,06
Source:
In 2000: Inventory of 822 hospitals of all kind – Treatment Department [7]
In 2005: Health Statistical Yearbook – MoH 2005 (879 hospitals of all
kinds) [10]
High-tech medical equipment mainly concentrates in
central and provincial hospitals. In provincial hospitals
alone, the number of high-tech medical equipment doubles
the average number of equipment of all hospitals (on
every 100 hospitals there are 229 ultrasound machines,
380 endoscope equipment, 52 set of CT scanner - 2003).
The reasons are different: there is a shortage of
specialized staff, engineers and maintenance staff for
high-tech medical equipment, especially a lack of fund
for procuring supplies, repairs and replacement therefore
the number of high-tech medical equipment broken down and
inactive accounting for 14-20% of total available
machines.
Table 2 Number of high-tech medical equipment in provincial
hospital by region
Region
Red river
delta
North west
North east
North
central
coast
South
central
coast
Central
highland
South east
Mekong delta
Total
Number
of
hospital
Ultrasound
Endoscope
equipment
Total
Colour
ultrasound
CT
scanner
11
40 (3.6)
7
71 (6.5)
7 (0.6)
3
11
6
5 (1.7)
20 (1.8)
12 (2.0)
0
2
2
3 (1.0)
39 (3.5)
39 (6.5)
1 (0.3)
3 (0.3)
4 (0.7)
6
10 (1.7)
3
15 (2.5)
5 (0.8)
4
7 (1.8)
2
6 (1.5)
1 (0.3)
8
12
61
17 (2.1)
29 (2.4)
140
(2.3)
6
29 (3.6)
7
30 (2.5)
29 232 (3.8)
7 (0.9)
4 (0.3)
32 (0.5)
Notes: Data in bracket is the average high-tech medical equipment per
hospital
Source: Survey in 61 provincial general hospitals 2003 [12]
Distribution of high-tech medical equipment by region
is uneven if taking into account the average high-tech
medical equipment per hospital, lowest is the North west
20
and Central Highland; highest is the Red river delta,
North central coast and south central coast (See Table
2).
3.5 Utilization of high-tech medical equipment
Utilization rate of image diagnostic equipment tends
to increase overtime and by level of care. Date of
hospital inventory 1998-2000 and hospital inventory 20042005 suggests that it is possible to analyze the trend in
utilization of CT scanner, endoscope and ultrasound. This
is the aggregate data without distinction between CT
scanner and magnetic resonance (MRI), gray and colour
ultrasound,
and
between
diagnostic
endoscope
and
endoscope surgery. This information, however, can help
assess the prevalence of these 3 types of technology (See
Table 3 and 4). In Table 3, it is clear that since 1998,
ultrasound has become a very popular technique at
provincial level, and by 2005 it is commonly used at
district level. CT scanner and endoscope technique are
becoming prevalent in provincial level although they are
still new to districts.
21
Table 3 Proportion of general hospitals undertaking SC
scanning, ultrasound and endoscope techniques, 1998~2005
Unit: %
1998
CT, MRI
Province
District
Ultrasound
Province
District
Endoscope
Province
District
1999
2000
2004
2005
6.6
1.1
8.2
0.8
19.7
1.1
56.9
0.6
61.8
0.6
95.1
56.3
96.7
68.9
100.0
79.0
94.8
93.4
98.2
94.7
23.0
0.6
26.2
1.3
37.7
1.9
86.2
4.3
89.1
9.7
Source: Hospital inventory in 2000, 2005
The average utilization rate of high-tech equipment
per year is increasing (Table 4); at provincial level,
average utilization rate of CT, endoscope and ultrasound
has doubled between 1998 and 2005; at district level,
utilization rate of ultrasound is increasing while it
drops in endoscope. As the data in CT at district level
are collected in only 3 hospitals therefore its
reliability is questionable and is not analyzed here.
Table 4 Average times of undertaking CT scanning, ultrasound
and endoscope per hospital that have available equipment,
1998~2005
Unit: Times/hospital/year
Times of
Province
District
Times of
Province
District
Times of
Province
District
1998
1999
2000
2004
CT scanning, MRI/hospital/Year
1407
1553
1276
2369
..
..
..
..
ultrasound/hospital/year
11205
11640
12225
24872
2052
2022
2117
3359
endoscope/hospital/year
1731
1739
1262
3684
1381
1277
1299
862
2005
3016
..
31008
3838
4351
516
Notes: As there are only 3 district hospitals undertaking CT scanning
therefore the average times of CT/hospital is not representative and is
not presented here.
Source: Hospital inventory in 2000, 2005 [10]
3.6 Assessment of efficacy of utilization of medical
equipment
There are many indicators to measure the efficacy of
utilization of high-tech medical equipment in diagnosis
and treatment. However, in order to assess whether
or
not use of machine is effective, we have to take into
account the degree of capacity used combining assessment
of the appropriateness of machine used in each case. Even
if a hospital uses up the capacity of machine, it might
22
be ineffective as the
cases. However, such a
machine utilization in
assessment studies limit
machine is used on unnecessary
full study on the efficacy of
Vietnam is still pending. Most
to the degree of using machine.
Based on perceived assessment of users in a survey of
61 provincial hospitals in 2003, it is reported that [12]
about 17% of medical equipment used ineffectively
(Ultrasound machines, CT 16,2%, endoscope equipment
24,8%). Also, in assessment of inactive and broken down
high-tech medical equipment, it is said that [12] the
proportion of broken down machine in image diagnosis
department (Ultrasound machines, CT) is 18.8%, Endoscope
equipment is of 13.4%.
Another approach is to base on average service per
medical equipment. This indicator also helps reflect
efficacy of machine utilization and comparison among
regional hospitals. Statistics in 2003 report that on
average, one colour ultrasound machine serves 6503
tests/year, grey ultrasound 17,380 tests/year, CT system
of 6350 tests/year, and 3438 tests of stomach, rectum
/year;
Endoscope
of
digestive
system
(esophagus
endoscope, 80; rectum endoscope, 715; abdomen area,
1991/year) [12]. Even though, the indicator of service
per year also depends on whether or not the appointment
is correct or abuse of service, and the proportion of
service incurred as medical requirements. It also depends
in the qualification of health workers, level of care and
the demand for high-tech medical equipment.
Table 5 Average test per high-tech medical equipment
Type of equipment
CT system
Colour ultrasound
Grey ultrasound
Endoscope kit of
stomach, rectum
In 2003
In 2005 (all public hospitals)
Provincial
Number
Number of
Average
general
equipment
test
per
hospital
equipment
6350
58
219.162
3778
6503
1358 6.707.062
4832
17.350
3.438
No data
No data
No data
available available available
* 2003: Inventory of diagnostic equipment in 61 provincial hospitals
* 2005: Health Statistical Yearbook – MoH 2005.
Table 5 shows that the number of test/equipment at
provincial level is 1.3 to 1.5 time higher than the
average calculation for all levels of care. Test using
colour ultrasound is similar to CT scanning in provincial
level. Test using grey ultrasound is 3 times higher than
colour ultrasound. This does make sense as colour
ultrasound is mainly used in cardiovascular sphere while
grey ultrasound is used in many areas.
23
Some
researchers
said
that
the
indicator
of
assessment of efficacy is more appropriate than average
test per inpatient, or average patient visits. In a
clearly divided level of care where disease patterns of
the same level are similar, this argument is correct, and
differences in indicators between hospitals may reflect
different efficacy of equipment utilization. However, in
the current context of Vietnam health system, resources
(human and equipment) between hospital of the same level
and the disease pattern between regions are sparsely
different, therefore it is very difficult to use this
indicator to compare level of efficacy in using the
equipment.
Results represented in Table 6 reveal that average
test service per inpatient keeps rising overtime and
concentrate in provincial and central general hospitals.
At central level, CT scanning is 14 times higher than the
average of all hospitals and ultrasound is also twice as
much as other levels. The proportion of endoscope surgery
is also rising in provincial/district level while this
proportion stays stable in central level.
24
Table 6 Average test using high-tech medical
equipment/inpatient by level of care
Indicators
1.Total hospitals of all kind:
822
Average CT scanning,
MRI/inpatient
Average diagnostic
ultrasound/inpatient
% of surgery using endoscope
2. Central Hospital:27
Average CT scanning,
MRI/inpatient
Average diagnostic
ultrasound/inpatient
% of surgery using endoscope
3. local Hospitals: 768
Average CT scanning,
MRI/inpatient
Average diagnostic
ultrasound/inpatient
% of surgery using endoscope
1998
1999
2000
0.01
0.01
0.01
0.4
0.5
0.5
7.74
9.10
19.80
0.09
0.12
0.14
0.8
0.9
1.0
16.67
14.54
14.69
0.0
0.0
0.01
0.4
0.9
0.5
0.4
8.09
20.82
Notes: Local hospitals include provincial, district hospitals
Source: Inventory of hospitals in 2000-MoH
In 2005, statistics from MoH indicate that the whole
country has 7,891,049 inpatient visits with an average
patient visit using CT scanner of 0.027 time (or of 1,000
inpatients, 27 inpatients using CT) and 0.85 diagnostic
ultrasound of all kinds which is much higher than 2000.
In order to see the degree of using CT, ultrasound
and endoscope in Vietnam as compared to other countries,
the report makes a comparison of average case per 10,000
inhabitants in the USA and Australia. The data of Vietnam
merely refer to average times of performing these
diagnostic procedures on patients in public health
facilities while data of other countries cover both
public and private sector. According to the data
presented in Table 7, in Vietnam, times of using CT and
endoscope are lower than those of the US and Australia,
but services using ultrasound is higher. This suggests
that, at present, the level of investment or utilization
of CT and endoscope of Vietnam is low while ultrasound is
sufficient, and begins to control appropriate use of
ultrasound.
Table 7 Average times of performing diagnostic procedures per
10,000 people
USA
CT
Total
(2004)
385.8
Inpati
ent
28.7
Outpat
ient
357.1
Australia
Hospital
(2004)
Vietnam
public
hospitals
(2005)
211.4
26.4
25
Ultrasound
Endoscope
709.9
905.3
28.2
36.7
681.7
868.6
26.1
238.3
806.9
67.3
Notes: For the US, CT includes MRI.
Source: USA- National Institute of Health Statistics [28, 31, 32, 27];
Australia, Institute of Health and Welfare, Australia [25]; Vietnam- MoH
[1]
At present, there is insufficient information to
assess exactly the level of utilization of medical
equipment is low or high as compared to the need. In some
places, machine is rarely used as they lack qualified
staff, lack equipment and lack funding to repair the
broken ones or the local people are unable to pay for the
services. But in other places, there is a phenomenon of
doctor abusing using the technology in unnecessary cases
to recover cost or to charge more user fees to benefit
person income. In the future, this issue will be further
studied in order to find out optimal measures ensuring
that utilization of technology in necessary cases not
abuse it, avoid causing societal waste and financial
burden for the health insurance system and livelihoods of
households.
3.7 Shortcomings in investment in and utilization of
high-tech medical equipment
There have been positive changes in investment,
upgrading and putting into operation of high-tech medical
equipment recently. Investment in medical equipment comes
from various sources: Government budget, preferential
loan, grants…and the mobilization of dynamic health
facilities,
joint-venture
within
and
outside
the
hospital. Many provincial, central hospitals
including
private hospitals have began to invest in high-tech
medical equipment such as CT scanner, colour ultrasound,
televised
X-ray
machine,
off-body
stone
grounding
machine, endoscope system… making contributions to
responding and improving quality of care for the people.
However, the investment and management of high-tech
medical equipment are revealing certain limitations and
problems as identified by the study of Hanoi Medical
School, 2003 [12].
 Investment is too scattered with average annual
government budget of VND 700 billion spent on
Purchase, upgrading medical equipment (including
central and local government budget)[14]. Given the
current large health care system of Vietnam, it is
estimated that there are about VND 255 million per
public health facility (equivalent to USD 16,000)
while the demand is so great therefore many health
26
facilities have bought high-tech medical equipment
but they are not synchronous. Much equipment,
invested before 1995 has downgraded and broken which
is very difficult for diagnosis and treatment. The
capacity of some district or provincial hospitals is
small therefore it is not cost-effective to invest
such expensive modern equipment (worth VND billions)
as they fail to exploit full capacity of the
machine.
 The contingent of health staff has not been trained
in the subject-matters and lack of knowledge to
explore effectively the invested equipment. There is
a severe shortage of medical technical staff and
qualified technicians which are not commemorate with
the investment.
 In many facilities, there is insufficient money to
buy materials and supplies therefore many machines
have to stop working or just use the most basic
functions.
 Technical service and counseling system is weak
therefore the repair and maintenance of machines is
very much depending on suppliers, which pushes up
the
price.
Although
much
equipment
has
been
provided, they prove incompatible with the demand
for use.
 Socialization for health sector as launched by the
Party, Government and MoH has created favourable
conditions for health facilities to mobilize more
resources to invest in medical equipment. Mobilized
fund of private hospitals and public facilities have
been used to invest in medical equipment but it is
not stick to the Government plan. Monitoring and
assessment
of
performance
efficacy
of
health
facilities is done in a systematic manner, even some
government agencies do not know the distribution of
high-tech medical equipment throughout the country.
Such a situation leads to a great waste in
investment or inducing burden in abusing high-tech
equipment, and voluntary health services transgress
public services. Uneven investment across localities
where rich localities invest more in equipment than
the poor leading to inequity in access to high-tech
health services for the people. The Government is
facing difficulties in controlling and implementing
its leading role in high-tech medical equipment.
27
In the trend of integration of Vietnam to the world,
it is necessary to strengthen high-tech medical equipment
in diagnosis and treatment in order to open up service
users and meeting the growing needs for health care.
However, the investment should be oriented with focus,
especially the effectiveness of investment in medical
equipment must be taken into serious consideration.
28
4 Study method
This is a case study that combines both qualitative
and quantitative method in order to survey the current
situation of investment in and utilization of 3 types of
high-tech medical equipment of CT scanner, endoscope and
ultrasound machines in some provincial/municipal general
hospitals.
4.1 Study duration:
From 6/2006- to 1/2007.
4.2 Study location: in 5 following hospitals:
 Friendship hospital is a central general hospital
located in Hanoi and is the first hospital of
Vietnam invested in CT scanner before 1993.
 Saint-Paul Hospital is a provincial hospital of
Hanoi.
 Hatay provincial hospital is a general hospital
representing for the Red river delta
 Dong Hoi general Hospital is a general hospital
representing for the central region.
 Ba-Ria Vung tau Hospital is a general hospital
representing for the Southern region
4.3 Quantitative study:
Study about the current situation of investment in
and utilization of 3 types of high-tech medical equipment
of CT scanner, endoscope, Ultrasound machines in 5
hospitals.
-
Techniques in data collection:
forms (Form 1 and 2).
-
Informant (in each hospital):
Using
administered
 Staff of general planning department
 Staff of medical equipment department.
 Staff of image diagnosis department
 Staff of clinical department that has endoscope.
-
Contents of survey:
 Basic information
patient loads...
of
the
hospital:
capacity,
 Number of machine in each hospital.
29
 Situation of
operation.
staff
and
training
in
machine
 Situation of operation and maintenance of machine
 Efficacy of utilization (Patient visits examined
and diagnosed by CT scanner, endoscope, ultrasound
machines in 5 hospitals)
In each hospital, select the most modern machine of
3 high-tech medical equipment (CT scanner, Colour
ultrasound, digestive endoscope) for in-depth study as
illustration.
4.4 Qualitative study
To assess the situation of investment in 3 types of
high-tech medical equipment in terms of forms, source of
funding
for
investment,
process
of
investment,
synchronouness of the investment and quality of these
machines in selected hospitals.
4.4.1
In-depth interview (with recording – Form 3)
- Interviewees in each hospital:
 Representative of the Directorate
 Head of general planning department
 Department
staff)
of
medical
equipment
(1
head,
1
 Head of image diagnosis department, or operators
of CT scanner and Colour ultrasound.
 Head of clinical department that has digestive
endoscope.
-
Contents
of
interview:
current
situation
of
investment and use of 3 high-tech medical equipment
(CT, Colour ultrasound, digestive endoscope).
 Process of investment in each
synchonouness and cost involved.
machine,
its
 Situation of staff and training related to this
equipment..
 Difficulties in using the machine.
 Efficacy of utilization (by level of: overload,
rarely used, or used full capacity, why?)
 Needs for orientation in investment, utilization
of the machine and human.
30
4.4.2
Group
discussion:
A
guidelines
for
group
discussion (Form 4- recording).
- Participants
are
8-10
doctors
of
clinical
departments that require high techniques such as
ultrasound, endoscope, CT (Form 4).
-
Contents of the group discussion: Current situation
and efficacy of utilization of 3 types of high-tech
medical equipment (CT, Colour ultrasound, digestive
endoscope) in diagnosis and treatment; issues of
assessment of service, abuse and equity in using
high-tech
medical
equipment;
difficulties
and
limitations in using and proposing measures for
improvement.
4.5 Pilot test:
All
the
contents
of
both
quantitative
and
qualitative studies are pilot tested in Thanh Nhan
hospital, Hanoi (not included in the selected hospitals
of study Form).
All survey forms, implementation are supplemented
and adjusted (with technical inputs from international
consultants of medical equipment) to fit into the 5
hospitals in the official survey.
4.6 Study team:
Include qualified, experienced researchers of Hanoi
Medical School and the Institute of Health Policy and
Strategy. They involved in developing the study tools and
trained before going to the field in order to collect
quality and reliable data.
4.7 Data processing analysis
Quantitative data are processed using EXCEL
Qualitative data are analyzed after transcription,
using such techniques as setting up matrix tables.
4.8 Ethics issue
All selected hospitals have been informed clearly
about the purpose of this study. The study is implemented
upon the agreement of all hospitals.
Recording of interviews is informed to respondents
and obtain their consent before recording.
All information
purpose.
collected
is
to
serve
the
study
31
4.9 Limitations of the study:
-
Assessment of medical equipment is a very new issue
in Vietnam with a very large scope. This study is
only a branch of case study in CT, Colour ultrasound
and digestive endoscope in diagnosis in order to
assess the current situation of investment in and
utilization of 3 types of equipment in some
provincial general hospitals representing for 3
regions of North, Central and South.
-
The study merely bases on the actual situation of
selected hospitals and views of service providers
(health staff) not views or opinions of service
users
(patients)
therefore
the
issue
of
effectiveness and equity is not scrutinized.
5 Study results in current situation of investment
and utilization of 3 types of high tech-medical
equipment in 5 provincial hospitals, 2006
5.1 General information of selected hospitals:
Among 5 selected hospitals surveyed in 8,9/2006,
Friendship hospital is a central hospital, 4 remaining
hospitals are provincial general hospitals of Hanoi, Dong
Hoi (Quang Binh) and Ba Ria- Vung Tau with an average
patient beds of 400-500 and classified Level I and II
(See Table 8). Friendship hospital is a hospital for
senior or high ranking officials with high rate of old
patients and chronic diseases. Saint-Paul hospital is a
municipal
hospital
providing
services
at
request
therefore it has higher patient loads than 3 remaining
32
hospitals. Dong Hoi Hospital used to be a central
hospital but has been handled to the local authority as a
provincial hospital. Ha Tay and Ba-Ria Vung Tau both have
provincial general hospitals and regional hospitals.
Every year, there are about 200,000 patient visits
per provincial hospital, Saint-Paul hospital alone, there
are over 400,000 patient visits. Inpatient visit account
for about 10%-15% of total examination visit.
Number of health workers, especially post-graduate
specialized staff of Ha Tay, Dong Hoi and Ba-ria
hospitals is much lower than that of Friendship hospital
and Saint-Paul hospital.
Table 8 General information of 5 surveyed hospitals
Indicators
Level of hospital
Nuber of planned beds
2005
Total staff 2005
Total health staff
Total doctor
Professors and
associates
PhD
Post-graduate
Specialized level II
Specialized level I
Total patient visits
2005
Total length of stay
for inpatients 2005
Total inpatient
treatment 2005
Friends
hip
1
410
SaintPaul
1
500
705
493
189
1
Hatay
Dong
Hoi
Ba-ria
2
400
2
450
2
500
750
638
169
0
452
341
108
1
570
359
91
0
435
350
97
0
20
33
13
48
2
20
21
69
1
9
12
68
1
8
5
41
1
5
1
32
187892
440464
200887
188119
278882
168792
267449
159312
211466
167919
21054
29041
20540
25300
39070
Notes: HN: Friendship hospital: Saint-Paul hospital. HT: Hatay Hospital.
§H: Dong Hoi Hospital. BR: Ba-Ria Hospital.
5.2 Current situation of investment and utilization
of doppler ultrasound machines
5.2.1
Current situation of investment in ultrasound
machines
Among surveyed hospitals, Saint-Paul hospital and
Dong Hoi hospital (Quang Binh) have no doppler ultrasound
machines therefore this study just analyzes cases of the
