Clinical Friction in Dual-Healthcare Systems: Institutional Barriers to Integrative Traditional Medicine
DOI:
Abstract
Vietnam operates a unique, state-mandated healthcare system that structurally integrates Traditional Vietnamese Medicine (TVM) within conventional hospitals. However, the operational success of this dual model relies heavily on the clinical behaviors and collaborative practices of Western-trained conventional physicians. This multi-center, cross-sectional study investigated the levels of objective knowledge, professional attitudes, and cross-departmental referral workflows regarding TVM among conventional physicians practicing in major urban medical hubs in Vietnam. A validated, 28-item structured questionnaire was distributed to licensed modern medicine physicians across tertiary (Tier-1) and secondary (Tier-2) hospitals in Hanoi and Ho Chi Minh City. Data from 412 completed surveys were analyzed using descriptive statistics and binary logistic regression to identify independent predictors of active referral workflows. The data revealed a critical “Attitude-Knowledge Paradox.” While a majority of conventional physicians exhibited highly positive cultural attitudes toward TVM (Mean Likert Score: 3.8 0.6), objective pharmacological knowledge was critically low (Mean Score: 4.2 1.8 out of 10). Specifically, 78.4% of respondents failed to identify verified herb-drug interactions. Consequently, active outbound referrals were low (24.3%) and heavily restricted to chronic musculoskeletal pain (82.0%) and neurological rehabilitation (68.0%). The leading institutional bottlenecks were a lack of randomized controlled trial (RCT) data on native Vietnamese flora (86.5%) and fears of unpredictable drug-herb toxicities (79.2%). Formal TVM exposure during medical school was a powerful independent predictor of active clinical referral practice (aOR = 2.45; 95% CI: 1.32 - 4.56; p < 0.01). Structural integration in Vietnamese hospitals has not achieved functional clinical synthesis. Conventional physicians default to defensive prescribing habits due to an educational vacuum and a lack of evidence-based pharmacological parameters. To bridge this divide, the Ministry of Health must prioritize pharmacology-focused curriculum reforms, automated electronic drug-herb interaction screening, and state-funded clinical trials for indigenous phytotherapeutics.
Downloads
Views : 0
Downloads : 0
References
ASEAN+3 Macroeconomic Research Office (AMRO), “How Can Vietnam Transition from a Golden Population Structure to a Successful Aging Society,” amro-asia.org, May 2, 2024. [Online]. Available: https: //amro-asia.org/how-can-vietnam-transition-from-a-golden-population-structure-to-a-successful-aging-society. [Accessed: Jan. 8, 2026].
T. K. Toan, “Contemporary Vietnam's Health Status and Health System,” in Routledge Handbook of Contemporary Vietnam, J. D. London, Ed. Abingdon, Oxon; New York, NY: Routledge, 2022, ch. 20, pp. 277–286. doi: 10.4324/9781315762302-23.
S. Nanda, “Integrating Traditional and Contemporary Systems for Health and Well-being,” Ann. Neurosci., vol. 30, no. 2, pp. 77–78, Apr. 2023, doi: 10.1177/09727531231185648.
N. A. Tefara and L. Balasundaram, “Traditional Medicine in Vietnam,” PriMera Sci. Med. Public Health, vol. 3, no. 6, pp. 28–31, Dec. 2023, doi: 10.56831/PSMPH-03-106.
National Strategy for people's health protection approved, Vietnam Law Magazine, Feb. 14, 2024. [Online]. Available: https: //vietnamlawmagazine.vn/national-strategy-for-peoples-health-protection-approved-71257.html. [Accessed: Jan. 8, 2026].
N. K. Quan and A. W. Taylor-Robinson, “Vietnam's Evolving Healthcare System: Notable Successes and Significant Challenges,” Cureus, vol. 15, no. 6, p. e40414, Jun. 2023, doi: 10.7759/cureus.40414.
