Not calculating the correct and full price of medical services, public hospitals are disadvantaged

Many ventilators at Hai Duong Lung Hospital are broken but there is no money to repair them.

The current price of medical services only includes 4 out of 7 components, many of which are very outdated. This has a huge impact on hospitals, especially those implementing financial autonomy.

No money for repairs, major purchases

4 of the 7 factors that make up the current price of medical services include: medicine, direct materials; electricity, water, waste treatment; asset maintenance; salary and allowances. 3 factors that are not included in the price are: major repairs of fixed assets, asset depreciation and training and scientific research costs.

Dr. Nguyen Van Luu, Director of Hai Duong Lung Hospital, said that the current medical service price regulations have existed for a long time while current prices have changed too much. In recent years, the failure to properly and fully calculate the factors that make up the medical service price has caused Hai Duong Lung Hospital to encounter many difficulties in implementing the financial autonomy mechanism. Revenue from basic medical services is only enough to cover human expenses and purchase supplies and chemicals for daily patient treatment, with no money to reinvest in facilities. “Since implementing the autonomy mechanism, we have only been able to buy a single CT scanner with money borrowed from the bank. Some ventilators are now broken but there is no money for maintenance and repair,” Dr. Luu informed.

Provincial hospitals in Hai Duong are currently implementing a mechanism of regular financial autonomy, not yet full autonomy. Daily medical service revenue is only enough for the hospital to cover regular expenses, while major construction and repair items are still invested in by the provincial budget. However, the budget is often slow to reach the hospital while medical machinery and equipment require immediate repair to serve medical examination and treatment. "The hospital requested over VND800 million to repair a CT scanner from 2021, but the money has not yet arrived. If the price of medical services were calculated correctly and fully, we might be able to repair it ourselves," said Nguyen Thi Thuc, Director of Hai Duong Children's Hospital.

According to the reporter's investigation, the pricing structure of many medical services at hospitals has been built for many years and is now outdated. At the Provincial General Hospital, the maximum price for an electrocardiogram service is only 45,900 VND/time, intravenous infusion 20,000 VND/time, ultrasound 49,000 VND/time... Hai Duong Lung Hospital charges 53,000 VND/time for blood testing, 25,000 VND/time for sputum. “Many services are losing money, such as color ultrasound services for patients. After printing the diagnosis results without printing the color ultrasound images for the patient, the hospital will have its ultrasound service price deducted by health insurance. However, to print in color, you need paper, a printer, color ink, etc. These are all purchased by the hospital itself. Implementing a financial autonomy mechanism without properly and fully calculating the factors that make up the price of medical services will make it very difficult for the hospital,” said a hospital leader who asked to remain anonymous.

Training and scientific research are very important tasks for the medical industry. Medical staff need to be regularly trained in order to have the qualifications to keep up with the development trends of world medicine and master machine technology. However, medical services have not yet included this factor in the price structure. “A new general practitioner can only do basic work, if he wants to develop his capacity, he needs to go to specialized training. After that, he has to work for another 18 months to be granted a practice certificate. For doctors who are already skilled, they still have to study at least 40 specialized lessons every year, if they do not study, they will not be granted a practice certificate. Due to difficulties, hospitals can only support a part, but doctors have to pay for their own study,” added Dr. Nguyen Van Luu.

Currently, the prices of many medical services are outdated, causing difficulties for public hospitals. In the photo: Doctors at the Children's Hospital examine and treat children in the Intensive Care Unit. Photo: Thanh Minh

Adjust to current prices

The quality of medical services at some provincial hospitals has been complained by the people, many of whom do not trust them and have transferred to other hospitals. The increasing number of medical staff resigning is due to many reasons, an important part of which is that the prices of a series of current medical services are no longer suitable, leading to low revenue for hospitals. Therefore, hospitals do not have enough conditions to improve their income, retain good doctors and invest in modern equipment to improve the quality of medical examination and treatment.

Deputy Director of the Department of Health Nguyen Thi Trung Chinh said that the price of medical examination and treatment services covered by health insurance is developed by the Ministry of Health, the price of voluntary medical services is approved by the Provincial People's Council. Basically, the price range of medical examination and treatment services covered by health insurance and voluntary medical services in Hai Duong is not much different. Many services are outdated and need to be adjusted to current prices to overcome difficulties for hospitals. "Recently working with the National Assembly's monitoring delegation, we made recommendations on this issue. Hopefully, the superiors will soon have a solution to remove difficulties, how to calculate correctly and sufficiently for hospitals," said Ms. Chinh.

Some hospital leaders believe that calculating the correct and full price of medical services will increase hospital fees, directly affecting the patient's expenses. However, calculating correctly and fully is not abusing patients but allowing the hospital to survive, have resources to invest in modern machinery and equipment, attract and retain good doctors, and improve the quality of medical examination and treatment.

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