Transferring hospitals for medical examination and treatment under health insurance is difficult or easy?
Health insurance (HI) examination and treatment activities have created convenience and reduced costs for people to receive medical examination and treatment. However, many people have reported "having difficulties" when wanting to transfer to a higher-level hospital under HI...
Is it difficult or easy to transfer hospital to enjoy health insurance?
Mr. Nguyen Quoc T. in Ben Thuy Ward, Vinh City has had diabetes for many years, so he often goes to medical facilities in Vinh City and Nghe An General Hospital. Recently, due to his old age, Mr. T. has had complications with digestion, heart, eyes, ears, etc., and his family wants to transfer him to the Central level for examination and treatment under health insurance. However, Mr. T.'s family members reported that transferring him to the Central level is not simple. Initially, the provincial hospital affirmed that its capacity allows it to control and treat the diseases that Mr. T. is being treated for, and there is no need to transfer him to a higher level. The hospital said that if the patient is determined to transfer to the Central level, the hospital will not hold him back, but the patient will receive 60% of the health insurance according to the regulations of the Ministry of Health.
Similar to the case of Mr. T. mentioned above, many people in some districts in Nghe An reported that it is “difficult to request” to transfer patients covered by health insurance from district hospitals to provincial hospitals. In terms of legitimate needs, patients always want to be examined and treated at higher quality medical facilities and expect to enjoy the highest payment rate from health insurance.
“But this field needs to be viewed frankly and objectively. That is, medical facilities in the province have properly implemented the regulations according to Circular 37/2014/TT-BYT dated November 17, 2014 of the Minister of Health guiding the registration for initial medical examination and treatment and referral for medical examination and treatment under health insurance. For patients who go to the district level for medical examination and treatment and below, they are transferred to the district level and enjoy benefits according to the health insurance benefit levels - 100%, 95% and 80%. In case the patient is admitted to the emergency room, any medical facility is entitled to the right medical examination and treatment benefits”, Ms. Le Thi Hoai Chung - Director of the Department of Health explained.
Also according to Ms. Le Thi Hoai Chung, every year the Department of Health presides over and coordinates with the provincial Social Insurance to issue guidelines for transferring health insurance examination and treatment lines in the area to create the best conditions for patients. In particular, it must comply with Circular 37/2014/TT-BYT dated November 17, 2014 of the Minister of Health: "Medical examination and treatment facilities transfer patients from lower levels to higher levels when the disease is not suitable for the diagnostic and treatment capacity, the technical list of the unit or the disease is suitable but the unit is not qualified to diagnose and treat...".
According to objective assessments of many people, in recent years, the health system at all levels in Nghe An has focused on improving the capacity of doctors and medical staff, purchasing more modern equipment for medical examination and treatment, and undertaking good medical examination and treatment according to the lists prescribed by the Ministry of Health.
Through discussion, Director of Vinh City General Hospital Nguyen Hong Truong said: "Every time a patient needs to be transferred, the hospital needs to explain thoroughly so that they understand the hospital's treatment capabilities and the regulations of health insurance. Of course, the hospital complies with health insurance regulations, does not keep or make things difficult for patients. The most important thing is that each hospital must improve its medical examination and treatment capabilities and service style so that people are satisfied and they can return to the hospital when they need care."
“If common diseases can be treated at lower-level medical facilities, they will not be transferred to hospitals, which is both wasteful and puts too much pressure on higher-level hospitals. That is the difficulty in transferring health insurance examination and treatment. In the current mechanism, if those common diseases are treated, people can go to higher-level hospitals for examination and treatment without needing a referral from lower-level hospitals, and still enjoy 60% of the cost according to health insurance regulations. When cases are beyond professional capacity, all medical facilities in the province decide to transfer patients to higher-level hospitals. That is a mandatory regulation of the health sector according to the law, and it is also the responsibility and ethics of doctors at medical facilities,” Ms. Le Thi Hoai Chung emphasized.
Continue to improve the quality of medical examination and treatment
The Nghe An Health - Social Insurance Joint Stock Company has regulations that when some diseases exceed the professional capacity of lower-level hospitals, they will be transferred directly from health stations to provincial hospitals, for example: Cancer, periodic hemodialysis... On November 27, 2024, the National Assembly passed the Law amending and supplementing a number of articles of the Law on Health Insurance. Accordingly, an additional content is added for patients to access health insurance examination and treatment services such as: Remote medical examination and treatment, patients diagnosed with certain rare diseases, serious diseases, diseases requiring surgery or using high-tech services according to the list of diseases and regulations of the Ministry of Health are entitled to 100% health insurance and do not need to transfer medical examination and treatment.
Currently, over 92% of the population has health insurance. With innovations in the field of medical examination and treatment, patients in general and those with health insurance are increasingly receiving better care and reducing costs. However, recently, many facilities lack drugs and supplies for medical examination and treatment. This is a common difficulty of the health sector nationwide when some drugs and medical supplies have not found bidders according to regulations. The health sector is looking for ways to resolve this issue to serve the people's medical examination and treatment.
In Nghe An, there are currently 531 medical facilities that have signed contracts for health insurance examination and treatment. Of these, 1 is a central facility, 12 are provincial facilities; 59 are district facilities (34 are non-public facilities, including 16 hospitals and 18 general clinics) and 459 are commune-level medical examination and treatment facilities.
The medical examination and treatment system of Nghe An Health sector has developed relatively completely in general and specialized fields; developed in technical expertise and leading non-public medical facilities in the country. There are 2 hospitals: Nghe An General Hospital Friendship, Oncology Hospital, the province's final line for general medical examination and treatment and 25 specialties recognized by the Ministry of Health as the final line in the North Central region in the fields of Surgery, Internal Medicine, Obstetrics and Oncology. The number of technical lists approved by competent authorities for medical examination and treatment facilities in Nghe An province is more than 190,000 techniques.
The network of core and satellite units of the health sector in Nghe An interacts and supports each other, thanks to which satellite hospitals improve their medical examination and treatment capacity through enhanced training, infrastructure renovation, upgrading medical equipment, technology transfer and medical examination and treatment consultation using information technology. Thereby, strengthening connections with upper-level hospitals, cooperating with many hospitals and universities to train and improve professional capacity for medical staff. Medical examination and treatment facilities regularly connect with central hospitals, inviting doctors to deploy specialized techniques at the unit to help transfer techniques and improve skills for medical staff in the province. Regular online consultations through remote medical examination and treatment activities.
Medical facilities in the province have mastered many specialized high-tech techniques such as: Cardiovascular intervention to treat cardiovascular and cerebrovascular diseases (coronary artery stenting; permanent pacemaker implantation; peripheral artery stenting); Angioplasty and treatment of extracranial artery stenosis; Radiofrequency treatment of arrhythmias; Cerebral artery thrombectomy; Fibrinolysis to treat early cerebral infarction; assisted reproduction, kidney transplantation, organ transplantation from brain-dead people, jaw bone transplantation, organ vascular intervention, endoscopic nasal anastomosis, etc. These factors contribute to improving the examination and treatment capacity of the health system in Nghe An, reducing the number of referrals to central hospitals.
In 2024 (until November), there were 5,308,926 people receiving health insurance treatment at Nghe An medical facilities (outpatients: 4,549,612, inpatients: 759,314). The total cost was nearly VND 5,331 billion, of which the cost proposed for health insurance payment was nearly VND 4,817 billion.