L. Redwood, G. J. Fox, T. A. Nguyen et al., “Good citizens, perfect patients, and family reputation: Stigma and prolonged isolation in people with drug-resistant tuberculosis in Vietnam,” PLOS Glob. Public Health, vol. 2, no. 7, p. e0000681, Jul. 2022, doi: 10.1371/journal.pgph.0000681.
K. Takashima, K. Wada, T. T. Tra, and D. R. Smith, “A review of Vietnam's healthcare reform through the Direction of Healthcare Activities (DOHA),” Environ. Health Prev. Med., vol. 22, no. 1, p. 74, Oct. 2017, doi: 10.1186/s12199-017-0682-z
T. H. Dang, T. A. Nguyen, M. Hoang Van, O. Santin, O. M. T. Tran, and P. Schofield, “Patient-Centered Care: Transforming the Health Care System in Vietnam With Support of Digital Health Technology,” J. Med. Internet Res., vol. 23, no. 6, p. e24601, Jun. 2021, doi: 10.2196/24601.
N. T. T. Ha, D. T. Nghia, H. T. V. Nga, T. T. Lua, N. T. B. Hong, N. T. Hanh et al., “Traditional Vietnamese herbal medicine TD0015 in Knee Osteoarthritis: A Phase-II randomized controlled trial,” Integr. Med. Res., vol. 14, no. 2, p. 101143, Jun. 2025, doi: 10.1016/j.imr.2025.101143.
D. B. Duong et al., “Innovations in medical education in Vietnam,” BMJ Innov., vol. 7, no. Suppl 1, pp. s23–s29, Mar. 2021, doi: 10.1136/bmjinnov-2021-000708.
D. D. Nguyen, “Exploring the Potential of Vietnamese Traditional Medicinal Herbs: Trends, Challenges, and Global Market Opportunities,” Int. J. Sci. Res. Manag., vol. 12, no. 10, pp. 7648–7654, Oct. 2024, doi: 10.18535/ijsrm/v12i10.em10.
Promoting traditional Vietnamese medicine in new era, Việt Nam News, Sep. 17, 2025. [Online]. Available: https: //vietnamnews.vn/society/1725338/promoting-traditional-vietnamese-medicine-in-new-era.html. [Accessed: Jan. 8, 2026].
Y. C. Seck, “Vietnam: New law on medical examination and treatment,” Global Compliance News, Mar. 22, 2023. [Online]. Available: https: //www.globalcompliancenews.com/2023/03/22/https-insightplus-bakermckenzie-com-bm-healthcare-life-sciences-vietnam-new-law-on-medical-examination-and-treatment_03152023/. [Accessed: Jan. 8, 2026].
The Prime Minister directs the acceleration of the development of Vietnamese traditional medicine in the new phase, Vietnam.vn, Sep. 15, 2025. [Online]. Available: https: //www.vietnam.vn/en/thu-tuong-chi-dao-day-manh-phat-trien-nen-y-hoc-co-truyen-viet-nam-trong-giai-doan-moi. [Accessed: Jan. 8, 2026].
N. T. Ha, N. Q. Anh, P. Van Toan, and N. T. Huong, “Health Insurance Reimbursement to Hosptials in Vietnam: Policy Implementation Results and Challenges,” Health Serv. Insights, vol. 14, p. 11786329211010126, Apr. 2021, doi: 10.1177/11786329211010126.
Ministry of Health, “Circular No. 35/2016/TT-BYT promulgating the list of conditional reimbursed and non-reimbursed medical services by Health Insurance,” Ministry of Health, Vietnam, Circular No. 35/2016/TT-BYT, Dec. 30, 2016.
G. Lê, H. T. T. Bui, T. Mirzoev, and H. T. Nguyen, “Negotiating Compliance: The Case of Autonomous Hospitals in Vietnam,” Dev. Policy Rev., vol. 33, no. 3, pp. 373–390, May 2015, doi: 10.1111/dpr.12112.
