District hospitals 'suffer' because of practice certificates

(Baonghean) - Besides the lack of facilities and equipment, district-level hospitals in Nghe An are also facing many difficulties in terms of human resources with practice certificates, frequency of examinations/desks/day, and payment for medical services.

Hospitals say it's difficult

Thanh Chuong District General Hospital is a class II hospital with 240 beds, providing medical examination and treatment for the people of the district and surrounding areas. On average, the hospital receives about 300 - 600 patients per day for examination and treatment in 16 clinical and paraclinical departments.

Doctor Nguyen Hai Linh - Director of Thanh Chuong District General Hospital said: "Depending on the nature of the disease, some departments are very crowded but others have few patients. In departments with many patients, the unit's examination and treatment is difficult because of the lack of doctors with practice certificates. The hospital currently has 41 doctors, of which only over 30 have practice certificates.

According to the 2009 Law on Medical Examination and Treatment and related circulars, doctors are only granted a practice certificate after 18 months of practice at a medical examination and treatment facility. According to regulations, doctors without a practice certificate cannot examine and treat, and if they do, their examination and treatment cases will not be covered by health insurance. In my opinion, the law is correct, sufficient and clear, but when applied in practice in Nghe An, it causes problems because district-level hospitals find it very difficult to attract and recruit new doctors.

Emergency care for patients at Thanh Chuong District General Hospital. Photo: Thanh Son

The lack of licensed doctors is a common problem in district hospitals. Doctor Nguyen Dinh Son - Director of the Southwest General Hospital said: "District hospitals also have to perform all specialties like provincial hospitals but the number of doctors is much smaller.

Due to the inability to pay, the hospital often does not arrange for doctors without a practice certificate to examine and treat patients. There are times when there are many patients, when doctors with practice certificates come in to examine and treat, the hospital is caught up in the regulation on the frequency of examinations, which is not allowed to examine more than 45 patients/day.

Flexible, proactive solution

Regarding the difficulties related to medical practice certificates, Dr. Nguyen Thanh Ngoc - Deputy Head of Medical Affairs Department analyzed: "The current situation of lack of doctors with medical practice certificates has led to impacts on medical examination and treatment, and health insurance payment is largely due to the fault of district-level hospitals.

Hospitals have not proactively studied regulatory documents such as Circular 41/2011/TT-BYT and Decree 109/2016/ND-CP dated July 1, 2016, regulating the issuance of practice certificates to practitioners and the issuance of operating licenses to medical examination and treatment facilities.

These documents clearly stipulate: Doctors during the practice period can perform medical examinations and treatments under the guidance of a doctor who has a practicing certificate. Patient medical records created by doctors during the practice period under the responsibility of the instructor can be fully covered by health insurance.

Regarding the difficulties of district-level medical facilities, pharmacist Le Hong Linh - Head of the Department of Medical Practice Management (Department of Health) also discussed: Currently, Nghe An Health sector has issued about 10,000 practice certificates in and out of the public sector and is preparing to add 1,000 practice certificates for other nurses and doctors. When hospitals have a list of requests and compare the correct practice time, the Department of Health will issue the certificates immediately.

To avoid the shortage of licensed doctors and the impact on medical examination and treatment, the health sector recommends that district hospitals, when sending doctors to study new specialties, must have a roadmap and specific calculations to arrange suitable replacement staff. Hospitals should not send doctors who have just been granted a license to practice to study immediately afterwards.

The biggest problem currently facing district-level hospitals is that according to Joint Circular No. 37/2015/TTLT-BYT-BTC dated October 29, 2015 of the Ministry of Health - Ministry of Finance, the unification of health insurance service prices between hospitals of the same rank nationwide, the average number of examinations used to calculate the salary structure into the price of health insurance services for all hospital ranks must not exceed 45 examinations/table/day (8 hours).

The Social Insurance Agency only pays for medical examinations according to the standards prescribed by the Ministry of Health. In case of sudden large number of patients, the medical examination and treatment facility must arrange additional examination tables, doctors or temporarily organize examinations outside of working hours to serve the patients, then the Social Insurance Agency must be notified to assess payment and coordinate regulation to ensure quality and patient rights.

Emergency transport. Photo: Thanh Son

However, in reality, this regulation is causing difficulties in the operations of district-level medical facilities as well as health stations, because currently, district-level and grassroots medical facilities are lacking doctors. If at times when the number of patients suddenly increases, if the above regulation is rigidly followed, there will not be enough doctors to examine patients.

Each clinic only has one doctor, if any clinic examines more than 45 patients/day, it will have difficulty in paying health insurance. Therefore, the Department of Health will have recommendations to resolve difficulties and problems in health insurance regulations, first of all, the regulation limiting the number of patients/doctor/day.

One of the district hospitals that has been flexible and proactive in resolving issues regarding certified personnel and regulations on examination frequency is Vinh City General Hospital. The hospital currently has 65 doctors. Since the regulation on connecting health insurance examination and treatment lines took effect on January 1, 2016, the hospital receives about 900 - 1,500 patients for examination and treatment every day.

To meet the requirement of no more than 45 examinations/table/day, in addition to arranging full capacity operations, the hospital also arranges human resources from treatment departments to participate in examination time when there is overload in the clinics.

In addition, the hospital also contracts with highly qualified doctors (retired) to participate in the work; thanks to that, the health insurance examination and treatment work of the unit has been guaranteed in quality in the past time. It is thought that this is also a way for district hospitals to learn and proactively overcome difficulties to improve the quality of medical examination and treatment for the people.

Article and photos:Thanh Son