Healthcare and Hospitals in Vietnam During the Subsidy Era (1975–1986)

During the subsidy era, Vietnam's healthcare system and hospitals were organized under a centralized public healthcare model based on the principle of entirely free care for state cadres, civil servants, and the general public. Despite facing immense economic hardship and severe material shortages, this period laid the foundation for a nationwide primary healthcare network.

1. Operational Mechanism & Healthcare Policies

• Free Healthcare & The Coupon System: Patients paid no fees for medical consultations, medications, or hospital beds. Medicines, medical supplies, and hospital meals were distributed according to quotas, medical record books, and ration coupons.

• Strict Referral System: The healthcare system was clearly stratified from local clinics (commune/ward level), district/city hospitals, and provincial hospitals up to central-level hospitals (such as Bach Mai, Viet Duc, Cho Ray, and Hue Central Hospital). Patients seeking care at higher-tier facilities were strictly required to hold an official referral letter from lower-level clinics.

• Institutional Infirmaries: Most factories, enterprises, state farms, and cooperatives maintained their own infirmaries or medical officers to provide primary care for workers.

2. Realities & Characteristic Shortages

• Shortages of Medicines & Medical Supplies:

  • Western medicines (especially antibiotics and specialized drugs) were extremely scarce. Doctors relied heavily on traditional Vietnamese herbal medicine (such as xuyên tâm liên, star anise, and đinh lăng) to treat common ailments.

  • Hypodermic needles, glass syringes, and rubber gloves had to be sterilized in boiling water and reused multiple times.

• Overburdened Infrastructure & Equipment:

  • Hospitals frequently lacked electricity and clean running water; many surgical procedures were performed under gas lanterns or small generators.

  • Modern diagnostic tools (such as X-rays and microbiological testing) were primitive and rare. Electric fans or private hospital beds were luxuries, with patients often sharing beds (2–3 people per bed).

• Livelihood of Medical Staff: Salaries for doctors and nurses were paid in grain rations (rice, wheat, and coupons) like other professions. Despite severe material hardships, they maintained a strong sense of responsibility and high medical ethics.

3. Historical Legacy & Values

• Building a Primary Healthcare Network: This era established a widespread healthcare network reaching down to villages and cooperatives, helping effectively control basic infectious diseases and implement expanded immunization programs.

• Advancement of Traditional Medicine: The shortage of Western drugs spurred a flourishing movement integrating traditional and modern medicine, creating momentum for traditional Vietnamese medicine to solidify its standing.

• Human Connection & Medical Ethics: Mutual support and compassion between doctors and patients, as well as among patients sharing common hardships, became a profound memory of human connection during the subsidy period.