Do not let health insurance patients buy drugs on the list of benefits themselves.

Not entitled to full benefits

In mid-July 2023, Ms. TDT (in Vinh city) was transferred from a district hospital to a provincial hospital for surgery and treatment. Ms. TDT said: To be admitted to the hospital, my family initially paid 500,000 VND to the hospital's cashier. After being admitted to the hospital and before the surgery, my family continued to be asked to pay an additional 3 million VND...

Ms. TDT was upset: As a civil servant, employee, and having participated in health insurance for more than 20 years, I still had to buy everything when I had surgery and treatment. Before the surgery, the doctor gave the family a list of things to buy, including IV fluids, alcohol, saline, bandages, anesthetics, sutures, antibiotics for injection, surgical caps, etc. The total amount of money the family had to spend on supplies and medicines on this list was 1,470,000 VND.

According to Ms. TDT, during her hospitalization after surgery, the hospital only gave Ms. T 2 painkillers. As for other supplies for wound care such as drainage bags and daily dressings, the family had to continue to spend money to buy them... Having surgery at the same time, with the same disease and sharing the same room with Ms. T at this time, there were 5 other people (including 3 teachers, 1 medical staff) who also had to spend their own money to buy medicine and medical supplies.

When Ms. TDT and other patients expressed their dissatisfaction because they could not fully enjoy their health insurance benefits, the staff of this provincial hospital explained: "We hope that patients will sympathize and share because the hospital does not have many types of medicines and medical supplies because it could not bid for them"...

Based on Ms. TDT's reflection, the reporter had an exchange with a leader of the hospital where Ms. TDT was treated and was told: "The procurement of medicine and medical supplies through bidding at medical units encountered many difficulties. Many bidding items were rejected; many small items did not have contractors participating in the bidding due to low demand of the unit and low profit. From that difficulty, the rights of health insurance patients were affected."

Further investigation revealed that it was not just Ms. TDT's case but also many other patients.health insuranceWhen examining and receiving treatment at medical examination and treatment facilities in the province, people had to spend extra money to buy medicine and medical supplies that are on the list of benefits for health insurance participants... because the hospital could not purchase medicine and medical supplies.

Mr. Pham Dinh Luyen, Director of Quy Hop District Medical Center, shared: “Mountainous medical units have been unable to purchase a number of medicines and supplies because there are no contractors participating in the bidding. As a result, when patients come for examination, the medical facility can only prescribe the medicine for the patient to buy outside. This not only affects the rights of the patients but also damages the brand of the medical facility…”.

Must proactively remove difficulties

According to information from the Nghe An health sector, the Department of Health recently organized a centralized local bidding for 2023-2024 with 232 items with a total value of nearly 522 billion VND. The results selected 182 winning items with a total value of over 429 billion VND (78% of the list, 82% of the value). For the 22% of items that did not win the bid, the Department of Health directed the units to proactively organize bidding.

Medical facilities in Nghe An province have organized plans to select contractors with 186 bid packages including 24,522 items, total value of over 2,490 billion VND; conducted bidding for 115 bid packages including 11,931 items (48.7%), total value of over 1,492 billion VND (59.9%). The results of the selection were 7,020 winning bid items (reaching 58.8% compared to the bid invitation), total value of nearly 1,044 billion VND (reaching 70.0% compared to the bid invitation value).

The bid rejection rate at medical facilities was 41.2%, of which 32% were bid rejections due to no bidders, 5% were bid rejections due to exceeding the planned price... There were 20 medical facilities reporting a shortage of drugs with a total of 3,030 items missing, with a total value of over 291 billion VND (accounting for 12% of the total demand of medical facilities in the province); 8 facilities were short over 20%; 8 facilities were short over 10%; 4 facilities were short less than 10%...

Nghe An Department of Health has requested medical units to proactively re-organize bidding for items that have not won the bid and have no alternative items; proactively organize contractor selection for 51% of items that have not yet been selected. The Department of Health continues to improve the bidding capacity of medical facilities; direct and guide units to proactively plan and organize bidding for items not on the list of centralized procurement; items on the list of centralized procurement but have not yet had results or have used up all the winning bid quantity.

On July 17, 2023, Nghe An Department of Health issued Official Dispatch No. 2211/SYT-NVD on strengthening the management of prescription and prescription drug sales at medical facilities. The content of the dispatch stated: Recently, the Department of Health has received feedback from patients and their relatives about prescribing for patients to buy drugs outside the scope of health insurance payment, treatment support products at some medical examination and treatment facilities...

To ensure the rights of patients participating in health insurance, the Department of Health requests that medical examination and treatment facilities in Nghe An province proactively develop plans and organize procurement bidding to ensure adequate and timely supply of drugs, chemicals, and supplies for treatment of patients; not allowing patients participating in health insurance to purchase drugs and medical supplies on their own that are on the list of benefits within the scope of benefits of health insurance participants.

The Department of Health has also clearly requested that medical facilities need to implement necessary measures to avoid shortcomings and limitations in prescribing and selling prescription drugs, specifically prescribing outside drugs for health insurance patients that are within the scope of benefits of health insurance participants while being able to replace those drugs with equivalent drugs currently being supplied at the unit according to the winning bid results.

Mr. Tran Minh Tue - Deputy Director of Nghe An Department of Health

The instructions of the Department of Health are very clear. However, to ensure the rights of patients in general and health insurance patients in particular, the health sector and the provincial social insurance sector need to have a specific inspection and assessment of the situation so that patients have to buy their own medicines and medical supplies on the list of benefits within the scope of benefits for health insurance participants, especially checking whether the medical facility pays for health insurance for the medicines and supplies that the patient has purchased himself or not. The health sector and the insurance sector need more support so that medical facilities can effectively carry out the bidding and procurement of medicines, biological products, medical supplies as well as health insurance examination and treatment./.