'Vindicating' patients and healthcare facilities

(Baonghean) - Patients abuse their health insurance cards to visit clinics and obtain medication multiple times, and healthcare facilities accept more patients than the set limit. Is the fault entirely theirs?

Nghe An: Risk of exceeding the health insurance fund by 1,700 billion VND.

In 2016, Nghe An ranked second nationwide in exceeding the health insurance fund. Despite intervention from various levels and sectors and numerous corrective measures, the overspending continues at an alarming rate. Nghe An Social Insurance (BHXH) forecasts that if the current spending trend continues, the total expenditure requested by medical facilities in 2017 will exceed 3,500 billion VND, exceeding the fund by approximately 1,700 billion VND.

I went for multiple check-ups because... I wasn't reassured.

On the afternoon of April 19th, Ms. NTT (residing in Dong Vinh ward, Vinh City), who has a health insurance card that covers 80% of her expenses, experienced symptoms of abdominal pain and an itchy rash and went to Minh Hong General Hospital for examination. After depositing her insurance card at the patient reception area, Ms. T was directed to examination room number 1, where she was examined by Dr. Le Thuan. After describing her symptoms, Dr. Thuan diagnosed her with hemorrhoids and ordered an abdominal ultrasound and examination for the condition.

At the ultrasound room, Dr. Ha Quang Phung concluded that Ms. T had a "right ovarian cyst" and sent the results back to Clinic No. 1. There, Dr. Thuan concluded that Ms. T had internal hemorrhoids and an ovarian cyst, prescribing 30 packets of Merica, 60 tablets of Futiamine, 10 tablets of Fexodinefast 120 mg, and 1 packet of Davac. In addition to the costs covered by insurance, Ms. T had to pay an extra 43,000 VND.

Register for medical examination and treatment at Vinh City General Hospital.

On the morning of April 20th, Ms. T again brought her health insurance card to Vinh City General Hospital. At the reception desk, she was asked about her condition and what she needed examined, then directed to outpatient clinic number 27. There, Dr. Bui Danh Anh diagnosed her with abdominal and pelvic pain, and dermatitis, and ordered an ultrasound and a dermatological examination. The dermatologist examined the itching and concluded it was an allergy. Ms. T asked if she needed tests, and the doctor replied, "If the medication doesn't help, come back for tests."

The doctor prescribed 5 tablets of Fexodinefast 120 mg and 1 tube of Gensonmax 0.64 mg. An ultrasound revealed results which Dr. Anh later diagnosed as an ovarian cyst, and referred her to the obstetrics department for consultation. At the obstetrics department, the doctor said, "We suspect internal bleeding; it's best to be admitted for further examination and surgery." Ms. T was distraught and asked to go home to consult her family. At Vinh City General Hospital, Ms. T did not have to pay any additional fees.

On the afternoon of April 20th, Ms. T again presented her insurance card at the Dong Au Private General Hospital and was directed to Internal Medicine Clinic No. 119, run by Dr. Nguyen Thi Ngoc. After describing her previous symptoms, the doctor ordered an abdominal ultrasound. The results were normal, except for a "right ovary with an anechoic image measuring 30mm," and the diagnosis was "Right ovarian cyst."

Dr. Nguyen Thi Ngoc referred her to the obstetrics department for "specialist medication." Regarding the itchy rashes, the doctor told her to "go back there (obstetrics department?) and ask them to prescribe some anti-itch pills." At obstetrics room 104, Dr. Pham Thi Le concluded it was "Menstrual Disorder" and prescribed 20 tablets of 500mg vitamin C and 30 tablets of vitamin E. Ms. T did not have to pay any additional fees for this visit.

Staff in the Outpatient Department process patient paperwork.

Thus, in just two days, Ms. T visited three different hospitals using her health insurance card. With the same symptoms, each hospital gave different results and prescriptions, raising questions about the quality of medical services in hospitals of the same level. In fact, this is one of the reasons why patients use their health insurance cards to seek treatment at multiple hospitals of the same level in a short period of time.

The reality is that supply does not meet demand in many hospitals.

Dr. Nguyen Hong Truong, Director of Vinh City General Hospital, stated that to date, Vinh City General Hospital has had over 10 billion VND withheld from payment by Nghe An Social Insurance. Of this amount, 4 billion VND is for examinations exceeding the limit of 50 patients per 8 hours. Nghe An Social Insurance explained that this limit is based on Decision 1313/QD-BYT dated April 22, 2013, issued by the Ministry of Health, which provides guidance on the examination process at the outpatient department of hospitals.

However, the Ministry of Health sent a letter to the Nghe An Department of Health on October 31, 2016, stating: The regulation on the frequency of examinations is a target for the health sector. This target is not a prescribed standard for an examination room that the Social Insurance agency uses as a basis for payment.

In reality, Nghe An's health sector is unlikely to achieve the targets set by the Ministry of Health due to limited infrastructure and human resources. According to a report from the Nghe An Department of Health, the number of doctors per 10,000 people in Nghe An in 2016 was 7.6; the target for 2017 was 7.7. This figure is still lower than the national average of 8.4. The number of hospital beds per 10,000 people in Nghe An in 2016 was 27.4; higher than the national average (25 beds/10,000 people). In 2017, Nghe An plans to increase by 300 beds, reaching 27.5 beds/10,000 people.

Waiting for a medical examination at Vinh City General Hospital.

Despite being above the national average, Nghe An still experiences hospital overcrowding, leading to the addition of extra beds beyond the allocated plan. However, this overcrowding is localized in some medical facilities, contrasting with a number of other facilities that are experiencing low occupancy rates after the integration of healthcare services.

Dr. Dau Huy Hoan, Deputy Director of the Nghe An Department of Health, stated: "The policy of allowing patients to access healthcare services ensures their rights and creates healthy competition among healthcare facilities. However, in reality, patients tend to bypass commune-level healthcare facilities and go to district-level facilities instead. Even within the same category, some healthcare facilities attract more patients than others."

Statistics from the Nghe An Social Insurance Agency in 2016 also show the aforementioned "water flowing to the lowest point" trend in people's psychology when seeking medical treatment. In the first nine months of 2016, the number of medical examinations and treatments at commune health stations was only 71.3% compared to the same period in 2015. Conversely, the number of medical examinations and treatments at the district level increased by 82%.