three remaining hospitals. In the data collected of 3
hospitals that have doppler ultrasound machines (colour),
colour ultrasound machine is mainly used to diagnose
cardiovascular diseases (correct appointment). However,
in Friendship hospital and Ha Tay hospital, they also use
33
this machine to diagnose disease in abdominal area,
detecting tumors, prostate, obstetrics and urinary.
Table 9 Information of appointment and use of colour
ultrasound
Name of
hospital
Friendship
hospital
Ha Tay
general
hospital
Ba-ria
hospital
Appointed to use colour
ultrasound
Heart, leg vein, body
vein, liver, bile,
spleen, pancreas, ovary,
kidney, prostate
Cardiovascular,
obstetrics, digestive
system, urinary
Heart, blood vein
Type of machine
Siemens G60S
Alloca SSD4000
Medison
Staff of general planning department, department of
Medical equipment and image diagnosis department of the
hospitals
is
asked
some
questions
about
general
information of doppler ultrasound machines and current
colour doppler of the hospitals, and detailed information
of doppler ultrasound machines (colour) used most.
According to the survey result in 5 hospitals, there
are 3 hospitals that have
doppler ultrasound machines
(colour). Friendship hospital, have a high proportion of
old-aged patients and many patients with heart disease,
has 3 doppler ultrasound machines, while each hospital in
Ha Tay and Ba-Ria has only one doppler ultrasound
machines. The oldest Doppler Ultrasound machine bought
since 2000 in Friendship hospital and Ba-Ria hospital.
The latest machine bought in Ha Tay hospital, since 2006.
(See Table 10).
Table 10 Investment in ultrasound machines in 5 hospitals
Number of
doppler
ultrasound
machine
Number of
broken
Oldest
machine
bought in
Latest
machine
bought in
Friendsh
ip
3
Hatay
Ba-ria
1
1
0
0
0
Year
2000
Year 2006
Year 2000
Year
2004
Year 2006
Year 2000
Detailed information of most used doppler ultrasound
machines in each hospital is presented in Table 11.
34
Doppler ultrasound machines are bought from different
countries, Germany, Japan, and South Korea (Made in
Austria). Three hospitals reported that the machine is
not synchronous. As design, these machines can be used
from 10 to 15 years. Original purchase price is VND 1.5
to 2 billion and all these machines bought from the
Government budget. While purchasing colour ultrasound
machine, some hospitals reported that they have to invest
more in buying air-conditioners, adaptors, humidifier,
vacuum cleaner or printers with a cost of VND 13-40
million, and Ha Tay hospital has constructed a separate
room for the colour ultrasound machine.
Table 11 Information of colour ultrasound machines in 3
hospitals
Name of machine
Country of
production
Is the equipment
complete
Status of machine
at sale
Length of
utilization as
designed
Year of Purchase
Year put into
operation
Original price
Other investment
when the machine
put into
operation
Source of funding
Friendship
Siemens G60S
Germany
Hatay
Alloca SSD4000
Japan
Ba-ria
Medison
South Korea
Yes
Yes
Yes
Brand-new
Brand-new
Brand-new
15 years
13 years
No data
available
2004
2004
8/2006
8/2006
2000
2000
No data
available
No data
available
VND 1.5 billion
Separate room,
computer system,
air-conditioners
VND 1,963
million
Printer (VND
39.9
million)
100%
Government
budget
100%
Government
budget
100%
Government
budget
Proposals and opinions of doctors in medical
equipment are: in the future “opinions of clinical
doctors about investing in and purchasing equipment
should be taken into account”. In Friendship hospital,
all doppler ultrasound machines is not complete with
different suppliers therefore it is very difficult to
maintain and repair the machines.
35
5.2.2
Current situation of human resource and training
for using doppler ultrasound machines
Table 12 reveals all basic information of staff
using
doppler
ultrasound
machines
in
3
selected
hospitals. In general, staff using machines is very
different across hospital. While Friendship hospital has
8 staff using 3 doppler ultrasound machines, about 3
persons per machine, Ba-Ria hospital has 7 doctors using
one machine. In hospitals where they have sufficient
conditions and heart patients, staff can undertake colour
ultrasound while other hospitals with fewer patients,
doppler ultrasound performers have to perform different
types of ultrasound in order to use up the time. This
practice may affect quality of diagnosis by ultrasound as
they lack specialized expertise.
Since investment in doppler ultrasound machine, many
hospitals have sent staff for training
in order to
exploit the full capacity of the doppler. In general, for
ultrasound machine, most operators are doctors with very
few
technician
and
most
technicians
are
doing
administrative work such as recording ultrasound results.
In Ba-Ria hospital, there are few proficient staff using
doppler ultrasound machine, only 2 out of 8 people can
operate proficiently the machine even it was purchased in
2000.
Table 12 Basic information of staff using ultrasound machines
Indicator
Number of machine in use
Year put machine into
operation
Total staff
Doctor
Technician
Others (engineers, admin,
public health, etc...)
Number of doctors trained in
colour ultrasound
Number of trained technicians
Number of proficient
technicians
Friendship
3
1993
Ha Tay
1
2000
Ba-Ria
1
2000
11
8
3
10
4
6
8
7
1
0
0
0
8
4
5
0
0
1
11
4
2
5.2.3
Current situation of utilization of colour
ultrasound machines
Results in Table 13 show that the average times of
doppler ultrasound per month is very different between
hospitals. While Friendship hospital reported “Overload”
with 50 cases of test per day (1,000 cases per month), Ha
36
Tay hospital said that they use up capacity with 60 cases
per day, and Ba-Ria hospital indicated that they rarely
use the machine with 180 cases per month (about 5-6
cases/day).
Price per case of ultrasound as regulated (Circular
14/TTLB dated 30/9/1995) is VND 10,000-20,000 for grey
ultrasound
and
VND
20,000
to
80,000
per
colour
ultrasound.
In
2006,
Circular
03/TTLT
supplements
additional prices to some techniques as compared to
Circular 14. According to Circular 03, price of colour
Doppler for heart/vein is VND 80,000 to 150,000. Other
ultrasound may costs VND 500,000 such as colour doppler
for heart/vein through gullet or Endeavour ultrasound of
heart.
Survey
results
show
that
ultrasound is VND 20,000 per test
of doppler in Ba-Ria hospital is
is temporarily using the price of
to colour ultrasound. Obviously,
more expensive diagnostic method
used in necessary cases.
the
price
of
grey
in all hospitals. Price
VND 80,000 while Ha Tay
grey ultrasound applied
doppler ultrasound is a
therefore it should be
Table 13 Current situation of most used colour ultrasound
machines in 3 hospitals
Colour ultrasound
Number of machine
Workable machine
Number of staff using
machine
Utilization capacity
No. of test/day
No. of test/month
Price per case of
colour ultrasound
Price per case of grey
ultrasound
Friendship
3
3
11
Ha Tay
1
1
4
Ba-Ria
1
1
8
Overloaded
50
1000
Up capacity
60
1500
Rarely used
5-6
180
VND 20,000
VND 20,000
VND 80,000
VND 100,000
VND 20,000
VND 20,000
In interviews, all hospitals comments on efficacy of
using doppler ultrasound machine. Doctor in Ha Tay said
that many clinical doctors fail to update knowledge
in
order to appoint utilization of doppler ultrasound. In
the meantime, Ba-Ria hospital staff reported that they
fail to use full capacity of doppler ultrasound machine.
At present, they use the machine mainly for heart
diseases, rarely used for detecting vein as they lack
well trained staff and poor quality of the machine. In
Friendship hospital, doppler ultrasound machine is
overloaded even when they have 3 machines. The number of
patients with heart disease is increasing. Furthermore,
colour doppler ultrasound machine in Friendship hospital
37
is used not only for diagnosing heart diseases but to
examine liver, bile, kidney, spleen, pancreas, ovary and
prostate. Friendship hospital is also using colour
ultrasound machines to diagnose tumours, probing lung
membrane and take biopsy of liver. Friendship hospital is
also facing difficulties as they lack the probe for
biopsy of prostate and colour films. They have to use
grey film therefore it is difficult to analyze and
diagnose the disease.
5.2.4
Current situation of machine repair
In all hospitals reporting about doppler ultrasound,
they all have monitoring notebooks with regular updates
of the machine. Warranty time is usually 1 year, but some
hospitals have 18 month warranty. In general, most
hospitals do not face difficulties during the warranty
time.
The frequency of maintenance is different in
different hospitals. Friendship hospital takes a yearly
maintenance, Ba-Ria hospital takes quarterly. Maintenance
work is undertaken by the machine supplier. In 2005, only
one hospital reported about a shortage of fund for
maintenance because warranty period has lapses, and they
have to pay VND 4 million per year for maintenance.
Table 14 Repair, maintenance of most used ultrasound machines
Machine with
monitoring
notebooks
Years of warranty
Any problems
during warranty
period
Maintenance time
Maintenance
agency
Annual
expenditure of
maintenance in
2005
Times of repair
since Purchase
Costs of repair
in the latest
time
Reason for repair
Number of
hospital staff
repairing and
maintaining CT
Friendship
Yes
Ha Tay
Yes
Ba-Ria
Yes
18 months
None
1 year
None
1 year
None
Every year
Machine
supplier
0
No data
available
Machine
producer
No data
Quarterly,
whole machine
Machine
supplier
VND 4 million
0
0
3
No data
No data
VND 77
million
Never ever
broken
5
No data
Poor quality
machine
0
0
38
Information from hospitals reports that Friendship
hospital (purchased in 2004) and Ha Tay hospital
(purchased in 2006) have never had it repaired. Ba-Ria
Hospital has to repair it 3 times, the latest repair time
they had to pay USD 5,000 (about VND 77 million). When
asking about the reason for repair, the answer is poor
quality machine.
5.3 Current situation of investment and utilization
of CT system
5.3.1
Current situation of investment in CT system
Data from hospitals indicate that the CT scanner system
is appointed to use as below:
Table 15 Information of appointment and use of CT scanner
Hospital
Appointed to use CT
Friendship (Machine Scan heart artery
with supplemented
Kinetics
probe)
Nerve system
Mobility
Saint-Paul
Skull
Vertebral column,
Chest, abdomen
Ha Tay
Skull
Thorax
Abdomen
§ONG Hoi (Quang
Skull
B×nh)
Abdomen
Chest
Vertebral column
Ba Ria
Cerebral injury (75%)
Cerebral stroke
Probing blocks in body
Abdominal and thorax injuries
So, the appointment of CT use in 5 selected
hospitals is compatible with the technology design.
However, whether or not hospitals use CT when they have
cheaper alternatives such as ultrasound in some cases?
This question needs further studied as within this study
we are unable to scrutinize it. Usually, for use of CT
scanner, if patients want to be paid by health insurance,
they need to be wholly consulted (according to the pilot
study in Thanh Nhan hospital). But for out-of-pocket paid
patients, there is no binding mechanism that limits use
of CT in unnecessary cases.
The study results also show that each hospital has
from one to 2 machines. In 5 hospitals, only one hospital
has broken machine. The oldest machine bought in 1997 in
39
Ha Tay hospital but all 5 hospitals
purchased since 2000 (Table 16).
have
machine
Table 16 Situation of investment in CT system of 5 selected
hospitals
CT system
No.of broken
machine
Oldest
machine
bought in
Latest
machine
bought in
Friendsh
ip
1
0
SaintPaul
2
0
Ha Tay
Dong Hoi
Ba-ria
2
1
1
0
1
0
2002
2000
1997
2003
2000
2002
2004
2005
2003
2000
The origin of machine is also very diversifed. Of
all 5 hospitals, there are 2 hospitals purchasing from
GE, 3 hospitals purchased from Toshiba, and the rest
purchased machine from many suppliers and countries
including Picker (USA), Hitachi (Japan). Reports from
hospitals indicate that most recently purchased machines
are brand-new with complete system and length of use as
designed from 10-15 years. In Ha Tay hospital alone, the
current CT scanner was purchased second hand without
knowing its age but in very good working condition. Most
these machines were purchased using the Government
budget, only Ha Tay hospital used mobilized fund from
private contributions. Purchase price ranges from VND 3
billion to 7.3 billion depending on the time of purchase
and its capacity and suppliers. Some hospitals, in
investing in new CT machine, have to build separate room
to place it in. Most hospitals have to purchase
supportive air-conditioners, adaptors, humidifier in
order to maintain the CT scanner system, and such
additional cost should be included in the cost of
purchasing machine (See Table 17). Ha Tay hospital alone,
when purchasing new machine, they have to build a new
place that has sufficient conditions to place a CT
scanner.
Table 17 Information of CT in 5 selected hospitals
Brand, name
of machine
Country of
production
Is the
system
complete
Friendshi
p
GE
SaintPaul
Toshiba
Ha Tay
Dong Hoi
Ba-ria
Toshiba
Toshiba
USA
Japan
Japan
GE
CT
Hispeed
Fx-i
USA
Yes
Yes
Yes
Yes
Yes
Japan
40
Friendshi
p
Brand-new
SaintPaul
Brand-new
Ha Tay
Dong Hoi
Ba-ria
Old
Brand-new
Brand-new
Length of
utilization
as designed
Time of
Purchase
15 years
Repaired
but
currently
in use
10 year
Some
technical
errors but
solved
No data
available
Repaired
but
currently
in use
15 years
Repaired
but
currently
in use
10 years
12/2002
2000
4/2003
8/2000
Time
putting
machine
into
operation
Original
price
12/2002
2001
10/2005
(bought in
1994)
10/2005
4/2003
11/2000
VND 5-6
billion
VND 3
billion
VND
7,344.0
million
Air-con,
adaptor,
printer
(included
in the
purchase
price),
humidifie
r, vacuum
cleaner
100%
governmen
t budget
VND
3,744.6
million
Transform
er
station
(VND 340
million)
Status of
machine at
Purchase
Current
status
Supportive
equipment
Source of
funding
Aircondition
ers
electrici
ty
adaptor
(VND 20
million)
100%
governmen
t budget
100%
governmen
t budget
100%
supported
by donor
100%
governmen
t budget
5.3.2
Situation of staff and staff training in use of
CT
Data of hospitals indicate that numbers of staff who
use CT are very different in different hospitals.
Friendship hospital and Ba-Ria hospital have 6 to 7
doctors and 3 to 6 technicians to support doctors. SaintPaul hospital with 2 machines has 5 doctors and 4
technicians using CT. Dong Hoi and Ha Tay hospitals have
only 2 to 3 doctors using machine but none of them is
proficient in using it (See Table 18).
Before putting CT into use, most hospitals have sent
doctors and technicians for training, except for some
hospitals whose staff had been trained in image diagnosis
in medical school. However, among 5 selected hospitals,
only one hospital send clinical doctors for training in
CT, the remainders are doctors of image diagnosis. This
41
suggests that there might be problem in the fact that
clinical doctors appointed to use and analyze results
from CT in diagnosis and treatment (See Table 18). In
Friendship hospital, there is a shortage of staff using
CT scanner, and contracting doctors to meet the needs for
using CT scanner.
Table 18 Basic information of staff working on most used CT
Indicator
No.working
machine
Year put into
operation
Total staff
Doctor
Technician
Others
(engineers,
admin, public
health, etc...)
Number of
doctors trained
in CT
Number of
trained
technicians
Number of other
staff trained in
CT
Number of
proficient
technicians
Friendship
SaintPaul
Ha Tay
Dong Hoi
Ba-ria
1
2
1
1
1
2002
2001
2005
2003
2000
12
6
6
11
5
4
10
2
7
7
3
4
10
7
3
0
2
1
0
0
6
3
2
1
7
6
2
2
0
3
0
0
0
0
0
No data
10
4
2
9
5.3.3
Current situation of utilization of CT scanner
According to hospital reports, only 2 hospitals
reporting that they have used CT at overloaded level. Ha
Tay hospital reported that they fail to use full capacity
of the machine while Saint-Paul and Dong Hoi hospitals
used up capacity of the machine. However, the number of
test/month is very different between hospitals. Most
machine in hospitals takes about 10 cases/day. CT of
Friendship hospital is always used in cardiovascular area
leading to overload of machine use (Table 19).
The price per case of CT, according to the policy of
partial collection of use fee (Circular 14/TTLB dated
30/9/1995) is VND 300,000 to 1 million. Survey in the
hospitals indicates that the average price per case of CT
is VND 500,00 – 850,000. It is possible to calculate
revenue from machine at the price of VND 800,000 per case
per year of a hospital. When comparing revenue from
service charge with purchase price, it is calculated that
42
it might take only 2 years for the hospital to recover
the investment cost, while it might take 5 years in Dong
Hoi hospital where the machine is rarely used. Of course,
we have to take into account the operating costs,
maintenance, repair in order to identify whether the
investment is cost-effective. Other costs such as film,
chemicals and spare parts are not collected for analysis.
Table 19 Current situation of utilization of CT in 5 hospitals
CT scanner
case/month
Utilization
capacity
No.of test
per day
Price per
case
Friendsh
ip
240
Overload
Ha Tay
Dong Hoi
Ba-ria
70
Behind
capacity
6-7
160
Not
overload
10
454
Overload
12
SaintPaul
300
Not
overload
10
VND 700
thousand
VND 800
thousand
VND 800
thousand
VND 850
thousand
VND 500800
thousand
NO DATA
5.3.4
Management, maintenance and repair of machine
In the literature review, lack of ability for prompt
repair limits effective use and exploitation of machine
capacity. Study results show that all machines have
monitoring notebooks and are recorded regularly. Three
out of 5 hospitals maintain the whole CT scanner system
in quarterly basis but one hospital maintains whole
machine once every year, and 1 hospital only maintains
partially on yearly basis at request (as purchase of
second hand machine). Warranty time often lasts from 1 to
2 years. If the machine is still warranty time, the
hospital pays nothing for maintenance but when the
warranty period is over, they may pay from VND 30 to 64
million per year (See Table 20).
Two out of 5 hospitals have to repair the CT
scanner system but only one hospital reported paying VND
500 million for repair. In general, most machines are
working smoothly. For CT, hospitals rely on the suppliers
or producers to repair or maintain the machine. However,
most hospitals send staff for training in maintenance of
CT scanner system.
Table 20 Situation of maintenance, repair of CT system
Friendship
Machine
with
monitoring
notebooks
Years of
warranty
Yes
SaintPaul
Yes
2 years
1 year
Ha Tay
Dong Hoi
Ba-ria
Yes but
note record
regularly
Yes
Yes
None as the
machine is
too old
2 years
1 year
(70,000
slices)
43
Any
problems
during
warranty
period
Errors in
the main
processor
None
Maintenance
time
Quarterly
whole
machine
Maintenance
agency
Engineer
of the
supplier
Every
year,
whole
machine
Supplier
Annual
expenditure
of
maintenance
in 2005
Times of
repair
since
Purchase
Costs of
repair in
the latest
time
No.of
hospital
staff
repair and
maintain CT
machine
No data
No data
Errors in
the
operator
of the
lifting
table
Every year Quarterly
partial
whole
maintenance
machine
None
Quarterly
whole
machine
Supplier
Engineer
of the
supplier
Engineer
of Luc
Tinh
Company
(Machine
provider)
VND 64
million
VND 30
million
Don’t know
0 (in
warranty
time)
Not yet
Not yet
2 times
Minor
repair
1
No data
No data
Don’t know
No data
VND 500
million
5
6
0
0
0
Although most interviewed hospitals reported that
they do not face many difficulties in maintenance and
repair CT scanner system, Saint-Paul hospital recommends
that the MoH should only allow suppliers or producers who
are able to repair and maintain machine to be provided
with license for sale. This suggests that the hospital
has ever faced difficulties in maintaining medical
equipment as they bought the machine from a supplier
without in-the-spot maintenance resources.
5.4 Investment and utilization of digestive endoscope
5.4.1
Current situation of investment in endoscope
For digestive endoscope, all 5 hospitals reported
having machine that can perform endoscope of upper
digestive system.
Table 21 Information of appointment and use of endoscope
44
Name of hospital
Friendship
Saint-Paul
Hatay general
hospital
Dong Hoi hospital
Ba-ria hospital
Appointed to use endoscope
esophagus, stomach, duodenum, large
intestine
Whole digestive system (esophagus,
stomach, duodenum)
Biopsy to detect malignant cells or
treat ulcers of bleeding
esophagus, stomach, duodenum, large
intestine
esophagus, stomach, duodenum, large
intestine
Upper digestive system, esophagus,
stomach, duodenum
Digestive
endoscope
is
placed
in
different
departments depending on different hospitals: (endoscope
in
functional
exploration
(2/5
hospitals),
image
diagnosis (1/5 hospitals), digestive department (1/5
hospitals)
and
internal
medicine
(1/5
hospitals).
Decision to place endoscope in any department depends on
the size of hospital and specialization of work. In small
hospitals,
endoscope
staff
often
takes
on
other
responsibilities.
In all 5 hospitals, the oldest machine bought in
1997 and 2000, and the latest machine bought in between
1998 and 2005. Four hospitals have endoscope purchased
since 2000. Break-down of endoscope is a problem for 3
hospitals (causes leading to the break down of machine is
described in maintenance section). All hospitals have
endoscope for stomach, duodenum, only 4 hospitals have
endoscope for large intestine but only 2/4 endoscope for
large intestine are working. Some machines can perform
endoscope of both upper and lower digestive system.
Table 22 Investment in endoscope in 5 selected hospitals
Department
where
digestive
endoscope
placed
No.of
endocope
No.of
broken
machine
Friends
hip
Digesti
ve
departm
ent
Saint-Paul
Ha Tay
Image
diganosis
dept,
endoscope room
Functiona
l
explorati
on dept
Dong
Hoi
Functio
nal
explora
tion
3
5
4
3
0
2 needs
repaired/repla
ced (1 large
intestine, 1
stomach)
3
1
(waitin
g for
funding
for
repair)
Ba-ria
Internal
medicine
,
endoscop
e room
1
0
45
Type of
endoscope
Oldest
machine
bought in
Latest
machine
bought in
Friends
hip
7
tubes:
large
intesti
ne (3),
stomach
(3),
duodenu
m (1)
Saint-Paul
Ha Tay
Large
intestine (2),
stomach (3)
Large
intestine
(1),
duodenum
(2),
rectum
(1)
[endoscop
e of
rectum is
in good
condition
]
1997
1999
1998
Dong
Hoi
Large
intesti
ne
(broken
),
stomach
,
duodenu
m,
rectum,
abdomen
with
video
camera
system
2000
2004
2005
1998
2005
Ba-ria
Stomach,
rectum
with
soft
tube
2000
2000
Most endoscope machines in 5 selected hospitals
originate from Japan (Brand Fujinon, Pentax, Olympus),
