The rate of medical examination and treatment covered by health insurance at the central level will decrease by 25% in 2021 and the rate at the provincial level will increase by 73%, putting great pressure on the Health Insurance Fund.
According to the Vietnam Social Insurance, in 2021, the Health Insurance Fund (HI) paid more than 8,500 billion VND for 1.76 million inpatient visits beyond the provincial level. In 2020, insurance will pay more than 2,300 billion VND for more than one million patients.
Ms. Nguyen Thi Thanh Ha, Head of Health Insurance Policy Department, explained that the increase in costs is normal, because the average cost of medical examination and treatment insurance paid at the upper level is always higher than that of the lower level. 2021 is the first year the free policy comes into effect, the cost of out-of-province inpatient treatment is 100% covered by insurance instead of 60% as before, plus the great impacts of the pandemic.
People go for medical examination and treatment at Ho Chi Minh City Oncology Hospital, April 2021 before the fourth outbreak of the epidemic. Image: Quynh Tran
According to Ms. Ha, the impact of the epidemic caused the number of medical examination and treatment covered by health insurance in 2021 to decrease by 24.5% compared to the previous year. The average payment cost for inpatient treatment tends to decrease slightly, but up to 69% of provincial health facilities, the average cost of health insurance for inpatients increased by more than 2020.
In the first year of implementing the provincial policy of inpatient treatment with health insurance, there was a sharp increase in the number of outpatients in all regions, such as the Northern Midlands and Mountains increasing by 300%, the Red River Delta, the North Central and Central Coast increased by about 100%; The Southeast region slightly decreased due to the impact of the epidemic.
In the first three months of the year, the pace of life gradually normalized, people returned to hospitals for examination and treatment, so the number of inpatients across the country increased by over 5% over the same period last year. Specifically, the district level is over 42%, the provincial level is nearly 53% and the central level is over 5%.
The policy of connecting the provinces helps people to receive inpatient treatment, but it also creates opposite pressures. Mr. Le Van Phuc, Head of the Health Insurance Policy Implementation Committee, analyzed that because of the convenience, people choose to go to the provincial level because they enjoy many benefits even though the district hospital has quite good treatment. Medical facilities also want to bring more people to inpatient treatment to increase profits. Currently, 100% of the cost of inpatient treatment by health insurance when opening the hospital is paid.
Mr. Phuc cited a number of diseases that people can treat at lower levels, such as nuclear cataracts in the elderly, vestibular neuritis, non-specific urinary stones…; some diseases are sensitive to outpatient treatment, can prevent hospitalization such as neck pain, duodenitis, hypertension… A survey at 194 hospitals showed that many facilities always maintain the rate The rate of inpatient treatment is extremely high, up to 95-100% continuously for two years.
The route helps people easily access medical services, medical examination and treatment at higher levels according to their needs, while still enjoying benefits such as going to the right lines, creating motivation for hospitals to improve patient service quality, reduce the load on the frontline. center. However, when inpatients are not really necessary, it costs money due to the average cost at the higher level, which easily causes overload for the provincial health care provider. Increasing access is also not good for the management policy of the state, when the health statistics do not accurately reflect the demand for medical examination and treatment, increasing costs from the Health Insurance Fund…
These pressures were forecasted by the Vietnam Social Insurance representative before the policy took effect. According to Mr. Phuc, the trend of the world is to increase outpatient treatment or from the lower level, primary health care to reduce all costs later, rather than focusing on inpatient treatment. Vietnam is the opposite, the ratio between inpatient and outpatient treatment in 2020 is 60/40 and now the difference is 70/30, while in previous years the ratio was 50/50.
Inpatient treatment increases costs in all aspects, when a patient is hospitalized with family members to visit and take care of, dragging other costs of society to increase. The imbalance in the number of lower-level medical staff with the upper-level is more serious, creating a disparity in the quality of medical examination and treatment of medical facilities at all levels.
With this momentum, the rate of inpatient treatment with provincial health insurance will increase sharply in the coming time, the payment costs from the Fund will increase, putting great pressure on the system, especially after the epidemic is under control. patients return to the doctor”, he forecasted and said that there should be reasonable regulatory policies.
The two branches of social insurance and health insurance have issued a lot of regulations to manage the online mode, guide in diagnosis and treatment so that patients who come for medical examination and treatment need to be inpatient to be admitted, to avoid abuse of diseases. not to the point of still being sent to inpatient.
The decree on hospital admission conditions that the two sides are developing will specify which cases are inpatient and how they need to be adjusted. Many world welfare experts also recommended the Vietnam Social Security and the Ministry of Health, that the rate of inpatients in Vietnam is very high and suggested that there should be a specific admission process. This is to ensure that the patient needs inpatient treatment, not everyone can be admitted.
“It is necessary to strengthen the grassroots health system and provide treatment at the district level. In severe cases, it is necessary to go to the provincial or central level, reducing the load on the hospitals above as well as saving costs for the family. and society,” advised Mr. Phuc.
From January 1, 2021, holders of health insurance cards will go to the wrong hospital for medical examination and treatment – that is, not at the place where they initially registered for medical examination and treatment, without a referral at provincial hospitals, if they are designated and treated. inpatient treatment, the cost will be paid 100% by the Health Insurance Fund according to the benefit level of that group, instead of 60% as before. This provision does not apply to outpatient treatment.
Hong Chieu
at Blogtuan.info – Source: vnexpress.net – Read the original article here
