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One of the biggest budgets for expats in Vietnam is getting world class health treatment

The reason is like in the pizza the ingredients that compose it: #1 the insured member, #2 the treatment provider hospital and clinics and finally #3 the insurer accountant. 

The problem is -and has always been- in this 3 partners relationship no one (in aggregate) knows nor cares about the costs of the treatment. Worse, most times in Asia the final good result, the cured insured patient, is unrelated to the actual treatment costs paid.

As I write, the famous and excellent Bumrungrad and Samitivej Thailand hospitals are joining the league of Singapore’s expensive healthcare providers. More insurers will load their Asean region pricing if you want to access those. Let’s detail the cocktail of ingredients that makes healthcare one of the highest inflationary services in the world as the picture shows.

Medical Inflation by Hospitals Input Vietnam ASEAN developing countries

Think about this: when the new French International Hospitals were built say in Hanoi or in HCMC late 1990s, here are some costs one can not imagine they had to face: import constructions materials as simple as soundproof windows and doors, electricity generators, medical supplies recycling unit, water treatment mini-plant, refrigerating units for medicines. Even amortized over 10-years, the prices are inflated by costs that would normally be borne by the government and the country’s population taxes. Here, the ‘privileged’ Expat and wealthy locals patients are the payers.

Good specialists doctors in Vietnam costs triple 


A good doctor or an excellent surgeon will obviously do well in their home country with patients queuing for consultation or surgery. To attract those specialists to run international standards hospital or medical practice has a price tag. Of course, their excellence has been gathered by experience and at their middle age the employer has to consider relocating the whole family. Knowing the cost of English speaking education at international schools, you can add a 2500$/month/child for schooling. 

Now add the costs of work permit, registration to the Ministry of Health and other administrative hurdles.


In developing countries you need to have all in-house and new. New because the government does not want to risk becoming à dumping place for old equipment. 

In-house, because there is no healthcare level playing field ecosystem which is regulated to the state-of-the-art. For instance, in Vietnam cancer cell biopsy (maybe still now) are sent over to Singapore for testing and receiving results back. International clinics dont have the proper equipment, supplies and teams to run them to the highest standards. Some Vietnamese bigger hospitals may have but the whole chain of process is not trustworthy. Even million dollar MRI, PET scanners can be purchased -or donated by foreign governments- now the cost of maintenance and repairs may not be affordable or simply by-passed by incompetent technicians. The healthcare provider may also have to import skills and parts or worse purchase additional equipment to stabilize all inputs like water or electricity.

If available at all, the latest technology are costly to keep the full process to high working standards. Lab tests and imaging labs start to set-up to alleviate the burden the main healthcare flagship hospitals.

Supply chain

Because of the purchasing power of the general population, it is not the few thousands expats that will create the market for some specific disease supplies. For instance, Vietnam does not have the latest prenatal equipment nor a blood bank to world class requirements. Neurosurgeons still work with past century techniques as costly equipment can not be amortized by the few hundred dollars the patients or the social security is ready to pay.

Let’s take the example of the ICU rooms for highly infectious disease counts a couple of hundreds for 100 Mio population. The   Covid Vaccines needing -35 degree refrigeration was one à major headache. 

International SOS clinics in Vietnam, a few years ago, reckon 30% of their turnover consist in medical evacuations of Expats to neighboring countries with healthcare excellence, namely Thailand and Singapore.

Medical Inflation by insured members

One upside of the Expat lifestyle is a high salary package, the downside is you pay everything at inflated international prices as there are no subsidies or government paid quality infrastructure you are used to in your home country. On top of this, you want a foreign doctor, your family can speak the same language. You can not afford to stop working due to illness as paid leaves and salary replacement is very limited, if it exists at all.

Therefore, all Expats and wealthy locals want the best specialist doctors there is for treatment -if available-, in economist jargon it’s a provider’s market: offer is king. In many developing countries worldwide an Expat oncologist, cardio specialist, ENT, eye, allergy, skin doctor or hand/foot surgeon are difficult to find.