one endoscope of rectum was purchased from Germany. Most
machine is complete, but Dong Hoi hospital alone is
provided with an incomplete video endoscope for abdominal
area. Among the most recently purchased machines, 3
hospitals use the government budget to buy it; Friendship
hospital uses its own fund, while Ha Tay hospital is
supported by international grant (See Table 23). The cost
for purchasing new machine ranges from VND 285 million to
800 million. There is no data of additional investment
supporting the machine. Only 2 hospitals reported that
they have to buy air-conditioners or other sterilization
instruments, etc… No reports from other hospitals. Dong
Hoi hospital has an incomplete video endoscope for
abdominal area but rarely use it (lack cylinder of C02).
Table 23 Information of endoscope in 5 selected hospitals
Brand, name
of machine
Friendsh
ip
Pentax
(stomach
and
large
intestin
e)
SaintPaul
Fujinon
EG 250PE
(stomach
,
duodenum
)
Ha Tay
Dong Hoi
Ba-ria
Fujinon
(stomach,
duodenum)
Olympus,
GET E8
D2 + CFU
01
(stomach
,
duodenum
, large
intestin
e)
Olympus
46
Country of
production
Is the
machine
complete?
Status of
machine at
Purchase
Length of
utilization
as designed
Time of
purchase
Time put into
operation
Original
price
Friendsh
ip
Japan
SaintPaul
Japan
Ha Tay
Dong Hoi
Japan
Japan
Yes
Yes
Yes
No
Yes
New
New
New
New
New
15 years
No data
10 years
No data
No data
2004
1/2002
1997
7/2005
4/2000
2004
2/2002
3/1998
7/2005
5/2000
No data
VND 500600
million
No data
VND 802.1
million
VND
284.5
million
Airconditio
ner
VND
447.8
million
No data
100%
governme
nt
budget
100%
governme
nt
budget
Supportive
equipment
Tube
cleaning
machine
Source of
funding
100%
governme
nt
budget
100%
governme
nt
budget
Air-con,
adaptor,
vacuum
cleaner,
operating
light,
set of
steriliza
tion (VND
188
million);
new room
100%
internati
onal
donated
Ba-ria
Japan
Notes: Exchange rate in 1997 was VND 12,330 =1USD
5.4.2
Current situation of staff and staff training in
endoscope
Study results of most used endoscope indicate that
the lowest number of doctor per machine is one (SaintPaul hospital) and highest is 2 doctors per machine (3
remainder hospitals). Most hospitals have technicians to
support doctors in giving and cleaning the tools.
In order to use endoscope, all hospitals have to
send doctors for training and some hospitals send
technicians for training. The number of staff using
machine proficiently is equivalent to number of doctors
using endoscope.
Table 24 Basic information of staff using most used endoscope
Indicator
Total
Friendship
3 (both
SaintPaul
Ha Tay
3
Dong Hoi
1
2
Ba-ria
1
47
working
machines of
the same
type
Year put
into
operation
Total staff
Doctor
Technician
Others
(engineers,
admin,
public
health,
etc...)
Number of
doctors
trained in
endoscope
Number of
trained
technicians
Number of
other staff
trained in
CT
Number of
proficient
technicians
stomach (stomach,
and large duodenum)
intestine)
(stomach (stomach/ (stomach,
and duodenum) duodenum)
duodenum)
1997
2002
1998
2005
2000
8
5
3
5
2
3
4
2
2
5
2
2
2
2
2
0
0
0
1
0
5
2
3
4
2
3
0
2
2
0
0
0
0
0
0
8
5
4
5
2
Notes: In Friendship hospital, interviews of information on utilization of
machine bought in 1997 are different from the machine described in Table
23
Saint-Paul hospital applies the endoscope technology
in early time as they have large size hospital and has
accumulated experience. At present, Saint-Paul hospital
takes a role in technical support for lower level
hospitals, creating a place for doctors from other
hospitals to practice in endoscope techniques.
5.4.3
Current situation of utilization of endoscope
Results in Table 25 show that among survey machines,
there is a great variation in the number of test per day
or month. Lowest is 80 cases per month in Ha Tay hospital
(where more endoscope machine is broken down), and
highest in Saint-Paul hospital and Friendship hospital,
from 2 to 3 machines. Friendship hospital has a spare
machine in case the other machine is broken down.
However, in Dong Hoi hospital, although the machine use
less (only 150 cases per month), it is reported that they
are overloaded.
48
Table 25 Current utilization of digestive endoscope in 5
hospitals
Endoscope
No.of
working
machine
No.of staff
using
machine
No.of test
per day
No.of test
per month
Utilization
capacity
Price per
case
Friendshi
p
3 (2
stomach,
1 large
intestine
)
8
SaintPaul
2
Ha Tay
Dong Hoi
Ba-ria
1
(rectu
m)
1 (stomach/
duodenum)
1
5
4
5
2
18
(stomach)
7 (large
intestine
)
250
(stomach)
, 80
(large
intestine
)
Overload
15
NO
DATA
10
10
320
80
150
200
Overload
Rarely
used
VND
24,000
(rectu
m)
Overload
average
VND 30,000
(stomach,
esophagus,
rectum),
VND 45,000
(large
intestine),
VND180,000
and
injection
and clip to
stop the
bleeding
VND
60,000(
stomach
-VND
150,000
(lamina
te and
take
worm./i
njectio
n/clipt
o stop
the
bleedin
g)
VND
70,000
(stomach)
, 250,000
(large
intestine
)- 1.5-2
million
(laminate
and take
stone/wor
m/foreign
body)
VND
30,000
(stomach,
abdomen,
rectum),
VND
45,000(la
rge
intestine
,
laminate
and
stretch
esophagus
/biopsy)
Notes: In Friendship hospital, interviews of information on utilization of
machine bought in 1997 are different from the machine described in Table
23
The price of endoscope is charged by policy of
partial collection of user fee (Circular 14/TTLB dated
30/9/1995) and is different: endoscope of large intestine
+/- biopsy is VND 15-45,000, rectum, stomach or abdomen
+/biopsy
is
VND
10-30,000.
In
2006,
Circular
03/2006/TTLT dated, 26/1/2006 supplements prices for some
services which were not included in the Circular 14/TTLB.
Endoscope of stomach attached by injection or clip to
stop the bleeding is VND 50-250,000, small intestine is
VND 230-320,000, small intestine and injection, clip to
stop the bleeding or cut polup is VND 250-400,000,
endoscope of large intestine attached by injection or
49
clip to stop the bleeding is VND 270-320,000 and rectum
attached by injection or clip of hemorrhoids is VND 100150,000.
According to the survey, the price of health
insurance or user fee is lowest for endoscope of stomach,
esophagus and rectum, ranging from VND 24-70,000 in
different hospitals. Endoscope of large intestine is a
little higher from VND 45-250,000. Highest price
is
endoscope combined with treatment such as take stone out,
worm, foreign body or injection at VND 150,000 to 2
million per case. The price is highest in Friendship
hospital, lowest in Ha Tay Hospital. For Saint-Paul
hospital, apart from price paid by HI, they charge higher
price at request of clients. For endoscope, the price
ranges from VND 100.000 to 1 million, depending on
different procedures. Even, some procedures are not
included in the HI, they perform at request of clients.
5.4.4
Current situation of maintenance and repair of
machine
For endoscope, the capacity of utilization is poor
due to broken machine. The tube of endoscope is very
sensitive and requires very careful utilization and
maintenance. Information in Table 26 shows that all 5
hospitals have monitoring notebook and 4 out of 5
hospitals
have
regular
recording.
Three
hospitals
reported maintenance on daily basis, one hospital on
quarterly basis and one without maintenance. Those
hospitals without maintenance (Ha Tay) also have most
machines broken and lowest price of endoscope. Only 3 out
of 5 hospitals have repair and maintenance staff of
endoscope.
Warranty time is usually 12 months to 18 months,
some hospitals have agreement with the supplier therefore
they benefit free-of-charge maintenance but pay only
spare-part. However, most hospitals reported that they
don’t face any difficulties during the warranty time
except for minor repairs. In 2000, in 5 selected
hospitals,
no
hospital
reported
having
fund
for
maintenance of endoscope.
Table 26 Maintenance and repair of endoscope
Friendship
Machine
with
monitoring
notebooks
Years of
warranty
Ha Tay
Dong Hoi
Ba-ria
Yes
SaintPaul
Yes
Yes
Yes
Yes but not
regularly
18 months
1 year
1 year
1 year
All time
free
50
Any
problems
during
warranty
period
Maintenance
time
Maintenance
agency
None
Minor
repair
None
None
Daily
Daily
Daily
Staff of
endoscope
room
Staff of
endoscope
room and
engineer
of
supplier
0
No
maitenance
NO DATA
Times of
repair
since
Purchase
Costs of
repair in
the latest
time
Reason for
repair
1
(stomach),
2 (large
intestine)
VND 50
million
Old (since
1997)
Overload
No.of
hospital
staff
repair and
maintain CT
machine
6
4
NO DATA
maintenance
None
Staff of
endoscope
room
Quarterly,
partial
Staff of
center for
maintenance
Broken,
awaiting
repair
Broken
1
NO DATA
No fund, no
repair
NO DATA
Glass
Unstable
Mistakes of
system is
source of
staff
not good,
electricity
no regular
maintenance
1
0
0
Notes: In Friendship hospital, interviews of information on utilization of
machine bought in 1997 are different from the machine described in Table
23
Of two hospitals that bought endoscope longest time
ago, Friendship hospital had to repair 3 times in one
machine, while Ha Tay hospital with all machines broken
down but no fund for repair. Other hospitals have
repaired once or waiting for fund for repair or no need
for repair as the machine is still new.
Reasons for repairs are much diversified. Some
hospitals reported of poor quality of the machine
(donated), or used too much (since 1997 or overused), or
unstable source of electricity or mistake of staff.
Experience of Friendship hospital and Saint-Paul
hospital show that if we perform as the instructions with
regular maintenance, there’s little chance for the
endoscope to be broken. However, if the machine has been
used for too long, it needs repair.
51
5.5 Investment in 3 high-tech medical equipment of 5
hospitals
Apart from collection of detailed information of each
machine, interviews of hospital leaders were also taken
in order to have better insights into the investment in
high-tech medical equipment. This section will analyze
the study results related to factors such as Decision on
investment, process of investment and incompleteness in
investment.
5.5.1
Factor that decides on investment
Most hospital leaders reported that before the
Provincial Health Bureau and the hospital decided to
invest in high-tech medical equipment, specifically
doppler ultrasound machine, endoscope and CT scanner,
they had taken into account the following factors:
1. They are provincial general hospital with the
highest techniques in the province, it must be
compatible with the trend of integration and
requirement for industrialization and modernization
of the locality.
2. Local people’s needs for health care, and requires
to improve quality of care and development of the
hospital.
3. Technical
expertise,
techniques
of
specialized
health staff has been trained in combination with
the current physical infrastructure of the hospital.
In addition, these hospitals are under the pressure
of implementing Decree 43/CP regulating autonomy and
accountability for the tasks, organization of the
apparatus, payroll and finance in public institutions and
health facilities, in particular. Decree 43 creates
conditions for the facility to improve quality of life
for hospital staff by exploiting health services at
request of clients in order to obtain more revenue. In
the light of increasing needs for services, some segments
of population want to be served at demand and able to pay
for high fees. In response to this practice, some
hospitals have opened up department of health care at
request therefore they have to invest in high-tech
medical equipment.
5.5.2
Process and forms of investment
The survey results show that the process (or
procedures/steps) of investment depends on the form of
investment. There are 2 forms of investment: top-down and
need-based.
52
According to the top-down form: hospitals are
completely inactive in the Decision on what to purchase?
From what suppliers? Which generation of machine? Also,
there is no preparation for the new technology: lack of
workshop, physical infrastructure, appliances, specially
trained staff in order to use new technology. This form
of investment is often seen in project that has budget
allocation.
A Typical example of this is Ha Tay hospital.
According to the information presented in Section 3.2 to
3.4, Ha Tay hospital has invested in all CT, digestive
endoscope
and
grey
ultrasound
from
international
donation. Decisions on investment were made by the
Provincial Project Management Unit of all machines,
suppliers. At present, 3 out of 4 endoscopes are broken,
one grey ultrasound machine has error in the monitor and
unable to repair it. Director of Ha Tay hospital said:
“the supplier has dissolved, these machines are the last
in their catalogue, there is no money to repair or invest
in these machines. The hospital is poor while it still
has to feed this old elephant (great money). It is placed
here and unable to sell or liquidate it”. For Hatay
hospital, this form of investment leads to the fact that
expensive and modern machines are not used effectively as
they are not compatible with the needs of patients
(doppler ultrasound while there are few heart patients),
broken
(endoscope),
lack
of
spare-parts,
supplies
(“caset” CT is not complete with the machine; lack of
spare part for endoscope; doppler ultrasound lack
appropriate probe to exploit full capacity of the
machine), lack trained staff to operate and analyze
results (Ultrasound machines Alloca). Opinions of health
staff indicate that in order to improve this situation,
opinions of clinical doctors should be taken into account
when deciding on investing in medical equipment.
According to need-based investment (that is based on
the proposal of hospital), after arising the needs for
investment in medical equipment, they consider various
factors
to
decide
to
purchase
high-tech
medical
equipment, and leaders of the hospital have to seek for
financing source. Sources of fund or form of investment
may come from government budget or allocated by the MoH,
or mobilization from the province/hospital or grant from
international donors.
A procedure for investment includes the following
steps:
53
Step 1: A technical committee will discuss the Decision
on investment in which medical equipment, for which
department and timeline.
Step 2: Hospital invites experts, central hospital,
machine counselors, select suppliers, generations and
cost.
Step 4: Carry out public bidding.
Step 5: Preparation: training staff, space and facility,
supplies and spare parts for the operation of machine.
Step 6 Installation and monitoring.
Such an investment procedure seems reasonable and
scientific. However, some hospital leaders still complain
that this form of investment is proving certain
limitations when the funding source comes from Government
budget. First, annual source of fund for equipment is
very little and not enough to procure expensive and
modern machine. Second, the procedures for approval are
troublesome and very slow due to the mechanism of
“Begging and Giving”. It is commonly reported that they
have to wait for 4-6 months, even 1 year (Ba-Ria
hospital) to have the proposal approved. Third, poor
knowledge of modern machine of hospital therefore
sometimes they purchased poor quality machine (Doppler
ultrasound machine -Ba-Ria hospital) or poor maintenance
service (CT Saint-Paul hospital). Four, although the
bidding process is open, supplier decides on the price
because the hospital lacks information.
Other sources of fund which is considered rational
by Decree 43/CP on autonomy and mobilized fund. The
source of fund may come from 3 sources: joint-venture,
cooperation with the suppliers, or private sector, and
Joint-stock company (international and domestic). For
example, Ba-Ria hospital collaborates with Australia and
Vietnam Petrolimex. In Saint-Paul hospital, the hospital
has mobilized fund by selling out hospital shares for its
staff its joint-venture fund to invest in the department
of health care at request.
Given such a form of investment and source of fund,
the procedure for investment includes the above-mentioned
steps plus budget estimates and submit to higher level
for approval. This form of investment facilitates
hospitals to be active in procuring equipment. The
process is quick or slow depending in the fund
availability.
54
Thus, form of investment and source of fund
purchasing medical equipment are decisive factors.
for
5.5.3
Completeness in investment in medical equipment
Lack of completeness in investment in equipment may
lead to waste and inefficiency. In order to assess the
completeness
of
investment
in
high-tech
medical
equipment, this study takes into account 4 following
factors:
 Completeness
between
type
of
equipment
and
functions, ability to appoint and use the results of
the hospital
 Completeness between type of equipment and staff
training to be able to use and operate new machine
 Completeness between type of equipment
details, spare parts and producers
and
its
 Completeness between type of equipment and physical
infrastructure: housing, electricity, anti-humidity,
materials and supplies
Of these 4 factors, completeness between type of
equipment and its details, spare parts depends on
the
supplier,
generation
and
contract
of
procurement, therefore it is very difficult for the
hospital to overcome. To address this issue, the
hospital should invite experts or consulting groups
to advise about the equipment. The other 3 groups of
factor, the hospital can actively handle even in the
Decision on investment
The
study
group
has
discussed
with
leaders,
conducted in-depth interviews head of equipment and
supplies department, head of planning department. Survey
results show that with various forms of investment and
abundant sources of fund, all these 5 selected hospitals
have purchased modern equipment for health care and
improve its effectiveness in diagnosis and treatment.
Besides, these hospitals also withdraw experience
lessons in investing in high-tech medical equipment.
 In general, all high-tech medical equipment such as
ultrasound, endoscope, CT …, is behind the people’s
needs for health care.
 Even fund for medical equipment comes from any
source, it is recommended that hospital be given
autonomy to decide.
55
 Technical issues should be taken into serious
consideration to limit the perfunctory bidding and
price coercion from suppliers.
 Investment in high-tech medical equipment must be
compatible with physical infrastructure and training
of staff in order to use the machine effectively.
5.6 Assessment of effectiveness and equity in using 3
types of high-tech medical equipment of 5
selected hospitals
In
Section
3.2
to
3.4,
current
situation
of
investment and utilization of 3 types of equipment
(ultrasound, endoscope, CT scanner) in 5 hospitals are
presented. In order to assess the effectiveness of
utilization of 3 types of equipment, this study focuses
on some indicators and information collected about the
machine, and most used machines.
5.6.1 Current situation of utilization
Table 27 presents the proportion of working machines
by hospital and type of machine. In 2 hospitals, the
proportion of working machine is 100% for all machines.
The remaining hospitals have at least one of three survey
equipment unusable. Study results indicate that doppler
ultrasound machine and CT scanner are the least broken
down machine as compared to endoscope. In Endoscope, 3
hospitals are having broken machines as compared to one
hospital with broken CT and no doppler ultrasound machine
is broken. Obviously, any hospital that has more broken
machines will obtain less effective performance than
other hospitals that have no broken machines.
Table 27 Proportion of machine used
Friendship
Doppler
ultrasound
machine
CT
Endoscope
Ha Tay
100%
SaintPaul
NO DATA
Ba-ria
100%
Dong
Hoi
NO DATA
100%
100%
100%
60%
50%
25%
100%
66%
100%
100%
100%
Source: Based on information from Tables 10,16,22
The average number of staff per machine (including
doctor and TECHNICIAN) is different between types of
equipment, and between hospitals. Saint-Paul hospital has
a ratio of staff per machine, lowest in CT scanner and
endoscope, which suggests that it is possible to exploit
maximum capacity of the machine given few staff provided
that work assignment is made rational. CT seems to
56
require more
(Table 28).
staff
with
5.5
to
12
staff
per
machine
Among staff that have ever used machine, most of
them are doctors that means that there are few
technicians to support doctor in doppler ultrasound
machine, but more supportive staff is seen in Ha Tay
hospital. Ba-Ria hospital is the hospital that has
highest number of doctor using machine, and it is also
the last hospital applying high tech-medical equipment.
In the survey, we did not explore information of other
work of the informants therefore it is difficult to
identify working productivity of hospital where more
doctors are working on one machine?, because it is
possible that those who work on these machines can
perform other tasks of the hospitals. For example, doctor
diagnose image can perform CT scanner, take ultrasound
and x-ray. However, the skills of performing ultrasound,
CT scanner and endoscope depends very much on the regular
performance of the operators.
Table 28 Average number of staff per working machine
Friendship
Average no.of
staff per working
machine
Doppler
ultrasound
machine
CT
Endoscope
Proportion of
staff who are
doctors
Doppler
ultrasound
machine
CT
Endoscope
SaintPaul
Ha Tay
Dong
Hoi
Ba-ria
3,7
NO DATA
10,0
NO DATA
8,0
12,0
2,7
5,5
1,7
10,0
4,0
7,0
2,5
10,0
2,0
73%
NO DATA
40%
NO DATA
88%
50%
45%
20%
43%
70%
63%
40%
50%
40%
100%
Source: Based on information from Table 12
Table 29 indicate the average time of performing
test per month. According to the survey result, Ha Tay
hospital with a machine has performed 1,500 case of
colour ultrasound per month and Friendship hospital with
3 colour ultrasound machines provided 1,000 cases per
month while Ba-Ria hospital taken 180 cases per month.
Two hospitals using full capacity of the machine for the
purpose of diagnosing heart disease and other diseases
while Ba-Ria hospital only applies this technology to
diagnose heart disease thus they fail to use up capacity
57
of the machine. For CT scanner, Ba-Ria hospital performs
454 cases per month as compared to only 70 cases in Ha
Tay hospital. Endoscope also serves 80 -330 cases per
month.
Table 29 Data of utilization of medical equipment
Friendship Saint-Paul
Average case
per machine
per month
Doppler
ultrasound
machine
CT
Endoscope
Overload
Doppler
ultrasound
machine
CT
Endoscope
Ha Tay
Dong Hoi
Ba-ria
1000
NO DATA
1500
NO DATA
180
240
330
300
320
70
80
160
150
454
200
Overload
Overload
Overload
NO DATA
Used up
capacity
