Ministry of Health: Financial autonomy causes lower levels to "keep" patients, limiting transfers

The Ministry of Health is in the process of soliciting comments on the Draft Law amending and supplementing a number of articles of the Law on Health Insurance. In the report summarizing 15 years of implementing the latest version of the Law on Health Insurance in September 2024, the drafting agency frankly pointed out the shortcomings, limitations, and inadequacies.

The Ministry of Health believes that participating in health insurance has contributed to reducing households’ out-of-pocket spending on health care. However, currently, the out-of-pocket spending rate in Vietnam is still relatively high, accounting for about 45% of medical expenses.

"Increased use of medical services" is the reason given. According to the Ministry of Health, according to a survey, people with health insurance cards have a higher rate of using outpatient and inpatient medical examination and treatment services than other subjects. The amount of co-payment as well as the amount of self-payment for drugs, medical supplies or services not covered by health insurance increases the amount of out-of-pocket payments.

In addition, the fact that medical service prices are not calculated correctly increases out-of-pocket costs. Some hospitals have difficulty purchasing drugs and medical supplies, leading to drug shortages and insufficient necessary drugs for patients. Drug bidding and drug management are not guaranteed, some necessary drugs are not supplied, so patients have to buy them from outside.

Currently, the Health Insurance Fund only pays for medical examination and treatment services, medical services performed at medical examination and treatment facilities, while some medical services can be provided by facilities other than medical examination and treatment facilities such as pharmacies and testing centers.

Regarding the quality of health examination and treatment covered by health insurance, the Ministry of Health acknowledged that it "has not met the needs" of the people, especially at the grassroots level and in mountainous provinces, remote areas. People still go to the provincial and central levels, leading to overload at higher levels, increasing unnecessary costs, making the out-of-pocket costs of patients still high.

"Most central hospitals are overloaded," the Ministry of Health's report stated. The situation of medical examination and treatment beyond the prescribed level leads to overload at higher levels and people are not satisfied with the medical examination and treatment procedures and waiting time.

One reason why patients have lost confidence in the health insurance policy is that there are still cases where patients have to pay for medicine and medical supplies within the scope of their benefits because medical facilities cannot provide them for various reasons.

Not to mention, some places have a situation where patients with health insurance cards are required to use socialized equipment while there are still budget-funded machines, which makes patients have to pay the difference between the two prices. Some costs have been included in the price structure such as (surgical clothing and hats, injection fees, inpatient examination fees...) but some facilities still calculate and require patients to pay.

One shortcoming in the implementation of health insurance examination and treatment is that the implementation of financial autonomy for medical examination and treatment facilities has led to a situation where some Lower level hospitals "keep" patients treatment, limiting referral to higher levels, affecting the rights of health insurance participants. The situation of over-prescribing some technical services such as testing, diagnosis, and medication still occurs.

According to the Government's Report sent to the National Assembly Standing Committee regarding the reception and revision of the draft Law on Medical Examination and Treatment (amended), by 2022, 100% of public health service units have been assigned autonomy and self-responsibility in groups, of which 253 units have been fully autonomous in regular expenditures.

The Law amending and supplementing a number of articles of the Law on Health Insurance is expected to be submitted to the National Assembly at the 8th session (expected in October 2024) and take effect from January 1, 2025.

By the end of 2023, more than 93.3% of the population nationwide will participate in health insurance. On average, the Health Insurance Fund will pay 87-89% of the total health insurance examination and treatment costs, and health insurance participants are responsible for co-paying 11-13%.

By 2024, the number of facilities signing health insurance contracts will be 2,897, including 1,791 public facilities and 1,006 non-public facilities.

In 2022, more than 13% of health insurance participants registered for initial medical examination and treatment at the provincial level, while 1.1% at the central level. Only 34% of cards were registered at the commune level, although the number of medical examination and treatment facilities at the commune level was up to nearly 10,000 units.

Since 2021, when the provincial-level connection is applied, the Vietnam Social Security report shows that the number of inpatient treatment and out-of-line examinations at the provincial level has increased. Some inpatient diseases at the provincial level can be effectively treated at the facility, such as cesarean section, normal delivery, gastritis and duodenitis, acute bronchitis, or vestibular dysfunction.