Views & Reviews Personal View

Hidden out-of-pocket payments can burden patients’ families but are under-recognised

BMJ 2015; 351 doi: (Published 23 September 2015) Cite this as: BMJ 2015;351:h4990
  1. Hirotsugu Aiga, senior adviser on health and nutrition, Human Development Department, Japan International Cooperation Agency (JICA), 3rd floor, Nibancho Center Building, 5-25, Niban-cho, Chiyoda-ku, Tokyo 102-8012, Japan; adjunct professor, Department of Global Health, Milken Institute School of Public Health, the George Washington University, 950 New Hampshire Ave, NW, 7th floor, Washington, DC 20052, USA
  1. aiga.hirotsugu{at}

In countries such as Vietnam, families often lose earnings while caring for relatives in hospitals. These and other hidden costs contribute to indebtedness and financial catastrophe, writes Hirotsugu Aiga

In April 2015 a crowd of hundreds of patients’ family members sitting on the ground caught my eye at An Giang General Hospital, one of 91 provincial government hospitals in Vietnam. They had been sheltering from the sun and sleeping outdoors under ward awnings and in interconnecting corridors for days or even weeks at a time.

Although Vietnam has hardworking nursing staff, inpatients’ families are responsible for basic non-clinical care, including food preparation, feeding, washing, changing diapers, cleaning laundry, and helping them to go to the toilet.1 Food preparation, even for patients who need special diets, is often the families’ responsibility, although it is an essential clinical intervention. Family members are required to stay either at inpatients’ bedsides or to be on standby outside wards 24 hours a day.

In this situation, in addition to the upfront costs of clinical …

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