NO DATA
Rarely
used
Not
Behind
Not
Overload
overloaded capacity overloaded
Overload
Rarely
Overload
Average
used
Another way to assess capacity use of a machine is
the opinions from health staff in the department where
the machine is placed. According to the survey result,
Friendship hospital is overloaded in all 3 types of
equipment. Endoscope is most overloaded in 3 out of 5
hospitals. Hospital Ha Tay is the only hospital that do
not have overload issue in all 3 types of technology,
only doppler ultrasound machine is used up capacity.
However, in this survey, we just based in the subjective
assessment of machine operators. If we further study and
correlate with actual capacity used, it will come up with
more objective assessment. For Friendship hospital,
service of 240 cases of CT is considered overload, while
Saint-Paul hospital serve 300 case and is not regarded as
overload even when they have fewer operating staff.
Results
of
in-depth
interviews
reports
that:
utilization of high-tech medical equipment has made
contributions to improving quality, effectiveness in
diagnosis and treatment of disease with more accurate
results, shortening treatment time. Given such a result,
these
hospitals
have
improved
their
reputation,
attracting more patients and reducing referred and
bypassed patients from lower level.
However, if we assess the effectiveness of using the
machine by its capacity as compared to the design, it
will be very difficult because average service per
machine/time unit depends on: needs for techniques or the
58
decision of clinical doctors to take (or the proficiency
of the operator) and quality of machine (generation,
old/new machine, good condition or not good condition).
For example, in Friendship hospital, doctors may appoint
to use CT scanner for whole body (skull, abdomen, thorax,
liver…) therefore the patient visits using service are
not compatible with the resolutions or slides of the
machine. Or ultrasound machines of 3 or 4 dimensions,
number of slides/CT. even though, the results presented
in Table 29 show that the capacity of Friendship hospital
is relatively high as compared to other hospitals.
In order to explain for this issue, the Director of
the hospital said: “ Friendship hospital is a central
hospital where most of its patients are government staff,
or retired servants with serious diseases and benefit
higher services than other citizens”.
5.6.1
Cost-effectiveness in utilization of high-tech
medical equipment
As presented in the previous sections, in this
section we do not have sufficient data to assess the
efficiency of investment in high-tech medical equipment
but relies on the information provided by the MoH.
In the trend of integration, implementation of
Decree 43/CP with self-balance and financial autonomy,
costs of high-tech in public hospitals should be fully
calculated and correctly with depreciation of machine,
supplies and salaries for direct staff in order to avoid
the fact that one hospital has to price systems (the
price of service costs of hospital is lower than that in
the voluntary health care section). It is because of
this, that people often claim that the hospital abuse
high-tech bloc to charge patients. It is hard to solve
this problem as it related to the current regulations for
payment rate for insured patients while we fail to catch
full information of rate applied to insurance paid for
high-tech equipment (opinion of hospitals where they have
room for voluntary health care).
Most
interviewed
health
workers
reported
that
investment in utilization of high-tech equipment in
diagnosis and treatment has made contributions to
increasing revenue for the hospital and income for health
staff, in general. Information of income generated from
utilization of these three machines was not collected.
However, from the Hospital Inventory in 2005, information
of times using CT scanner and ultrasound and total
revenue of the hospital has been collected. By which,
59
with a price of VND 800,000 per case of CT scanner and
VND 20,000 per case of ultrasound, it is possible to
estimate total revenue of the hospital using this
technology. For example: in the Friendship hospital,
revenue from CT scanner accounts for 4% of total revenue
and ultrasound takes 1%. Meanwhile, in Ba-Ria hospital,
this proportion is 9% and 2% respectively1. It is
recommended that a study on hospital costing be conducted
in order to calculate the proportional profits of the
hospital from this technology. Revenue from endoscope is
very low, less than 0.5 % as compared to the total
revenue of these 2 hospitals.
Some opinions in group discussion stated that
funding
source
from
either
government
budget,
preferential loans, or grant has not been depreciated,
nor covered costs for supplies, maintenance and repair.
Therefore, when the machine is broken, the hospital is
awaiting for government budget for maintenance and repair
(this problem will be presented in later section –
Management and repair of equipment). Such an issue has
not been regarded as rational. For the funding sources
from mobilization, joint-venture or joint-stock from
hospital
servant,
most
hospitals
have
initially
calculated economic benefits from the investment.
However, due to limited time and conditions, we did
not scrutinize but the issue of cost-effectiveness will
be further studied when hospitals implement Decree 43/CP
or equitization in the spirit of Resolution of the 10th
Party Congress.
5.6.2
Current issue of equity in utilization of hightech medical equipment:
Vietnam’s
Party
and
Government
intentions
and
policies are to ensure equity and efficiency in people’s
health care. Equity means that all people benefit health
care that is all people of different segments regardless
of rich or poor, social strata benefit the same quality
health care services. There are many ways to assess the
issue of equity in health care, one of those ways is to
compare the level of using health services between the
rich and poor, those with and without health insurance.
Many authors claim that the main reason for the poor
In 2005, Friendsip hospital undertook CT for 3,496 cases and ultrasound
for 47,106 and total revenue is VND 68,129,992,000; Ba-Ria hospital serves
CT for 4,442 cases, ultrasound for 35,123 cases with a total revenue of
VND 37,769,755,000.
1
60
benefit less high-tech medical equipment is economic
barrier (unable to pay for health services) and
geographical barrier (the poor in mountainous, remote and
isolated area where less high-tech medical equipment is
available ), and even local costumes and practices.
Within this study, we will merely analyze the issue
of equity from the view of economics. Moreover, due to
limited time, we were unable to assess quantitative data
(the poor without health insurance vs. rich and insured
people using health insurance) but in the perspective of
how the service providers appointed and used high-tech
equipment?
Interview results and group discussion with clinical
doctors and health staff in 5 hospitals show that “The
use and appointment of high-tech medical equipment
depends in the conditions of the disease, ability to
provide services of the hospital. It is a matter of moral
ethics regardless of who the patients are and whether
they have money or not”. Or in other way, it can be said
that inequity in using high-tech medical equipment in
hospital is not a big issue. However, when conducting the
in-depth interviews, some issues arising, they are:
For insured patients: with the test using endoscope,
diagnosis is often made by clinical doctors and it is not
difficult to implement this service as payment for this
service is not much, health insurance will pay 100% of
the fees. With surgery using endoscope, the use of this
service should be taken into account because: “Minor
surgery using endoscope, quick post surgery (less than 3
days), but the cost for the surgery is very dear. It will
take 7 days for open surgery, for example; operation on
large intestine is VND 15 million as HI does not cover
all payment for the treatment, therefore they often
undertake open surgery. This means that the use of hightech medical equipment is still depending on the ability
to pay of health insurance.
However, when the issue is related to life or death
matter, there is no discrimination. For example, when
appointing to use CT, for insured patients, the cost may
by VND 800,000 -1 million/test therefore clinical doctors
have to ask for advice from head of the department or
whole consultation of the Directorate. For accidents,
injuries and emergencies, we can’t wait for whole
consultation, most decisions are made by doctor on duty
regardless of what kind of patients, rich or poor with or
without insurance.
61
The proportion of poor patients without ability to
pay has declined thanks to Decision 139 that provided
free health insurance cards for the poor (10/2002).
Medical costs for the poor will be paid by health
insurance. The pressing issue is ability to pay amongst
the near poor group. In these cases, most hospitals have
the same way out: Decision from department head, if the
appointment is compulsory then they will apply by Decree
661/CP- that is the patient have to be identified as poor
household by local authority and they will benefit freeof-charge hospital fees or exemption, or advise them to
replace with cheaper techniques.
However, in general assessment, most opinions report
that in the market economy, the rich can pay for hightech costs : “”High-tech equipment for the rich”. The
issue of concern is abuse of high-tech equipment, causing
heavy burden for patients and affect health status for
the patients. In response to this issue, most survey
hospitals reported that for public hospitals, appointment
to use high-tech equipment is completely appropriate with
the conditions of patients not to cause burden on them.
In our opinions, the question of abuse should be further
studied as we have not found any satisfactory answer from
service providers, and it should be considered from the
view of patients and clinical professionals or assessment
of medical records to see whether the use of high-tech
medical equipment is appropriate or not.
The explanation of hospitals about public rumors of
abuse of high-tech medical equipment: In actual fact, in
the last 5 years, high-tech equipment have been provided
for provincial and central levels of care in order to
contribute to improving effectiveness in quick and
accurate diagnosis and treatment and shorten treatment
time. Of course, the proportion of patients using these
high-tech services increases and leads to the rumour that
hospitals induce high-tech equipment to charge more money
from patients. Such an understanding is not correct.
Hospitals also claim that if the doctors do not
appoint high-tech services, patients may say that the
doctors
are
not
enthusiastic
and
fulfill
their
responsibilities. Such a practice leads to the fact that
patient requires to use high-tech medical equipment. For
example: Patients with bile stone, doctor appoints to use
grey ultrasound at VND 30,000, patients may require to
undergo colour ultrasound at VND 200,000 or “Fetus
ultrasound, they require 4 dimension ultrasound to be
proud of”(Doctor in Friendship hospital).
62
Staff in surveyed hospitals also reported that the
price of pirate clinics is much higher and is 10-15%
higher than that in public hospitals but the patients
accept that fact. In private clinics, qualification of
doctors is not good, and accept any requirement of
patients, leading to a waste in utilization of the
machine. Some staff in public hospitals comments on
private clinics: “They work for money, not health of the
people.”(In-depth interviews of endoscope doctors in
Hospital Ha Tay).
5.7 Management, maintenance and repair of high-tech
medical equipment
In order to implement the national policy for medical
equipment period 2002-2010, approved by Government by
Decision 130/2002/Q§-TTg dated 4/10/2002, a decisive
issue for effectiveness of investment and utilization of
high-tech medical equipment is management, maintenance
and repair of high-tech medical equipment. In most
provincial and central hospitals, there are divisions of
equipment
and
supplies
with
clear
functions
of
management, planning for purchase, repair and maintenance
of medical equipment. In fact, the management of hightech medical equipment in hospitals is problematic.
According to the assessment of Department of Medical
Equipment, MoH there exists 4 shortcomings below [2].
 Health
staff
are
not
specially
trained
with
sufficient knowledge of modern equipment, high
technology (lack staff with university level and
qualified workers) and is not commemorate with
modern techniques of medical equipment.
 Many health facilities do not have sufficient fund
to purchase materials and supplies leading to the
fact that hospitals fail to use up capacity of the
equipment, only some basic techniques.
 Poor skills
equipment
in
counseling
for
use
of
modern
 Maintenance, repair is inactive and very much
depends on foreign suppliers leading to high and
unreasonable price.
Through the survey in 5 hospitals of the situation of
management, maintenance and repair of 3 types of hightech medical equipment, we have withdrawn the following
results.
63
Among the surveyed machines, very few machines are
in the warranty period the fore most hospitals have to
pay for its maintenance. According to the reports from
hospitals, the frequency of maintenance is very different
depending on each type of machine. In Ha Tay Hospital
where very few machines are maintained, never ever
maintained doppler ultrasound machine and endoscope and
only partial maintenance of CT scanner once per year. For
endoscope, most hospitals maintain the machine daily and
by staff of endoscope room. Doppler ultrasound machine
and CT require high techniques in maintenance therefore
they should rely on the suppliers. But for endoscope,
most hospitals can maintain the machine on daily basis
but very simple, including cleaning, reorder, without
knowing how to maintain it. In this survey, we failed to
collect full data of maintenance fund in each hospital.
For ultrasound machines, one hospital reported that the
maintenance fund was VND 4 million per year. For CT, the
fund is higher from VND 30 million to 64 million per
year. For endoscope, no information of maintenance cost
was found (See Table 30).
64
Table 30 Situation of maintenance of all machines in 5
hospitals in 2005
Year of
Purchase
Doppler
ultrasound
machine
CT scanner
Endoscope
Frequency
of
maitenance
Doppler
ultrasound
machine
CT scanner
Endoscope
Who
maintains
Doppler
ultrasound
machine
CT scanner
Endoscope
Cost of
maintenance
Doppler
ultrasound
machine
CT scanner
Endoscope
Friendship
SaintPaul
Ha Tay
Dong Hoi
Ba-ria
2004
NO DATA
8/2006
NO DATA
2000
12/2002
2/1997
2000
1/2002
10/2005
1997
4/2003
7/2005
8/2000
4/2000
Yearly
NO DATA
NO DATA
NO DATA
Quarterly,
whole
Quarterly,
whole
Daily
Yearly,
Whole
Daily
Supplier
NO DATA
Supplier
NO DATA
Supplier
Supplier
Supplier
Supplier
Liability
limited
company
Staff of
endoscope
room
Staff of
endoscope
room and
engineer
of
supplier
Central
medical
equipment
company
NO DATA
Staff of
endoscope
room
Staff of
center for
maintenance
0
NO DATA
NO DATA
NO DATA
VND 4
million
NO DATA
VND 30
million
Don’t know
0 (In
warranty
period)
VND 64
million
Yearly,
Quarterly,
partially
whole
No
Daily
maintenance
Quarterly,
whole
Quarterly,
partial
None
The need for repair of machine depends on the
machine, per se, machine operators. Endoscope is the most
needy and the fact that in many hospitals, the machine is
broken but not yet repaired. The fund for repair may be
high, especially for CT, in Ba-Ria hospital, the latest
repair, they had to pay up to VND 500 million. But the
65
repair cost for ultrasound machines and endoscope is also
high from VND 50 to 77 million.
Table 31 Situation of repair of medical equipment in 5
selected hospitals
Times of repair
since Purchase
Doppler
ultrasound
machine
CT scanner
Endoscope
Cost of the
latest repair
Doppler
ultrasound
machine
CT scanner
Endoscope
Friendship
SaintPaul
Ha Tay
Dong Hoi
Ba-ria
0
NO DATA
0
NO DATA
3
0
0
2 times
1
1
(stomach),
2 (large
intestine)
0
Broken
Minor
repair
Broken
NO DATA
Don’t know
VND 50
million
NO DATA
Don’t
know
NO DATA
Don’t
know
NO DATA
1
VND 77
million
NO DATA
No fund,
no repair
VND 500
million
NO DATA
In interviews with head of equipment division, the
common assessment is: there is a severe shortage of staff
maintaining medical equipment, the qualification of staff
can only meet the requirement for supplies management and
common equipment. Given modern equipment, these staff are
unable to meet the requirement and in need for training
in this issue.
In terms of hospital management for high-tech
medical equipment, there is a clear decentralization. In
the functional room, each machine has a profile with
procedure for utilization, maintenance and a monitoring
book with daily recording. Most hospitals do it
regularly, some don’t. The division of supplies and
equipment sign contracts with suppliers or center for
maintenance to maintain medical equipment on regular
basis and have plan for monitoring rooms of high-tech
medical equipment in the hospital. In Ha Tay hospital
alone, staff reported that as the Division of supplies
and equipment has been newly established therefore
activities of maintenance and management of machine are
not well functioning.
The repair, replacement of spare parts of high-tech
medical equipment is done by the suppliers as signed in
the contract. The most difficult issue for all hospitals
66
is fund for maintenance and repair of machine. In all
surveyed hospitals, staff reported that the MoH should
support fund for purchase high-tech medical equipment
plus fund for maintenance and repair yearly. According to
Department of Medical Equipment, cost of maintenance and
repair for CT/year is 40,000-70,000 USD, for MRI is
100,000 USD/year, this fund level may be different
depending on different types of machine. In the survey on
cost for maintenance and repair of high-tech medical
equipment, we failed to collect all information and the
information collected is also very different between
hospitals. It is estimated that the average cost for
maintenance, repair per year for 1 colour ultrasound
machine is VND 60 million, CT is VND 200-300 million.
Head of Division of Equipment of Friendship hospital was
quoted as saying: “ The more expensive the equipment is,
the higher cost for maintenance and repair incur – The
supplier is monopoly in price and purchaser don’t know.
Sometimes, hospitals do not have money to repair this
machine while other break down. Suppliers requires
hospitals to pay off before repairing the other – then
hospital has not machine to work”.
In general, in order to limit the fact of coercing
price, the Department of Equipment, MoH recommends that
hospitals should sign contract with reliable suppliers to
purchase both equipment and supplies, attached by annual
funding and updated information for hospitals.
For high-tech medical equipment, where the source of
funding come from private sectors or joint-venture it
quicker to have the funding for repair and maintenance,
while it is very hard to have repair fund from Government
budget funded machines.
Apart from the above opinions, hospitals propose to
the MoH to invest in a system of maintenance, repair and
replacement of modern equipment (may be in form of
private
sector,
government
using
joint-stock,
or
autonomous hospital) from 3 centers of the country
because it is very costly to invest in hospital division
of equipment. At the same time, there should have a
network of information on maintenance, repair and costs
of each items in all centers for maintenance in order for
them to avoid the situation of price monopoly.
5.8 Proposed orientation for investment, utilization
of high-tech medical equipment of hospitals
Survey results in investment, use of 3 high-tech
medical equipment (ultrasound, endoscope, CT) of 5
67
hospitals across regions to improve the use of these
equipment. There are 2 orientation issues that should
be taken into account.
5.8.1
Improvement
of
current
situation
to
use
effectively the existing equipment
In this survey, as presented above, most hospitals
have certain number of machine without working or
ineffective performance. Group discussions with hospitals
to agree on some points to be addressed in immediate
future.
 There should have plans to repair, renovate,
supplement conditions and physical infrastructure to
place the machine: stable source of electricity,
anti-heat, dust, …to limit unnecessary broken items.
 Train, upgrade machine operators in order to explore
full capacity of the machine as design as well as
train technical staff of the Division of Equipment
and Supplies to obtain better skills in management
and maintenance of equipment.
 Equip, supplement fund to purchase materials and
supplies, spare parts to replace the old ones,
upgrade the current equipment in a synchronous
manner in order to exploit full capacity of the
machine as design.
 Annual funding for hospitals should be secured to
pay for necessary maintenance and repair. In
addition, in order to avoid waste it is recommended
to liquidate unrepairable equipment or transfer
repaired one to lower level for use (as proposed by
Friendship hospital).
5.8.2
Orientation
for
effective
utilization
of
equipment
In the trend of integration, industrialization and
modernization of the health sector is a must in order to
meet the growing needs for health care for the people
ensuring equity and efficiency. Results from in-depth
interviews and group discussions in 5 hospitals, it is
recommended Decision on investment should based on the
following criteria:
 Information of epidemiological patterns in community
 Information of whether the technology can solve any
problem effectively with rational diagnosis without
harming the patients?
68
 Information of capable staff to solve problems as
identified by the technology?
 Information of staff able to operate and maintain
the machine?
 Information of staff able to read the results?
 Information of the price of equipment and ability to
pay for it?
 Among the above factors, most leaders of hospitals
reported that 4 problems of concern are:
 High need for high-tech services of certain diseases
through measuring indicators (as presented in the
Utilization section)
 Technical expertise and skills in utilizing hightech medical equipment of the hospital.
 Physical
infrastructure
conditions
possibility of expanding hospital
and
the
 Source and level of fund mobilized.