N. A. Jama, A. Nyembezi, S. Ngcobo, and U. Lehmann, “Collaboration between traditional health practitioners and biomedical health practitioners: Scoping review,” Afr. J. Prim. Health Care Fam. Med., vol. 16, no. 1, pp. e1–e11, Jul. 2024, doi: 10.4102/phcfm.v16i1.4430.
L. L. Restifo and G. R. Phelan, “The cultural divide: exploring communication barriers between scientists and clinicians,” Dis. Model. Mech., vol. 4, no. 4, pp. 423–426, Jul. 2011, doi: 10.1242/dmm.008177.
N. Yadav, S. Singh Chandel, T. Venkatachalam, and S. N. Fathima, “Herbal Medicine Formulation, Standardization, and Commercialization Challenges and Sustainable Strategies for Improvement,” in Herbal Medicine Phytochemistry, S. C. Izah, M. C. Ogwu, and M. Akram, Eds. Cham, Switzerland: Springer, 2024, ch. 40, doi: 10.1007/978-3-031-43199-9_40.
A. Angelino, D. T. Khanh, N. An Ha, and T. Pham, “Pharmaceutical Industry in Vietnam: Sluggish Sector in a Growing Market,” Int. J. Environ. Res. Public Health, vol. 14, no. 9, p. 976, Aug. 2017, doi: 10.3390/ijerph14090976.
Ministry of Health of Vietnam, “Circular No. 19/2013/TT-BYT: Specifying implementation guidelines for healthcare service quality management in hospitals,” Ministry of Health of Vietnam, Hanoi, Vietnam, Circular No. 19/2013/TT-BYT, 2013. [Online]. Available: https: //vanbanphapluat.co/circular-19-2013-tt-byt-implementation-guidelines-healthcare-service-quality-management-hospitals. [Accessed: Jan. 24, 2026].
D. C. Pham and T. S. Vu, “Factors influencing performance of public hospitals: The case of Vietnam,” Manag. Sci. Lett., vol. 9, no. 8, pp. 1231–1242, 2019, doi: 10.5267/j.msl.2019.4.022.
A. Talebpour, H. Sadeghi-Bazargani, A. Janati, F. Pashazadeh, and M. Gholizadeh, “Crucial key performance indicators for hospital evaluation: A scoping review,” J. Educ. Health Promot., vol. 14, p. 195, May 2025, doi: 10.4103/jehp.jehp_2102_23.
V. Petri, T. Antoine, B. Emma, H. Hervé, F. Emma, and V. Hana, “Clinical data integration and processing challenges in healthcare caused by contemporary software design,” Digit. Health, vol. 11, p. 20552076251374233, Sep. 2025, doi: 10.1177/20552076251374233.
J. Wang, A. Lin, Y. Huang, G. Li, T. Chen, C. Sun, W. Qian, S. Ren, H. Z. H. Wong, Y. Ding, and L. Zhang, “Medical Data as a Key Asset in the Digital Health Era: A Framework for Challenges and Strategies,” iMetaMed, vol. 1, no. 2, p. e70014, Nov. 2025, doi: 10.1002/imm3.70014.
S. Adorisio, A. Fierabracci, A. Rossetto, I. Muscari, V. Nardicchi, A. M. Liberati, C. Riccardi, T. V. Sung, T. T. Thuy, and D. V. Delfino, “Integration of Traditional and Western Medicine in Vietnamese Populations: A Review of Health Perceptions and Therapies,” Nat. Prod. Commun., vol. 11, no. 9, pp. 1409–1416, Sep. 2016, doi: 10.1177/1934578X1601100949.
S. Czigle, M. Nagy, P. Mladěnka, and J. Tóth, “Pharmacokinetic and pharmacodynamic herb-drug interactions-part I. Herbal medicines of the central nervous system,” PeerJ, vol. 11, p. e16149, Nov. 2023, doi: 10.7717/peerj.16149.