Westerners live older and want to live in good health… whatever it costs.

As most expats are of working age, they overlook the inflation caused by their possible future retirement in the country like Thailand, Cambodia or the Philippines. 

As we age the cost of treatment actually tends to decrease, but recovery of à 60 year old person takes longer than when you were 30. More costly are the chronic conditions that can now be treated by medical science. We all know that people die of AIDS anymore with tritherapy. Recently, I was surprised to hear that now leukemia can be cured by bone marrow transplant! These days, it is not rare to hear about 100 years old parents birthday celebrations in Europe and Japan.

According to WHO, it is mostly Western countries’ citizens who live more than 20-25 years beyond age 60, the age for ‘exepensive’ chronic illness like diabetes, cardiovascular and cancers set-in. As more Western retirees relocate in Asia and purchase ‘lifetime’ private health insurance, those insurers will bear most of the treatment costs, replacing the traditional function of their social security (often largely subsidized) of their home countries.of

Security of lifetime

With globalization, mixed couples and lifetime settlement to retire in your country of expatriation means you keep your insurance. Not that it is only recent that health insurers offer lifetime coverage for foreigners -it used to stop at age 65-. The rationale just a decade ago was, you work then you retire in your home country, where the social security will take care of the bill whilst you join and pay your national social security. 

The consequences for the insurer is that the over 65, retired in Asia, make a bigger portion with chronic conditions treated in Asia that most times costs beyond the premium they pay, thus increasing the contribution of ‘healthier and younger’ members. This solidarity, by repartition of the costs of the pool of members and the security that 1 family will not have to be penalized if their health is bad, is the base of the insurance system. Some new insurers, recently incorporated in Asia, do not adhere to the old European system of solidarity of ‘community price rating’, as it is called in insurance parlance, and use experience loading by increasing the renewal rate of 1 family or individual in the unfortunate case of à serious illness or accident. This is more à societal discussion than and insurer’s issue.

Get the best health care money can get, whatever it costs! professor, hospital and medicines…

Evacuation is a must-have because when one purchases insurance they want the best. As a counter example, a Vietnamese expat wife, despite not speaking english and living far away from the city- wanted to deliver her baby at the FVH international hospital in the single VIP room because the insurance was paying for it and she could take nice luxury suite selfie and send it back to the countryside. 

More seriously, when you paid for a hospitalization plan with a $1mio limit for worldwide treatment, for a serious condition you want to access the best surgeon in the world.

Now money is enough to treat rare conditions like HUS treated (rare blood cell degenerative condition).

More flabbergasting is the rare orphan disease costs of treatment, à swedish patient in Vietnam. By the time the diagnosis was found Mr Carls , was evacuated 2 times to Thailand and stayed 3-month in a top Thailand hospital to find the pathology, back in 2011, the patient literally WFH.ospital managing his business in Vietnam. Finding the right doctor -usually a busy professor-, took him another 2-month of research incidentally à lady Professor based in Stockholm. The next few years of treatment were between Sweden and Asia. To finally decide on a kidney transplant if Soliris medicine could stop the destruction of his red blood cells. This is how I discovered the Alexion Pharmaceutical cost of Soliris, the most expensive drug treatment in the world with a price tag of US$410,000/year.

• NextGen drug therapies – There are exciting advances in the field of medical technology,which are improving healthcare outcomes, but these are extremely expensive.

Medical inflation by Insurers

The myth about insurers is that they are the richest companies on the planet because they have to pay big dividends to the shareholders. There are market forces -the competitors prices- that makes it impossible to have higher prices than the competition. Except for the reasons the insurer claims costs are high and portfolio of clients is unbalanced towards more aging clients with chronic conditions like cardiovascular disease, diabetes or cancer, the insurer will apply a higher premium causing healthy clients to shift to another provider. Only the clients with treatments on-going will stay spiraling into more losses by the insurer.

In the era of the Internet a difference of +10% is spotted by comparators online and new clients will flee.