In terms of form of investment, apart from Government
Budget and aided funds, it is recommended to advocate
procedures
for
hospital
to
expand
its
form
of
socialization (joint-venture, joint-stock, equitization)
on the principle of non-profit business with interest.
In utilization, decisive factors of using high
techniques are health status of the patient, ensuring
equity, against abuse but have to calculate full and
correct costs of services.
The MoH, Department of Equipment should construct a
system of reliable centers for repair and maintenance of
medical equipment tin with full information network of
modern equipment, able to counsel when hospitals have a
need to invest in, inspect or verify all equipment to
ensure the stability, accuracy and safety of patients and
doctors.
69
6 Conclusion and recommendations
6.1 Conclusion
At present, 3 types of high-tech medical equipment
has been surveyed and invested in many regions across the
country, both in public facilities and private facilities
to modernize the health sector, making contributions to
improving effectiveness in people health care.
However,
there
exists
uncontrolled
investment
causing waste and ineffective use of machine, especially
in local hospitals, in facilities where investment did
not take into account the issue of health care need,
ability and capacity to use modern equipment.
6.1.1
Current situation of investment in 3 types of
high-tech medical equipment in survey hospitals
All high-tech medical equipment is imported, and
funded under various sources, but mainly from Government
budget. Some hospitals have a socialized form for health
(joint-venture, joint-stock, equitization of hospital
staff). When deciding on investment, most hospitals have
taken into account issues of investment decision but they
were still inactive and the process of getting things
done was too long (Begging – giving mechanism).
Socialization for health is more active and appropriate.
Incomplete investment is still popular (Equipment,
human, physical infrastructure – materials and supplies)
therefore there exist certain proportion of equipment
with low quality and break down. Some surveyed hospitals
were overloaded with services of these 3 equipment and in
need for new investment.
6.1.2
Effectiveness of utilization of 3 types of
machine
In the system of machine, current equipment of 5
hospitals are mainly brand-new and in good working
condition. Endoscope in 5 hospitals was seen broken and
repaired (due to operation error, unstable source of
electricity, overuse of the machine or poor quality of
the machine).
All equipment is used in correct function and
expanding to diagnosis and treatment. Some machines in
some hospitals, services are limited due to a lack of
supportive equipment, poor quality of health staff (only
60%-70% health staff use proficiently the equipment). The
capacity of using 3 types of equipment is very different
depending on types of machine, types of hospital and
70
number of patients. But some machines are underused.
Service price in public hospitals is lower than private
sector of 10%-15%. No evidence of abuse and inequity in
use of high techniques was found (as perceived by health
staff).
6.1.3
Management for maintenance and repair
Almost all Divisions of equipment and supplies and
rooms with high-tech medical equipment follow the
management and monitoring of machine but just in
administrative way. Maintenance, repair of high-tech
medical equipment through agreement with suppliers or
centers for maintenance and repair of medical equipment
is very inactive. Most hospitals lack information,
funding for maintenance and repair of machine.
6.2 Recommendations
Through survey results show that the utilization of 3
high-tech medical equipment in 5 hospitals at provincial
hospitals, it is recommended:
6.2.1
To improve the situation and effective use of
high-tech medical equipment, hospitals should:
 Make
plans
for
repair,
renovate,
supplement
conditions to limit unnecessary break down of
current equipment.
 Equip, supplement materials and supplies, spare
parts and other equipment in a synchronous manner to
use up the designed capacity.
 Liquidate unrepairable equipment.
 Train, upgrade machine operators in order to explore
full capacity of the machine as design.
6.2.2
To orient for effective investment in high-tech
medical equipment, hospitals should pay attention
to:
 Decisive factors of investment: based on utilization
indicators, disease patterns and health care needs.
Full understanding and ability to use high-tech
medical equipment, physical facilities and ability
to expand the hospital, possible source of mobilized
funding…
 Dimension of investment: Apart from the current
forms of investment, it is recommended to expand the
71
form of socialization in the principle of business
not for profit. If the investment is from Government
budget
and
loan,
it
is
advised
to
simplify
procedures, one-door policy in the management of
investment and use of equipment.
 In use: the Decisive factors of using high tech
equipment is human health status, equity, against
abuse of services but ensuring full and correct
costing of services.
 The MoH should study to construct centers for
maintenance and repair of equipment by region.
Trading in medical equipment should be supported by
information network so that hospitals have enough
fund to repair, and maintain high-tech medical
equipment.
6.2.3
Propose some monitoring indicators in assessing
investment in high-tech medical equipment
In order to the effectiveness of investment in
utilizing high-tech medical equipment, there are many
ways to assess it: cost-effectiveness, cost-efficiency
meeting health care need, health outcomes. Issue of
equity and abuse of techniques… Within this study, due to
limited time we just propose issues of effectiveness in
utilization of machine in one hospital.
 Average number of service per bed: Total services of
all machines of any type of equipment in a year
divided by average number of planned beds of any
hospital.
 Average number cases health examination per year
(per 1000): average 1000 health visits of any
hospital in a year have served how many patient
visits on such equipment.
 Average service number/1000 inpatient visits/year:
average of 1000 inpatients of any hospital in a year
with how many patient visits using services of any
equipment (similar to 1000 outpatient visits).
 Average
service
number/1,000,000
people/year:
average of 1 million people in any locality with how
many people using high-tech equipment in a survey
hospital.
 In 4 above-mentioned indicators, 3 first indicators
we can calculate indirect indicators of abuse and
equity in using high-tech medical equipment: the
72
poor, - non poor, people with insurance card of all
kinds – without HI card.
In order to withdraw indicators of effectiveness of
investment, utilization of high-tech equipment, it is
recommended to further study and compare it in a
scientific manner.
73
References
1. MoH. Decision on list of medical equipment dated
26/04/1991 on 123 types of essential equipment for
hospitals.
2. MoH. Decision 1419/BYT-Q§ dated 23/10/1996 regulating
a list of essential equipment for provincial general
hospitals, district hospitals, regional polyclinics and
commune health centers.
3. MoH. Orientation for the people’s health care
activities and planning for operation during 2000-2020.
Hanoi 4/2000.
4.
MoH.
Hospital
Department 2001.
inventory1998-2000.
Treatment
5. MoH. Circular of MoH 13/2002/TT-BYT dated 13/12/2002
on instructions of trading in medical equipment.
6. MoH. Circular 06/2002/TT-BYT guiding import, export of
medical equipment during 2002-2005.
7. MoH, Treatment Department, 2002, Hospital inventory
2000, Sub-Component 3.2. National Health Support Project.
8. MoH. Draft “Strategy for development
equipment for Vietnam up to 2020”.
of
medical
9.
MoH.
Circular
4428/YT-TTB
dated
05/06/2002
on
coordination in management and investment in high-tech
medical equipment.
10. MoH, Health Statistical Yearbook from 2000 to 2005.
11. MoH, Health cooperation Program between VietnamSweden, Assessment of medical equipment: Utilization of
diagnostic test of common diseases in hospitals during
1996-2002, Hanoi, 2002.
12. MoH (2004). Inventory and assessment of investment in
diagnostic equipment in provincial general hospitals.
Medical Publishing House, 2004.
13. Steering Committee for High-tech medicine project,
MoH, 2002, High-tech medicine center, a stride of the
Vietnamese medicine, Hanoi: Medical Publishing House.
14. MoH, 2006, National Health Account 1998-2003. Hanoi,
Statistical Publishing House
15. §o Nguyen Phuong. Orientation for the people’s health
care up to 2020. Hanoi, 2000.
74
16. Prime Minister. Decision 88/TTg dated 13/02/1995
Major contents of the Program for development of hightech medicine centers in Hanoi.
17. Prime Minister. Decree 52/1999/N§-CP dated 8/7/1999
of Prime Minister on Issuance of regulations for
Management of investment and civil work.
18. Prime Minister. Decree 88/1999/N§-CP dated 1/9/1999
of Government issuing Regulations for Bidding.
19. Prime Minister. Decision 130/Q§-TTg approving the
National Policy on Medical equipment during 2002-2010.
20. Prime Minister (2001). Decision 35/2001/Q§ TTg dated
19/03/2001 on approving the national strategy for the
people’s health care and protection period 2001-2010.
21. Prime Minister. Decision 139/TTg dated 07/03/1997 on
major issues of the program for development of high-tech
medicine center in HCM city.
22. Vietnam Communist Party (2006): Resolution Documents
of the 10th Party Congress. National political publishing
house, 2006
23. MoH, 2006, Health Statistical Yearbook 2005. Hanoi:
Statistics
and
Informatics,
Planning
and
Finance
Department.
24. Deanna R. Willis, How to decide whether to buy new
medical equipment, available from www.aafp.org/fpm.
25. Australian Institute of Health and Welfare (AIHW),
2006. Australian Hospital Statistics, 2004-05, AIHW cat.
No. HSE 41, Canberra: AIHW health services series no. 26
26.
Institute
of
Medicine,
Assessing
Medical
Technologies. Washington, DC: National Academy Press,
1985.
27. Hing E, Cherry DK, Woodwell DA, National Ambulatory
Medical Care Survey: 2004 Summary, Advance Data from
Vital and Health Statistics, No. 374, June 23, 2006.
28. Kozak LJ, DeFrances CJ, Hall MJ, National Hospital
Discharge Survey 2004, annual summary with detailed
diagnosis and procedure data. National Center for Health
Statistics, Vital Health Stat 13(162). 2006.
29. Mark Leys, Health Technololgy Assessment: The
contribution
of
qualitative
research,
International
Journal of Technology Assessment in Health Care, 19:2
(2003), 317-329.
30. Michael Tekletsion Berhan, A review of “ Health Care
Technology Assessment- the South African Health Care
75
System in Transition”, Health Ca Technology Assessment in
South
Africa,
available
from
www.home.att.net/~africantech/HCTAinSA.htm.
31. McCaig LF, Nawar EW, National Hospital Ambulatory
Medical Care Survey: 2004 Emergency Department Summary.
Advance Data from Vital and Health Statistics, No. 372,
June 23, 2006.
32. Middleton KR, Hing E, National Hospital Ambulatory
Medical Care Survey: 2004 Outpatient Department Summary,
Advance Data from Vital and Health Statistics, No. 373,
June 23, 2006.
33. National Information Center on Health Services
Research & Health Care Technology (NICHSR), Fundamental
Concepts
and
Issues,
available
from
www.nlm.nih.gov/nichsr/ta10104.htm.
34. Raymond C.W. Hutubessy, Piya Hanvoravongchai and
Tessa Tantorres Edejer, Diffusion and Utilization of
Magnetic Resonance Imaging in Asia, International Journal
of Technology Assessment in Health Care, (2002), 18:690704.
35. SDC- Health, Health Technology Management, available
from
www.scdhealth.ch/priorities_in_health/pro_poor_health_service/.
76
ANNEX– Information collection tools
FORM 1.1
BASIC INFORMATION OF HOSPITAL
1. Province: …………………………………………………………
2. Name of hospital: …………………………………………........
3. Level (Class) of hospital (Special, 1 - 4)
[ .............]
4. Full name of informant:……………………………
Work place:………………………………………………..
Telephone number of hospital:……………………………………
I. GENERAL INFORMATION OF staff and patient bed
5. No.of planned beds 2005:
............. ]
[
6. Actual beds (Actual by end of 2005):
[ ..............]
7. Total staff of all categories 2005:
[ ............. ]
In which:
7.1.Total medical staff:
............. ]
 Total doctor
............. ]
 Total Doctor assistant
............. ]
 Total Nurse
............. ]
 Total medical technician
............. ]
 Other medical staff
............. ]
 Other pharmaceutical staff
............. ]
7.2.Total staff of other areas:
[ ............. ]
[
[
[
[
[
[
[
 Total engineer of physics and biomedical
(equipment)[ ............. ]
 Total engineer and bachelors of other areas
[ ............. ]
 Total college/secondary/elementory level
staff
[ ............. ]
77
 Other staff
[
............. ]
7.3. Of all staff category listed in Section7.1;
7.2; 7.3; how many belong to the following groups:
 Professor and associate:
............. ]
 PhD
............. ]
 Post-graduate
............. ]
 Specialized level II
............. ]
 Specialized level II
............. ]
[
[
[
[
[
(Note: List the highest qualification of each staff. For
example: If an officer has both Doctor and Medical
specialty level I, only list him as Doctor not calculate
him as Medical specialty item)
78
II. Performance indicators
8. Total health visits in 2005 :
[… …………...... ]
9. Total hospitalization visits 2005:
[….…………...... ]
10.
Total days of inpatient treatment 2005
[….…………...... ]
11.
Total inpatients in 2005
[….…………...... ]
………………, date……..month………year 2006
Informant
(sign and name)
Date
,
month,
checking:……………………………………………
year
of
Supervisor:..............................................
.......................................
Signature:...............................................
...................................................
79
FORM 1.2
BASIC INFORMATION OF image diagnosis department
1. Name of hospital: …………………………………………........
2.
Name
of
Department:
................................................................................
3. Full name Informant:………………
4.
Phone:
..CQ.................................
mail:.................................
D§..............................E-
5. Position:………………………………………………..
I.
No
SITUATION OF staffing
Fulname
Position
(Describe
Qualification tasks of
current
job)
Duration
working
with
CT/US
Speciality trained
University Post
Short
graduated training
courses
1
2
3
4
5
6
7
8
9
10
80
II. Situation of medical equipment of the depT. (including medical equipment invested by
socialized method).
Questions for all availabe medical equipment, including useless ones
No
1
Situation of
medical equipment
Digital doppler ultrasound
machine, Doppler + color printer
or grey printer
(If not have doppler ultrasound
m/c, please ask about grey
ultrasound m/c)
CT scanner
Quantity of machine
M/c
1
M/c
2
M/c
3
M/c
4
M/c
5
M/c
1
M/c
2
M/c
3
M/c
4
M/c
5
M/c 6
(Please
indicate
exact
name of machine as called
by staff)
2
Tine
of
purchase
(month, year)
3
Original
(VN§)
4
Date of start using
(month/year)
Condition
of
machine
1. Good
2. Repaired but in
use
5
price
81
No
6
7
Situation of
medical equipment
CT scanner
3. Broken
Number of staff and - §¹i häc:............
qualification
of - Cao ®¼ng:..........
technicians
who - Trung häc:............
operate the m/c
(Note:
ask
all
health staff within
the team using the
m/c incl. medical
doctor (reading the
results)
and
technician
Total
of
average
cases
within
one
month in 2005
(Information can be
added
by
collect
list of synthesized
and
inventoried
medical
equipment
at the end of every
year
at
dept
of
medical
material
Digital doppler ultrasound
machine, Doppler + color printer
or grey printer
(If not have doppler ultrasound
m/c, please ask about grey
ultrasound m/c)
- §¹i häc:............
- Cao ®¼ng:..........
- Trung häc:............
82
No
8
Situation of
medical equipment
CT scanner
Digital doppler ultrasound
machine, Doppler + color printer
or grey printer
(If not have doppler ultrasound
m/c, please ask about grey
ultrasound m/c)
and
equipment
of
the hospital)
Utilization
capacity of machine
1=Overloaded
2=Used up capacity
3=Rarely used
83
10.
Health
prices
service
and Provided
by
the Price
hospital
(Please service
mark X if service
provided)
of Covered by Price
of
health
requesed
insurance
service
CT scanner
CT
Other (specify)
Ultrasound
Grey ultrasound
Color ultrasound
Doppler
ultrasound
(heart/blood vessel)
3D-4D color untrasound
Ultrasound_+
measure
eyeball axle
Colour Ultrasound Doppler
heart/vein
through
esophagus
Ultrasound of heart with
Endeavour
Colour Ultrasound Doppler
of heart+ sound resistance
Ultrasound endoscope
Other ultrasound (specify)
84
………………,
Date month year of checking:………………………
date……..month………year
2006
Informant
Supervisor:........................................................
(sign and name)
Signature:..........................................................................
85
FORM 1.3
BASIC INFORMATION OF digestive endoscope
1. Name of hospital: …………………………………………........
2.
Name
of
Department:
................................................................................
3. Full name Informant:………………… Phone: ________________e-mail_____
Position:………………………………………………..
I.
No
SITUATION OF staffing
Fulname
Position
(Describe
Qualification tasks of
current
job)
Duration
working
with
endoscope
m/c
1
2
3
4
5
6
7
8
9
10
86
Speciality trained
University Post
Short
graduated training
courses
III. Situation of medical equipment of the depT. (including medical equipment invested by
socialized method). Questions for all availabe medical equipment, including useless
ones
No
SITUATION OF equipment
Kit of
Kit of
Kit of
Kit of
Notes
endoscope
endoscope
stomach,
endoscope
for
for large
duodenum
for rectum
abdomen
intestine
soft tube
with video soft tube
system
1 Quantity
M/c
M/c
M/c
M/c
M/c
M/c
M/c
M/c
M/c
M/c
1
2
1
2
1
2
1
2
1
2
(Please indicate exact name of
machine as called by staff)
2
3
4
5
6
Date
of
buying
m/c
(month/year)
Price of purchase (VN§)
Date of start using
(month/year)
Condition of machine
1. Good
2. Repaired but in use
3. Broken
Number of staff and
qualification
of
technicians who operate
the m/c
(Note: ask all health
staff within the team
University
:.....
College:..
......
Secondaryn
d:....
University
:.....
College:..
......
Secondaryn
d:....
87
University
:.....
College:..
......
Secondaryn
d:....
University
:.....
College:..
......
Secondaryn
d:....
University
:.....
College:..
......
Secondaryn
d:....
No
7
SITUATION OF equipment
Kit of
endoscope
for
abdomen
with video
system
Kit of
endoscope
for large
intestine
soft tube
Kit of
stomach,
duodenum
soft tube
Kit of
endoscope
for rectum
Notes
using the m/c incl.
medical doctor (reading
the
results)
and
technician
Number
of
endoscope
cases/month (Please refer
to record books)
8
Utilization capacity of
machine
1=Overloaded
2=Used up capacity
3=Rarely used
10. Health service and Provided by the Price
prices
hospital
service
(Please mark X
if
service
provided)
Digestive endoscope
Endoscope abdomen +/biopsy
Endoscope stomach +/88
of Covered
health
insurance
by Price
requesed
service
of
10. Health service and Provided by the Price
prices
hospital
service
(Please mark X
if
service
provided)
biopsy
Endoscope
larege
intestine +/- biopsy
Endoscope rectum +/biopsy
Endoscope
esophagus
+/- biopsy
Endoscope esophagus to
take worm out
Endoscope
stomach+
injection or clip to
stop the bleeding
Endoscope
small
intestine
Endoscope
small
intestine+
injection/clip
stop
bleeding/cut polup
Endoscope
large
intestine
+
injection/clip to stop
bleeding
Endoscope
rectum
+
89
of Covered
health
insurance
by Price
requesed
service
of
10. Health service and Provided by the Price
prices
hospital
service
(Please mark X
if
service
provided)
of Covered
health
insurance
by Price
requesed
service
of
injection/tie
haemorrhoids
Endoscope major bile
duct
Endoscope of ureter
Endoscope
upstream
bile duct to take worm
or foreign bodies out
Others (specify)
Additional space if there are more than 2 machines
No
1
SITUATION OF
equipment
Kit of
endoscope
for abdomen
with video
system
Kit of
endoscope
for large
intestine
soft tube
Kit of
stomach,
duodenum
soft tube
Kit of
endoscope
for rectum
Notes
Quantity
M/c
1
M/c
2
M/c
1
M/c
2
(Please
indicate
exact
name of machine as called
by staff)
90
M/c
1
M/c
2
M/c
1
M/c
2
M/c
1
M/c
2
No
1
2
3
4
5
SITUATION OF
equipment
Kit of
endoscope
for abdomen
with video
system
Kit of
endoscope
for large
intestine
soft tube
Kit of
stomach,
duodenum
soft tube
Kit of
endoscope
for rectum
Notes
Quantity
Date of buying m/c
(month/year)
Price of purchase
(VN§)
Date of start using
(month/year)
Condition
of
machine
1. Good
2. Repaired but in
use
3. Broken
………………,
Date month year of checking:………………………
date……..month………year
2006
Informant
Supervisor:........................................................
(sign and name)
Signature:..........................................................................
91
form 2.1
information of CT Scanner
(This questions given to departments and technicians
who working with CT scanner)
-Name
of
hospital:...............................................
....................................
-Name
of
Department:.............................................
.............................................
-Name
of
machine:................................................
..........................................
-Full
name
Informant:..............................................
..
-Phone: …………………………………………………….
-E-mail:……………………………………………………………
Position:...............................................
...........................................
Introduce purposes of the interview:
1. Profile/initial status of machine.(Add information
from department head and department of equipment and
supplies or long time working experience personnel in
the department)
1.1
Brand,
country
of
production..............................................
.........................
1.2
Time
of
purchase:
...................
month...............year
Time
put
the
machine
into
month................year................
operation:
1.3
Initial
price:.................................... VND
In which,
......... %
purchase
Source from Gov budget
Source grants
.........
%
92
Source from hospital
..........%
Others (specify)
...........%
1.4 If the source is mobilized through socialization,
how was the agreement on utilization of the fund
reached?
………………………………………………………………………………………
………………………………………………………………………………………
………………………………………………………………………………………
…………………………………………………………………
1.5 Compare to the profile, is the machine overloaded?