H. T. Ly, T. T. H. Nguyen, V. M. Le, B. T. Lam, T. T. T. Mai, and T. P. T. Dang, “Therapeutic Potential of Polyscias fruticosa (L.) Harms Leaf Extract for Parkinson's Disease Treatment by Drosophila melanogaster Model,” Oxid. Med. Cell. Longev., vol. 2022, p. 5262677, May 2022, doi: 10.1155/2022/5262677.
S. Y. Zheng and X. Q. Zhou, “A perspective on the mechanisms of herbal medicine for cognitive impairment,” Front. Neurol., vol. 16, p. 1610542, Jul. 2025, doi: 10.3389/fneur.2025.1610542.
S. M, R. Puthiyedath, and Z. S. Pillai, “Drug-herb interactions: a challenge and clinical concern in primary healthcare,” Front. Med. (Lausanne), vol. 12, p. 1657005, Nov. 2025, doi: 10.3389/fmed.2025.1657005.
A. Perlman et al., “Effect of Enzyme-Inducing Antiseizure Medications on the Risk of Sub-Therapeutic Concentrations of Direct Oral Anticoagulants: A Retrospective Cohort Study,” CNS Drugs, vol. 35, no. 3, pp. 305–316, Mar. 2021, doi: 10.1007/s40263-021-00795-z. Erratum in CNS Drugs, vol. 35, no. 8, p. 919, Aug. 2021, doi: 10.1007/s40263-021-00844-7.
Q. C. Le, M. H. Bui, Q. L. Khuong, P. A. Le, D. T. Tran, Q. H. Nguyen Vu, and N. V. Vu, “Developing institutional policies for health professionals' education reform: a case study of medical education in Viet Nam,” Lancet Reg. Health West. Pac., vol. 57, p. 101551, Apr. 2025, doi: 10.1016/j.lanwpc.2025.101551.
P. D. Leiphrakpam, P. R. Armijo, and C. Are, “Incorporation of Simulation in Graduate Medical Education: Historical Perspectives, Current Status, and Future Directions,” J. Med. Educ. Curric. Dev., vol. 11, pp. 1–11, Jan.–Dec. 2024, doi: 10.1177/23821205241257329.
Y. Chen, W. Chen, Y. Deng, X. Lian, W. Meng, H. Zhang, Y. Qiu, X. Xie, K. Wei, and J. Luo, “The current state of defensive medicine and its association with empathy: a cross-sectional study among graduate students in Guangxi, China,” BMC Med. Educ., vol. 26, no. 1, p. 52, Dec. 2025, doi: 10.1186/s12909-025-08366-2.
T. D. Vo and H. T. Lam, “MAFLD in Vietnam: a neglected public health challenge requiring urgent policy action,” Front. Clin. Diabetes Healthc., vol. 6, p. 1687149, Dec. 2025, doi: 10.3389/fcdhc.2025.1687149.
Electronic Health Administration, “Circular No. 46/2018/TT-BYT regulating electronic medical records,” Ministry of Health of Vietnam, Hanoi, Vietnam, 2018. Accessed: Jan. 13, 2026.
M. Safi, R. Clay-Williams, B. R. Thude, J. Vaisman, and F. Brandt, “Today’s referral is tomorrow’s repeat patient: referrals to and between medical outpatient clinics in a hospital,” BMC Health Serv. Res., vol. 22, no. 1, p. 254, Feb. 2022, doi: 10.1186/s12913-022-07633-y.
J. Blinkenberg, Ø. Hetlevik, H. Sandvik, V. Baste, and S. Hunskaar, “The impact of variation in out-of-hours doctors' referral practices: a Norwegian registry-based observational study,” Fam. Pract., vol. 40, no. 5–6, pp. 728–736, Dec. 2023, doi: 10.1093/fampra/cmad014.
L. Kosowicz et al., “Lessons for Vietnam on the Use of Digital Technologies to Support Patient-Centered Care in Low- and Middle-Income Countries in the Asia-Pacific Region: Scoping Review,” J. Med. Internet Res., vol. 25, p. e43224, Apr. 2023, doi: 10.2196/43224.
