Vietnam Social Security gives reasons for needing to divide medical examination and treatment lines

Accordingly, if patients are not managed according to their level, patients will flock to higher levels for treatment, causing overload, the health system is at risk of being broken, greatly affecting health care and medical examination and treatment for people.

According to Vietnam Social Security (VSS), most countries in the world have regulations on medical examination and treatment. All cases (except emergencies) that want to go to a higher level must go through a family doctor or general practitioner and be referred by a lower level.

In our country, referral and technical expertise in medical examination and treatment have been specifically regulated in the Law on Medical Examination and Treatment and guiding documents of the Ministry of Health to provide comprehensive and interconnected health care for the people.

Specifically, according to the 2009 Law on Medical Examination and Treatment, our country's health system consists of 4 levels: commune, district, province, and central. The amended and supplemented Law on Medical Examination and Treatment (effective from January 1, 2024) also stipulates the professional decentralization in medical examination and treatment, including 3 levels: Initial medical examination and treatment level, basic medical examination and treatment level, and specialized medical examination and treatment level.

Based on the functions and tasks of each line, carry out planning, investment, construction of appropriate facilities, equipment and human resources.

Doctor Le Van Phuc, Head of the Health Insurance Policy Implementation Department (Vietnam Social Security), said that the pyramid-shaped health system model is applied by most countries and only this model can ensure comprehensive and effective health care and management.

“If patients are not managed according to their level, the healthcare system will certainly be disrupted. Therefore, managing medical examination and treatment at all levels using referral papers is an appropriate and necessary tool,” Dr. Phuc emphasized.

According to Mr. Phuc, if patients are not managed according to their level, the need for medical examination and treatment will be concentrated at upper and lower level hospitals for treatment, even in cases that are not suitable and unnecessary for the patient's condition.

This not only overloads upper-level medical facilities and causes inconvenience to patients, but also wastes facilities and human resources at lower levels due to not fully utilizing their capacity.

Ms. Nguyen Thi Thu Hang, Deputy Director of Ho Chi Minh City Social Insurance, said that in reality, most district and county hospitals in Ho Chi Minh City are classified as grade 1 and grade 2 and can perform many technical services at the provincial and central levels.

The city's provincial general and specialized hospitals are all large hospitals that perform many specialized techniques and have attracted patients from all over the country for medical examination and treatment. In particular, people with health insurance cards are always fully entitled to benefits according to regulations.

Must facilitate patients to transfer medical treatment

According to regulations, since 2014, patients must be transferred from lower to higher levels in order, but since 2016, the district-level medical examination and treatment route has been opened, and since 2021, the provincial-level inpatient treatment route has been opened.

Accordingly, when health insurance participants go to district-level hospitals or provincial-level inpatient hospitals nationwide, they will be paid by the health insurance fund as if they were going to the place where they initially registered for health insurance. These regulations have gradually created favorable conditions for health insurance participants when going to health insurance-covered hospitals.

Mr. Le Van Phuc said that Vietnam Social Security always supports the viewpoint of simplifying administrative procedures, creating favorable conditions for health insurance participants when going to medical examination and treatment. However, creating favorable conditions for participants must be associated with the sustainability of the health system, especially the grassroots health care system. Avoid the situation where even minor illnesses are treated at the central level, causing overload, unnecessary waste of financial resources, and failure to promote the effectiveness of grassroots health care.