Yes

No
- Appointment for use (technically):
CT scanner which part
........................................................
........................................................
........................................................
........................................................
........................................................
........................................................
.................................
………………………………………………………………………………………
……………………………………………………………………………
1.6 Information of changes
procurement of this machine
in
Number
of
trained
staff
(incl.
fresh
and
old ones)
staffing
related
Place
of Total
training
training
(pls
expéditeurs
indicate)
Clinical Doctor
Technician
Image
Doctor
diagnosis
2. Current situation
2.1 Machine performance
- Machine performance from the beginning up to now
Uninterrupted working

93
to

Interrupted working
Damaged and repaired

- Reason of damage :

Unstable electricity
Mistake of health staff 
Bad quality

Others

specify…………………………………….)
(pls
- In comparison with m/c design, how often have the m/c
used for diagnosis and curative activities?
Diagnosis:..............................................
.....................................................
........................................................
........................................................
......
Treatment:..............................................
..................................................
........................................................
........................................................
......
Average
service
provided/day:...........................................
....
Average
service
provided/month:.........................................
.....
2.2 Machine operator
How
many
person
operate
m/c:.............................................
this
In which:
Number of medical doctor:
..........
Number of assistant doctor : ..........
Number of medical technician:
Others :
...........
............
- Operation capacity of health worker:
Number of proficient staff
:
Number of apprentice:
............
3. Manage, maintain and repair/c
94
............
3.1 Management
The
machine
is
by:........................................
managed
Qualification:.....................................
................................
- Have this
observe)
Yes
machine

had
recording
book?
(Ask
and

No
- This recording book is recording regular or not? (Ask
and observe)
Yes


No
3.2 Maintain
- Time:
Every day

Every week

Every month

Every quarter

Every year

- Place of maintenance
Maintained at site (at the dept.)