In short, the pricing reflects the yearly costs health insurers faces + their operating costs + a standard margin for growth. In a good year of low claims and good sales, good profits are extracted and reserved building capital for bad years. The cumulated capital gives the insurer the financial strength clients like in the event of big treatment costs.

Health insurer portfolio management means younger pays for older client members

The insurance system is based on the community the more average or healthy clients the cheaper the prices. Obviously the ideal strategy to keep a good price is a portfolio of below age 30, healthy male professional clients who never claim. But soon they get married, have children and grow old. Maternity is costly, older age members’ chronic illness has predictable high costs over many years and sometimes it is chronic illness producing recurring treatment costs to the insurer. This reliability is sustainable by general increase affecting the healthy and to the benefit of the community. In other words, the price increase is the reason you have a reliable insurer that will pay for your claims regardless of your state of health over the years. This guarantee of your policy now often extends over a lifetime cover.

More health coverage as more illness are known and curable

COVID-19 – The pandemic has caused unprecedented disruption and placed an extraordinary strain on healthcare systems around the world.

As the competition rages every year some insurers innovate to satisfy the demand from Individual and corporate clients. 

For instance, in Vietnam or Cambodia, there are missing specialties -like neurosurgery- necessitating air Evacuation to Thailand or Singapore for urgent cases. This evacuation benefit is a standard now in health cover policies, it will never be used in other countries where all hospitalization facilities are available within ambulance drive away.

Every year, Cancer oncology specialty sees new expensive technology to detect early and to treat without invasive surgery or amputation. More plans offer cancer screening as part of outpatient preventive health-check care, this of course in order to avoid expensive cancer treatments in hospitals ahead of time. This comes as a cost that most members will use, not just the patients at risk.

It is all available to insured members wherever you can find it.

More recently Covid pandemic has been covered by health insurers when most non-medical consider a pandemic ‘an Act of God’ like an earthquake. With Covid confinement, many companies requested mental health or telemedicine benefits to be included for their employees. This is becoming à standard well-being benefit.

Lifetime cover globalization expats retired in Asia

Globalization means more expats live and retire in developing countries and they want to keep the same high standards they enjoy in the western world. 

This attracts new services who have the high costs of the new settlers. 

In any country like Vietnam, as the Expat community grows the best clinics offer is overwhelmed by demand, then comes the corporate employees and the wealthy locals who want the best treatment available in town. Price becomes secondary when small hospitals have scarcity of top medical professionals and specialists. The same goes for international schools who have to try to keep the number of Vietnamese students below 40% to retain the international expat level of service.

Some patients don’t even know the cost of their treatments because the company paid (in the case of Asian like Japanese or Korean) or the insured patient used the ‘cashless service’ showing their insurance card and the invoice was directly billed to the insurer.

CONCLUSION No one is concerned by who pays the hospital bills!

Here how the vicious circle of medical inflation goes:

  • The clinic has to recoup its high costs that are invoiced to deep pocket insurers whose limits are infinite, typically over $1,000,000 of hospitalization and consultation costs. In some unethical practices like repeat consultations for unknown diseases or tricky health conditions, and unnecessary test and imaging bills, insurers have tough times figuring out the real from the fake. In cases of abuses, insurers have been wondering if the end result of the medical practitioner was the patient to be finally cured?
  • The insured member without the knowledge of the country and the best practitioners in town goes to the most expensive international clinic in town. Sometimes because it is easy and sometimes having the feeling the more expensive the treatment,  the best value for money I get back.
  • The insurer, we pay the claims to satisfy our clients to keep their company/the insured members satisfied and they will pay for the premium increase at renewal.

The Harvard Professor of strategy, Michael Porter, commanded a study to find the solution to Healthcare inflation and to start real competition between medical providers. 

The solution was to calculate the average cost of a cured illness: for instance, if we could est establish the average cost to cure à thyroid cancer at say $9,000 in EU for instance, this would give à benchmark for the whole medical community to beat that cost by improving prevention, detection or curing techniques.

insurance in Asia

Not only health insurance is different but most general insurance: accident, life, home, travel, office or even car insurance will be different than your past experiences.