Health insurance for children under 6 years old: Part 3: Many difficulties need to be resolved

In 2010, according to the settlement report of medical facilities, the whole province had 23,988 outpatient visits, 14,959 outpatient treatments for children under 6 years old without health insurance cards with the amount of 16,371 billion VND. In addition to some impacts on the rights (although very small) for children, not having a card when going to see a doctor will cause difficulties in card management, settlement and fund management of this subject. In addition, there are also some shortcomings in the insurance policy that make people as well as implementing agencies feel not really satisfied.

In terms of beneficiaries of the insurance policy, although they are entitled to the same amount of medicine, the difference in qualifications, means, techniques, etc. is inevitable. In remote communes, there are many difficulties in terms of means, people, and qualifications, so the examination and treatment of children in these places is not guaranteed.

Even the regulation that allows children in Vinh City to go to Nghe An Children's Hospital for examination without having to be transferred from the commune or ward also makes many parents in other localities wonder: Is this fair, when their children have to pay 50% of the medical examination and treatment costs if they go beyond the commune or ward?

Mr. Hoang Cong Tru talked with reporters about the difficulties of cadres working part-time at the grassroots level.

Many parents in Nghi Xuan (Ha Tinh) take their children to Nghe An Children's Hospital for examination, which is closer than other facilities, but it is completely out of line, out of province, and they still suffer disadvantages. They hope that the social insurance policy should be adjusted so that children can benefit based on geography, not by boundary?

Another problem is the phenomenon of holding back patients at lower-level hospitals. According to Dr. Duong Cong Hoat - Director of Nghe An Children's Hospital, many cases of children being transferred to the Children's Hospital are too late. Any family that is too impatient to take their child to a higher-level hospital but the lower-level hospital does not agree to transfer them must pay 50% of the cost according to the regulations for going beyond the level. In addition, some drug and high-tech categories are not currently included in the list of insurance payments at the provincial level, while people and doctors really need to prescribe them for patients, such as drugs and techniques to treat congenital heart disease...

In addition, relevant enforcement agencies are also facing many difficulties: The handover of child lists between the two sectors of Labor, Invalids and Social Affairs and Social Insurance in many localities is still slow, and the card issuance process at the local level has not been unified. Even the calculation of the additional collection for the insurance fund for cases of late card issuance according to the recent official dispatch of the Joint Sector: Department of Finance - Department of Labor, Invalids and Social Affairs - Provincial Social Insurance has also caused confusion in many localities. Therefore, in May, Do Luong Social Insurance did not issue cards due to the lack of agreement on the amount of additional collection. Other districts are in a similar situation.

In particular, the guidance on collecting insurance funds has caused difficulties for the commune level, where the staff's qualifications are limited. On the other hand, the problem of the staff doing this health insurance work at the grassroots level still has many shortcomings.

Currently in the district, the staff working on children's affairs is usually a part-time person. For example, in Yen Thanh, a locality with many outstanding achievements in child protection work, there is only one deputy head of the children's section who also issues cards, Mr. Hoang Cong Tru. He shared: "Currently, our district has 79,000 children under 16 years old, nearly 30,000 children under 6 years old, but there is only one person who has to take charge of all areas: children in special circumstances, children with disabilities, providing wheelchairs, granting scholarships... Typing alone is too tiring, let alone going to the grassroots. Even the list of printed cards for children under 6 years old must be printed in 6 copies per commune according to regulations, and the district has 39 communes, so signing on each copy takes too much time." Mr. Tru also strongly suggested that there should be at least 2 permanent staff in charge of this field. That is also the common sentiment of Mr. Thuong and Ms. Thuy, officers of the Department of Labor, Invalids and Social Affairs of Do Luong, with whom we had a working session and discussion.

At the commune level, the staffing problem is even more difficult. Currently, each commune is assigning children's work to a part-time officer, in some places it is assigned to a policy officer, in other places it is assigned to a specialist in Population, Women... Because they do not receive any allowances or incentives, to complete the work they can only rely on their enthusiasm. Therefore, in some remote communes, where traveling to the district is not convenient, it is understandable that commune officers "save" when there are more children to submit the list to report, a few days past the deadline.

In addition, when asked about the total number of children under 6 years old born in the district, we were told that the Population Department knows this number best, but the calculation of card issuance is done by the Department of Labor, Invalids and Social Affairs. Since the card management was transferred to the Social Insurance, the Department of Labor, Invalids and Social Affairs no longer has management software, so the work is very manual and every time we need to compare the increase or decrease of cards, we "run" to the Social Insurance to find it quickly.

Therefore, according to the proposal of this industry, especially at the grassroots level, there should be a management software system. Grassroots officials also affirmed that it is not difficult to quickly resolve the problems in the issue of health insurance cards for children, but they really hope to sit down and participate in meetings between industries at all levels to discuss and find solutions.

TV