Maintenance at store

(inside hospital)
Maintainance at service center (outside hospital)

Others
indicate....................)

(pls
- Date of latest maintainance (day/month/year):
- Kind of maintainance:
Partly

Fully

- Who is the person conducting maintainance?
Engineer of hospital

Others
indicate…………………………………)

Total
expenditures
2005:…………………………VND
for
95
(pls
maintainance
within
3.3 Repair
- How many time have machine had
beginning up to now:................
repair
from
the
in
which,
repairing
with
replacement.............................................
..........
The
last
maintenance
in....................................
conducted
Maintenance
expenditure
for
the
last
time:..................................................
- Total of expenditure for repair in last year including
repair
and
spareparts:....................................VND
- Evaluate
repair
Good working
working
situation
of
m/c
after
the
last

Fair good working 
Fair working

Bad working

- Person conducting repair service
Engineer of hospital
Outside


4. Recommendation
4.1 Comments on effectiveness of machine utilization in
the dept.
........................................................
........................................................
........................................................
........................................................
........................................................
........................................................
................................
4.2 Difficulties in using m/c
........................................................
........................................................
........................................................
........................................................
........................................................
........................................................
.................................
96
4.3 Comments
utilization
to
improve
effectiveness
of
machine
........................................................
........................................................
........................................................
........................................................
........................................................
........................................................
.................................
………………, date........... 2006
Provided by
(Name and signature)
Date of checking:……………………………
Supervisor:……………………………………
Signature:…………………………………….
97
FORM 2.1b
Retrospective information of CT scanner
From department of equipment of the hospital
-Name
of
hospital:............................................
.......................................
-Name
of
machine:.............................................
.............................................
-Full
name
Informant:...........................................
.....
-Phone:…………………………………………………….
-E-mail:…………………………………………………………..
Position:............................................
..............................................
Introduce purposes of the interview:
1. Profile/initial status of machine
1.1
Brand,
country
of
production..............................................
.........................
- Is the equipment complete?

Yes

No
- Is the equipment installed in complete form
purchased separate item of machine for installation?
Complete installation


or
Buy separate items
1.1a When purchasing, is the machine brand-new?
New

Second Hand machine

- If secondhand, before placing in the hospital how many
years
were
it
used
(year
/month) :...............................................
...................................
as
design,
how
many
for?.......................
1.2
Time
of
purchase:
...................
years
is
it
designed
month...............year
98
Time
of
placing
machine
into
month................year................
operation:
1.3
Initial
price:.................................... VND
In which,
......... %
purchase
Source from Gov budget
Source grants
.........
%
Source from hospital
..........%
Others (specify)
...........%
1.3a Values of other work that the hospital has to
invest in when purchasing the machine (for example:
Build new room, or renovate room, purchase airconditioners, adaptors.....)
Newly
room:.....................................VND
built
- Decorate room……………………….. VND
Purchase
adaptor……………………………VND
air-conditioners,
- Other equipment:
(Specify name of equipment………….............)……………VND
- Supplies supporting machine operations
(Specify
………………)........................................VND
1.4 technical specifications (as design)
- Design capacity:
Operation
.............hours/day, or
Examination
.............patients/day
Scan
Others
.............film/day
……….
Maximum
capacity
machine :............................
of
Minimum
capacity
of
machine :...............................................
.....
99
Average
capacity
of
machine :...............................................
.....
1.5a Warranty period (and conditions
.....................................year
of
warranty)
........................................................
........................................................
.....
1.5b Problems during the warranty time
No problem, running good

Normal operation, with minor repair


Replace some parts
(Specify…………………………………………………………………)
1.6 Information of changes
procurement of this machine
Number
of
trained
staff
(incl.
fresh
and old ones)
in
staffing
Place
training
(pls
indicate)
related
to
of Total
training
expéditeurs
Engineer
for
maintenance
and repair
a. Number of staff and qualification of engineers for
maintenance and repair of CT scanner:
- University:
…………..
- College: …………..
- Secondary:
……………
………………, date……..month………year 2006
Informant
(sign and name)
Date month year of checking:………………………………………
Supervisor:.............................................
...........................................
Signature:..............................................
........................................................
.......
FORM 2.2
Information of colour ultrasound machines (3D-4D)
100
(Ask in the department and operators)
-Name
of
hospital:............................................
.......................................
-Name
of
Department:..........................................
................................................
-Name
of
machine:.............................................
.............................................
-Full
name
Informant:...........................................
.....
-Phone: …………………………………………………….
-E-mail:……………………………………………………………
Position:............................................
..............................................
Introduce the purpose of the interview:
1. Profile/initial status of machine.(Add information
from department head and department of equipment and
supplies or long time working experience personnel in
the department)
1.1
Brand,
country
of
production..............................................
.........................
1.2
Time
of
purchase:
...................
month...............year
Time
put
the
machine
into
month................year................
operation:
1.3
Initial
price:.................................... VND
In which,
......... %
purchase
Source from Gov budget
Source grants
.........
%
Source from hospital
..........%
Others (specify)
...........%
101
1.4 If the source is mobilized through socialization,
how was the agreement on utilization of the fund
reached?
………………………………………………………………………………………
………………………………………………………………………………………
………………………………………………………………………………………
…………………………………………………………………
1.5 Compare to the profile, is the machine overloaded?

Yes

No
- Appointment for use of machine (technically):
Ultrasound which part
........................................................
........................................................
........................................................
........................................................
........................................................
........................................................
.................................
………………………………………………………………………………………
……………………………………………………………………………
1.6 Information of changes
procurement of this machine
in
Number
of
trained
staff
(incl.
fresh
and
old ones)
staffing
related
to
Place
of Total
training
training
(pls
expéditeurs
indicate)
Clinical Doctor
Technician
Image
Doctor
diagnosis
2. Current situation
2.1 Machine performance
- Machine performance from the beginning up to now
Uninterrupted working


Interrupted working
Damaged and repaired

- Reason of damage :
102

Unstable electricity
Mistake of health staff 
Bad quality

Others

specify…………………………………….)
(pls
- In comparison with m/c design, how often have the m/c
used for diagnostic and curative activities?
Diagnosis:..............................................
.....................................................
........................................................
........................................................
......
Treatment:..............................................
..................................................
........................................................
........................................................
......
Average
service
provided/day:...........................................
....
Average
service
provided/month:.........................................
.....
2.2 Machine operator
How
many
person
operate
m/c:.............................................
this
In which:
Number of medical doctor:
..........
Number of assistant doctor : ..........
Number of medical technician:
Others :
...........
............
- Operation capacity of health worker:
Number of proficient staff
:
............
Number of apprentice:
............
3. Manage, maintain and repair/c
3.1 Management
The
machine
is
by:........................................
managed
103
Qualification:.....................................
................................
- Have this
observe)
Yes
machine

had
recording
book?
(Ask
and

No
- This recording book is recording regular or not? (Ask
and observe)
Yes


No
3.2 Maintain
- Time:
Every day

Every week

Every month

Every quarter

Every year

- Place of maintenance
Maintained at site (at the dept.)

Maintenance at store

(inside hospital)
Maintainance at service center (outside hospital)


Others
indicate....................)
(pls
- Date of latest maintainance (day/month/year):
- Kind of maintainance:
Partly

Fully

- Who is the person conducting maintainance?
Engineer of hospital

Others
indicate…………………………………)

Total
expenditures
2005:…………………………VND
for
(pls
maintainance
within
3.3 Repair
- How many time have machine had
beginning up to now:................
repair
from
the
104
in
which,
repairing
with
replacement.............................................
..........
The
last
maintenance
in....................................
conducted
Maintenance
expenditure
for
the
last
time:..................................................
- Total of expenditure for repair in last year including
repair
and
spareparts:....................................VND
- Evaluate
repair
working
Good working
situation
of
m/c
after
the
last

Fair good working 
Fair working

Bad working

- Person conducting repair service

Engineer of hospital

Outside
4. Recommendation
4.1 Comments on effectiveness of machine utilization in
the dept.
........................................................
........................................................
........................................................
........................................................
........................................................
........................................................
................................
4.2 Difficulties in using m/c
........................................................
........................................................
........................................................
........................................................
........................................................
........................................................
.................................
4.3 Comments
utilization
to
improve
effectiveness
of
machine
105
........................................................
........................................................
........................................................
........................................................
........................................................
........................................................
.................................
………………, date........... 2006
Provided by
(Name and signature)
Date month year of checking:………………………………………
Supervisor:………………………………………………………
Signature:……………………………………………………………………….
106
FORM 2.2b
Retrospect information of colour ultrasound machines
(3D-4D)
In equipment room of the hospital
-Name
of
hospital:............................................
.......................................
-Name
of
machine:.............................................
.............................................
-Full
name
Informant:...........................................
.....
-Phone:…………………………………………………….
-E-mail:…………………………………………………………..
Position:............................................
..............................................
Introduce purposes of the interview:
1. Profile/initial status of machine
1.1
Brand,
country
of
production..............................................
.........................
- Is the equipment complete?

Yes

No
- Is the equipment installed in complete form
purchased separate item of machine for installation?
Complete installation


or
Buy separate items
1.1a When purchasing, is the machine brand-new?
New

Second Hand machine

- If secondhand, before placing in the hospital how many
years
were
it
used
(year
/month) :...............................................
...................................
as
design,
how
many
for?.......................
1.2
Time
of
purchase:
...................
107
years
is
it
designed
month...............year
Time
of
placing
machine
into
month................year................
operation:
1.3
Initial
price:.................................... VND
In which,
......... %
purchase
Source from Gov budget
Source grants
.........
%
Source from hospital
..........%
Others (specify)
...........%
1.3a Values of other work that the hospital has to
invest in when purchasing the machine (for example:
Build new room, or renovate room, purchase airconditioners, adaptors.....)
Newly
room:.....................................VND
built
- Decorate room……………………….. VND
Purchase
adaptor……………………………VND
air-conditioners,
- Other equipment:
(Specify name of equipment………….............)……………VND
- Supplies supporting machine operations
(Specify
………………)........................................VND
1.4 technical specifications (as design)
- Design capacity:
Operation
.............hours/day, or
Examination
.............patients/day
Scan
.............film/day
Others
……….
Maximum
capacity
machine :............................
of
Minimum
capacity
of
machine :...............................................
.....
108
Average
capacity
of
machine :...............................................
.....
1.5a Warranty period (and conditions
.....................................year
of
warranty)
........................................................
........................................................
.....
1.5b Problems during the warranty time
No problem, running good

Normal operation, with minor repair


Replace some parts
(Specify…………………………………………………………………)
1.6 Information of changes
procurement of this machine
Number
of
trained
staff
(incl.
fresh
and old ones)
in
staffing
Place
training
(pls
indicate)
related
to
of Total
training
expéditeurs
Engineer
for
maintenance
and repair
b. Number of staff and qualification of engineers for
maintenance and repair of CT scanner:
- University:
…………..
- College: …………..
- Secondary:
……………
………………, date……..month………year 2006
Informant
(sign and name)
Date month year of checking:………………………………………
Supervisor:.............................................
...........................................
Signature:..............................................
........................................................
.......
FORM 2.3
Information of digestive endoscope
109
(Ask in the department and direct operators)
-Name
of
hospital:............................................
.......................................
-Name
of
Department:..........................................
................................................
-Name
of
machine:.............................................
.............................................
-Full
name
Informant:...........................................
.....
-Phone: …………………………………………………….
-E-mail:……………………………………………………………
Position:............................................
..............................................
Introduce the purpose of the interview:
1. Profile/initial status of machine.(Add information
from department head and department of equipment and
supplies or long time working experience personnel in
the department)
1.1
Brand,
country
of
production..............................................
.........................
1.2
Time
of
purchase:
...................
month...............year
Time
put
the
machine
into
month................year................
operation:
1.3
Initial
price:.................................... VND
In which,
......... %
purchase
Source from Gov budget
Source grants
%
Source from hospital
..........%
110
.........
Others (specify)
...........%
1.4 If the source is mobilized through socialization,
how was the agreement on utilization of the fund
reached?
………………………………………………………………………………………
………………………………………………………………………………………
………………………………………………………………………………………
…………………………………………………………………
1.5 Compare to the profile, is the machine overloaded?

Yes

No
- Appointment for use of machine (technically):
Endoscope which part
........................................................
........................................................
........................................................
........................................................
........................................................
........................................................
.................................
………………………………………………………………………………………
……………………………………………………………………………
1.6 Information of changes
procurement of this machine
in
Number
of
trained
staff
(incl.
fresh
and
old ones)
staffing
related
Place
of Total
training
training
(pls
expéditeurs
indicate)
Clinical Doctor
Technician
Image
Doctor
diagnosis
2. Current situation
2.1 Machine performance
- Machine performance from the beginning up to now
Uninterrupted working


Interrupted working
Damaged and repaired

111
to
- Reason of damage :

Unstable electricity
Mistake of health staff 
Bad quality

Others

specify…………………………………….)
(pls
- In comparison with m/c design, how often have the m/c
used for diagnostic and curative activities?
Diagnosis:..............................................
.....................................................
........................................................
........................................................
......
Treatment:..............................................
..................................................
........................................................
........................................................
......
Average
service
provided/day:...........................................
....
Average
service
provided/month:.........................................
.....
2.2 Machine operator
How
many
person
operate
m/c:.............................................
this
In which:
Number of medical doctor:
..........
Number of assistant doctor : ..........
Number of medical technician:
Others :
...........
............
- Operation capacity of health worker:
Number of proficient staff
:
Number of apprentice:
............
3. Manage, maintain and repair/c
3.1 Management
112
............
The
machine
is
by:........................................
managed
Qualification:.....................................
................................
- Have this
observe)
Yes
machine

had
recording
book?
(Ask
and

No
- This recording book is recording regular or not? (Ask
and observe)
Yes


No
3.2 Maintain
- Time:
Every day

Every week

Every month

Every quarter

Every year

- Place of maintenance
Maintained at site (at the dept.)

Maintenance at store

(inside hospital)
Maintainance at service center (outside hospital)

Others
indicate....................)

(pls
- Date of latest maintainance (day/month/year):
- Kind of maintainance:
Partly

Fully

- Who is the person conducting maintainance?
Engineer of hospital

Others
indicate…………………………………)

Total
expenditures
2005:…………………………VND
for
3.3 Repair
113
(pls
maintainance
within
- How many time have machine had
beginning up to now:................
repair
from
the
in
which,
repairing
with
replacement.............................................
..........
The
last
maintenance
in....................................
conducted
Maintenance
expenditure
for
the
last
time:..................................................
- Total of expenditure for repair in last year including
repair
and
spareparts:....................................VND
- Evaluate
repair
Good working
working
situation
of
m/c
after
the
last

Fair good working 
Fair working

Bad working

- Person conducting repair service
Engineer of hospital
Outside


4. Recommendation
4.1 Comments on effectiveness of machine utilization in
the dept.
........................................................
........................................................
........................................................
........................................................
........................................................
........................................................
................................
4.2 Difficulties in using m/c
........................................................
........................................................
........................................................
........................................................
........................................................
........................................................
.................................
114
4.3 Comments
utilization
to
improve
effectiveness
of
machine
........................................................
........................................................
........................................................
........................................................
........................................................
........................................................
.................................
………………, date........... 2006
Provided by
(Name and signature)
Date month year of checking:………………………………………
Supervisor:………………………………………………………
Signature:……………………………………………………………………….
115
FORM 2.3b
Retrospect information of digestive endoscope
In equipment room of the hospital
-Name
of
hospital:............................................
.......................................
-Name
of
machine:.............................................
.............................................
-Full
name
Informant:...........................................
.....
-Phone:…………………………………………………….
-E-mail:…………………………………………………………..
Position:............................................
..............................................
Introduce purposes of the interview:
1. Profile/initial status of machine
1.1
Brand,
country
of
production..............................................
.........................
- Is the equipment complete?

Yes

No
- Is the equipment installed in complete form
purchased separate item of machine for installation?
Complete installation


or
Buy separate items
1.1a When purchasing, is the machine brand-new?
New

Second Hand machine

- If secondhand, before placing in the hospital how many
years
were
it
used
(year
/month) :...............................................
...................................
as
design,
how
many
for?.......................
1.2
Time
of
purchase:
...................
116
years
is
it
designed
month...............year
Time
of
placing
machine
into
month................year................
operation:
1.3
Initial
price:.................................... VND
In which,
......... %
purchase
Source from Gov budget
Source grants
.........
%
Source from hospital
..........%
Others (specify)
...........%
1.3a Values of other work that the hospital has to
invest in when purchasing the machine (for example:
Build new room, or renovate room, purchase airconditioners, adaptors.....)
Newly
room:.....................................VND
built
- Decorate room……………………….. VND
Purchase
adaptor……………………………VND
air-conditioners,
- Other equipment:
(Specify name of equipment………….............)……………VND
- Supplies supporting machine operations
(Specify
………………)........................................VND
1.4 technical specifications (as design)
- Design capacity:
Operation
.............hours/day, or
Examination
.............patients/day
Scan
.............film/day
Others
……….
Maximum
capacity
machine :............................
of
Minimum
capacity
of
machine :...............................................
.....
117
Average
capacity
of
machine :...............................................
.....
1.5a Warranty period (and conditions
.....................................year
of
warranty)
........................................................
........................................................
.....
1.5b Problems during the warranty time
No problem, running good

Normal operation, with minor repair


Replace some parts
(Specify…………………………………………………………………)
1.6 Information of changes
procurement of this machine
Number
of
trained
staff
(incl.
fresh
and old ones)
in
staffing
Place
training
(pls
indicate)
related
of Total
training
expéditeurs
Engineer
for
maintenance
and repair
a. Number of staff and qualification of maintenance
staff for digestive endoscope:
University
College
Endoscope
of
abdomen with video
system
Large
intestine
soft tube
Stomach, duodenum
soft tube
Rectum
Others (specify)
………………, date……..month………year 2006
Informant
(sign and name)
118
to
Secondary
Date month year of checking:………………………………………
Supervisor:.............................................
...........................................
Signature:..............................................
........................................................
.......
119
Guidelines for in-depth interview
FORM 3.1: for staff of planning staff in charge of
procurement of equipment
-Name
of
hospital:..............................................
............................................
-Full
name
of
respondent:............................................
...............
Position:..............................................
.....................................................
-Phone:………………………………………………………………….
-E-mail:………………………………………………………………………….
-Time
of
interview :............................................
....................................
Introduce the purpose of the interview :
1. Comments on disease patterns among patients who
admitted to this hospital for examination and
treatment recently. In which, what kind of disease
that needs CT, ultrasound, endoscope in diagnosis
and treatment.
2. When did you start to purchase machines of CT,
Ultrasound, endoscope. When did you first purchase
endoscope, first ultrasound machine, first CT. Which
machine was bought first, why?
3. How was the plan for procurement of these machines
made? Describe the process of investing in the
equipment/technology
in
hospital
(since
the
identification
of
needs
to
installation)?
Role/functions of the general planning division in
the above process.
What kind of machine to buy, why?
How did you buy the machine (old, new...) ?
How many machine did you buy, why?
Where did you buy the machine, why?
120
Source of funding, form of investment?
- Reason for investment: Needs
needs for improved quality of care
treatment?
of
in
the patients,
diagnosis and
- Difficulties in initial investment: As compare to
machine capacity, whether the hospital face a lack of
patients? How long did it take from investment to the
time when the hospital have sufficient patients (until
the machine used up its capacity)
(specific to
endoscope)
each
kind
of
machine:
CT,
Ultrasound,
- What did the hospital do to improve the capacity
of using effectively the machine?
For example: Did you attract patients from other
hospitals that do not have this test? Or study a larger
scope of using these machines, or use the machine at
necessary level?...
4. Comment on the situation of high tech medical
equipment (CT, ultrasound, endoscope) of hospital.
- Is the procedures for investment/technology rational?
Why? What needs to be supplemented or amended?
- Investment (rational, sufficient as compared to its
demand or insufficient)
- What kind of equipment is insufficient? why?
- The hospital had to send patients to other places as
they lack equipment or the machine is broken ?
(specifically what kind of high-tech equipment done
outside the hospital. Can estimate the proportion of
these services performed outside the hospital according 3
above-mentioned techniques).
- Situation of using (Used up capacity, is the operator
fully trained in using it?) specifically for each type of
machine.
- If not used up capacity, then explain why: lack
patient (lack patients to use this test or patients have
no money to pay for this test), lack staff, broken
machine or other reasons….(For example no stable
electricity) - (Specifically for 3 types of techniques
above).
121
- Efficiency in terms of financing in investment of
this machine
- Efficacy in diagnosis and treatment
5. Changes related to the investment in new machine:
specially more investment in supportive equipment and
human resources. How is funding for this machine
allocated?
Expenditures for electricity, disposal materials and
supplies,
spare
parts,
and
others
that
need
for
operations of the machine… Estimate total spending per
year?
IN training for human resources? When purchasing
equipment, could they operate it properly or you had to
send them for training?
Mechanism related to salary, bonus for staff in the
hospital and other direct operators of these high-tech
equipment has been improved or not (compare between
before and after investment).
6. Plan (intentions) for investment in 3 types of
high-tech equipment (3 types of equipment) of hospital in
5 years to come.
Notes: Collect information for 2 sections: Equipment
supported by the hospital, and equipment supported by
socialization.
122
Guidelines for in-depth interview
FORM 3.2: For staff of equipment section
-Name
of
hospital:..............................................
............................................
-Full
name
of
respondent:............................................
...............
Position:..............................................
.....................................................
-Phone:………………………………………………………………….
-E-mail:………………………………………………………………………….
-Time
of
interview :............................................
....................................
Introduce the purpose of the interview :
1. Roles/functions of equipment department in the process
of purchasing equipment/technology in the hospital?
How is the management of high-tech equipment (CT, Colour
ultrasound, endoscope) done. What responsibilities that
the equipment department have to take? How is separate
function of between equipment and professional department
made? (For example: responsibilities for installation,
operations? Responsibilities for maintenance and repair?
2. In organization, and centralized management? What are
advantages and disadvantages? For socialization, how is it ?
3. Comments to qualification of staff in the department. How
is their ability meet the needs of work? Sufficient
staff, insufficient staff (In terms of quantity and
quality)? Needs for training?
4. Comment on the situation of high tech medical
equipment (CT, ultrasound, endoscope) of hospital.
- Is the procedures for investment/technology rational?
Why? What needs to be supplemented or amended?
- Investment (rational, sufficient as compared to its
demand or insufficient)
- What kind of equipment is insufficient? why?
- The hospital had to send patients to other places as
they lack equipment or the machine is broken ?
(specifically what kind of high-tech equipment done
outside the hospital. Can estimate the proportion of
123
these services performed outside the hospital according 3
above-mentioned techniques).
- Situation of using (Used up capacity, is the operator
fully trained in using it?) specifically for each type of
machine.
- If not used up capacity, then explain why: lack
patient (lack patients to use this test or patients have
no money to pay for this test), lack staff, broken
machine or other reasons….(For example no stable
electricity) - (Specifically for 3 types of techniques
above).
- Efficiency in terms of financing in investment of
this machine
Operating
costs,e.g.,
electricity,
disposal
materials and supplies, spare parts estimates total
expenditure per year?
Guidelines for in-depth interview
FORM 3.3: For image diagnosis doctors
-Name
of
hospital:..............................................
............................................
-Full
name
of
respondent:............................................
...............
Position:..............................................
.....................................................
-Phone:………………………………………………………………….
-E-mail:………………………………………………………………………….
-Time
of
interview :............................................
....................................
Introduce the purpose of the interview:
1. Is all equipment invested and used in this hospital
sufficient and meet the professional requirements
(diagnosis of disease)?
2. Comments on professional skills of doctors of CT,
Colour ultrasound? Capacity of the current staff ?
What is needed and needs training?
124
3. Assessment of the use of high-tech medical equipment
(ask for each type of CT and colour ultrasound).
 Is the investment
machine and human)
complete
or
not
(in
terms
of
 Assessment of capacity of using machine is made by
what way? (by number of patients or by hours/day or
times of using services... ?) What is the capacity of
machine?
 At present, the machine in the room is overloaded?
If yes/no, why?
 Is the machine good enough to
Colour ultrasound)
4. assessment of effectiveness
supporting the diagnosis and
Assessment of appointment
rational or abused... ?
diagnose exactly? (CT,
of these machine in
treatment of disease?
of clinical doctors:
5. Changes of income for staff since the presence of
these CT machine? Since presence of ultrasound
(doppler, 3D, 4D?)…
6. High use of these machines amongst patients
-Who are users of these machines ? patients with HI
cards, without HI card, rich or poor patients…
Is there any difference between appointment for use
of CT between patients with or without HI ? rich or poor?
-Patients using colour ultrasound hold what kind of
insurance? Patients with HI or without HI, rich or poor
patients…
Is there any difference between appointment for use
of CT between patients with or without HI? rich or poor?
- How did they pay for the costs (for
ultrasound) according to the hospital regulations?
CT,
- How many percent of patients who can pay or refuse
to undertake the test as they can not afford the test?
Is the price for these services rational? Is that
too high or too low? Follow the price schedule of
Circular 14 and Circular 03 ?
- In case, the patient is appointed to undergo hightech test but they are unable to pay for, how can the
125
problem be solved? Can it replaced with other diagnosis
techniques?
Is the price for these services rational? Is that
too high or too low? Follow the price schedule of
Circular 14 and Circular 03 ?
7. How is management, maintenance and repair of these
machines
decentralized
between
professional
departments
equipment
department ?
is
this
management form rational?
8. Recommendations for better use of these high-tech
medical equipment (investment in staffing, complete
equipment and possibility of co-payment....)
126
Guidelines for in-depth interview
FORM 3.4: for doctor in endoscope
-Name
of
hospital:..............................................
............................................
-Full
name
of
respondent:............................................
...............
Position:..............................................
.....................................................
-Phone:………………………………………………………………….
-E-mail:………………………………………………………………………….
-Time
of
interview :............................................
....................................
Introduce the purpose of the interview:
4. Is all endoscope equipment invested and used in this
hospital
sufficient
and
meet
the
professional
requirements (diagnosis of disease)?
5. Comments on professional skills of doctors of
endoscope? Capacity of the current staff ? What is
needed and needs training?
6. Assessment of the use of endoscope.
 Is the investment
machine and human)
complete
or
not
(in
terms
of
 Assessment of capacity of using machine is made by
what way? (by number of patients or by hours/day or
times of using services... ?) What is the capacity of
machine?
 Is the machine good enough to diagnose exactly? (CT,
Colour ultrasound)
4. Assessment of effectiveness of these machine in
supporting the diagnosis and treatment of disease?
Assessment of appointment of clinical doctors: rational
or abused... ?
5. Users of these machines amongst patients
-Who are users of these machines ? patients with HI
cards, without HI card, rich or poor patients…
127
Is there any difference between appointment for use
of endoscope between patients with or without HI ? rich
or poor?
-Patients
using
endoscope
hold
what
kind
of
insurance? Patients with HI or without HI, rich or poor
patients…
Is there any difference between appointment for use
of endoscope between patients with or without HI ? rich
or poor?
- How did they pay for the costs (for endoscope)
according to the hospital regulations?
- How many percent of patients who can pay or refuse
to undertake the test as they can not afford the test?
In case, the patient is appointed to undergo hightech test but they are unable to pay for, how can the
problem be solved? Can it replaced with other diagnosis
techniques?
6. Changes of income for staff since the presence of
these endoscope machine?
Is the price for these services rational? Is that too
high or too low? Follow the price schedule of Circular 14
and Circular 03 ?
7. How is management, maintenance and repair of these
machines
decentralized
between
professional
departments
equipment
department ?
is
this
management form rational?
8. Recommendations for better use of these high-tech
medical equipment (investment in staffing, complete
equipment and possibility of co-payment....)
128
Guidelines for in-depth interview
FORM 3.5: For hospital leaders.
(Director or deputy Director of hospital)
-Name
of
hospital:..............................................
............................................
-Full
name
of
respondent:............................................
...............
Position:..............................................
.....................................................
-Phone:………………………………………………………………….
-E-mail:………………………………………………………………………….
-Time
of
interview :............................................
....................................
Introduce the purpose of the interview:
1. Why did the hospital decide to invest in high-tech
medical equipment in general, specially (CT, Colour
ultrasound, digestive endoscope)? At present, is
there any form of investment in equipment for the
hospital? Advantages and disadvantages of each form
of investment?
2. When deciding to invest in any equipment/technology
(CT, Colour ultrasound, digestive endoscope)? Did
the Directorate identify the needs for strengthening
physical infrastructure for the equipment (including
operating costs for operations and maintenance of
machine, etc…) ?
3. advantages and disadvantages of the hospitals in
investment
in
these
machines.
(CT,
Colour
ultrasound, digestive endoscope)?) (Finance and
human)
4. Effectiveness of diagnosis and treatment since
investment in these machines (CT, Colour ultrasound,
digestive
endoscope)?
(is
the
disease
pattern
changed or not? How about number of patients?….).
Solutions to improve the effectiveness.
5. In terms of efficiency in investing in these
machines
(CT,
Colour
ultrasound,
digestive
129
endoscope)? (Source of revenue of these hospitals,
salary for hospital staff….). Solutions to improve
these effectiveness.
6. Advantages, disadvantages from the view of patients
using
these
high-tech
equipment
(CT,
Colour
ultrasound, digestive endoscope)? Is there any
difference between patients groups, rich vs. poor,
patients with and without HI cards?
7. Orientation for investment and utilization of 3
types of equipment (CT, Colour ultrasound, digestive
endoscope)? of the hospitals.
Notes:
Before
conducting
in-depth
interviews
of
hospital
leaders, the study group should combine results from
assessment
of
high-tech
equipment
(specifically
3
techniques of CT, ultrasound and colour digestive
endoscope) of the hospital to inform and agree upon with
the hospitals. On that foundation, will exchange and
supplement results with hospital leaders plus any
suggestion as mentioned above.
130
FORM 4
Guidelines for group discussion
Group discussion among clinical doctors of one department
requiring using high-tech equipment
(CT, ultrasound, endoscope)
Participants: 5-8 clinical doctors
State clearly the objectives and requirements of group
discussion:
1. Changes in diagnosis and treatment since the
presence
of
high-tech
equipment
(CT,
colour
ultrasound, digestive endoscope) (specifically for
diseases that could not be diagnosed but with hightech equipment, these diseases can be detected and
treated,…..)
2. What kind of diseases that usually use 3 types of
high-tech
equipment.
(CT,
colour
ultrasound,
digestive endoscope). Clinical doctors have to be
trained
in
appointment
and
use
of
high-tech
equipment in diagnosis and use of the results or
not…)
3. What kind of patients who are usually appointed to
use 3 types of high-tech equipment (CT, colour
ultrasound, digestive endoscope) - (insured, no
insurance, rich, poor patients….) In case the
patients are unable to afford, how would the
hospital solve the problem?
4. How are the procedures for whole consultation to
appoint using such expensive technique? Did you take
assessment of medical records to use these
technology as a necessary? Did you detect any case
that rarely use or use too much services of these
equipment?
5. Are high-tech equipment of hospital (CT, colour
ultrasound, digestive endoscope) meet the needs? Or
is that too abundant or insufficient. Why?
6. How is the use of high-tech equipment (CT, colour
ultrasound, digestive endoscope) in the hospital?
effective. Yes? No? Why? Measures to improve the use
of these machine?
7. The
coordination
between
clinical
doctors
and
doctors who operate CT, colour ultrasound, digestive
endoscope?
131
132
Notes for the study team:
- It is noted that study team members should place
themselves into the role of learners of experiences from
surveyed hospitals that have intended equipment (CT,
colour
ultrasound,
digestive
endoscope).
Therefore
positive and negative aspects of the investment should
also be taken into full account.
- During the process of probing information, it is
advised to explore disadvantages and ineffectiveness of
these investment. The purpose is not to assess but to
withdraw experiences for other health facilities to
follow from which measures for improvement will be made
in order to improve the effectiveness of investment.
- While interviewing, they
business card of the respondent.
should
try
to
have
- When interviewing, they should introduce the purpose of
the interview, ask for permisison of recording the
interview and report that this study aims to collect
information of hospital, and might be presented in
detailed in the study report.
133
1 MoH, 2006, Health Statistical Yearbook, 2005. Hanoi: Health Statistics
and Informatics, Planning and Finance Department.
2 Department of Medical Equipment and Civil work, MoH, 2006, Health Sector
Conference Report, 2005.
134