Nghe An Health Department requires strict implementation of regulations on referral and hospital transfer
(Baonghean.vn) - Recently, people in Nghe An in particular, and provinces and cities across the country in general, have expressed many opinions reflecting that the procedures for transferring hospitals and routes are still difficult, suggesting that flexibility and convenience should be created for the people.
Frustration over transfer procedures
Mr. LTN, 62 years old, in Que Phong district said: “I went to the provincial and central hospitals voluntarily. After being diagnosed with the disease, the hospital asked me to return to the unit where I registered for initial medical examination and treatment to be transferred. I had to return to the district hospital for another examination, then go to the provincial hospital for further examination before being transferred to the central hospital for treatment. I found that applying for a hospital transfer certificate was very troublesome, time-consuming and tiring.”
Similarly, Ms. NTS, 39 years old, in Vinh city, was upset: “My child was treated at a provincial hospital but did not see any results. I wanted to take my child to a higher level hospital for examination and treatment, but the hospital kept me and did not let me go because it violated regulations. Therefore, I was forced to ask to be discharged from the hospital and go to a higher level hospital myself, accepting that I would only receive 40% of the health insurance.”
In reality, the issue of referral has been causing frustration for many people. These frustrations also reflect the fact that people do not trust the quality of medical examination and treatment in the locality; suspect that medical units intentionally keep patients... People want to enjoy high-quality medical services and medical examination and treatment techniques; and want to be examined and treated at higher levels, regardless of whether the illness is serious or mild.
At the National Assembly forum, in the last session, a delegate proposed to abolish hospital transfer papers and promote the use of open lines to facilitate people when examining and treating diseases, in a way that is appropriate to their medical condition, quality of examination and treatment, travel time, and care conditions.
Why do we need to separate and connect routes?
According to the 2009 Law on Medical Examination and Treatment, our country's health system consists of 4 levels: Commune, District, Provincial, and Central. The revised and supplemented Law on Medical Examination and Treatment (effective from January 1, 2024) also stipulates the professional classification in medical examination and treatment, including 3 levels: Initial medical examination and treatment level, basic medical examination and treatment level, and specialized medical examination and treatment level. Not only in Vietnam, most countries have regulations on medical examination and treatment level, patients who want to go to a higher level must first have a referral from a lower level, or a family doctor (except for emergencies).
The division of health insurance examination and treatment routes and the classification of patients by route are very necessary to ensure the sustainable development of the health system from the grassroots to the central level, to take good care of people's health; to avoid the situation where upper-level hospitals are overloaded and lower-level hospitals have no one.
Since 2016, Vietnam has implemented the health insurance medical examination and treatment line at the district level and since 2021, the inpatient treatment line at the provincial level has been opened. According to the assessment of the authorities: The recent opening of the line is in line with the development trend; ensuring the rights of patients. However, this has partly caused the situation of overloading at the upper level, reduced the rate of medical examination and treatment at the grassroots level and caused an imbalance in the health insurance fund.
Should hospital transfer papers be removed?
Responding to voters' and National Assembly deputies' opinions on abolishing hospital transfer papers, representatives of the Ministry of Health and Vietnam Social Security stated: Under current conditions, it is impossible to connect to the Central level and abolish the regulations on transfer, because it will cause overload, pressure on the Central level and disrupt the entire medical examination and treatment system, affecting the quality of treatment and causing imbalance in the Health Insurance fund.
Overloading also poses a risk of causing errors, complications, reducing the quality and effectiveness of treatment, affecting patients. Along with that, overcrowding of patients while facilities, medical equipment and medical personnel do not develop in time also affects the rights of health insurance participants.
Referral papers are a valuable tool to maintain the health system and technical division. If the papers are removed immediately, patients will "dump" all to the upper level, the grassroots health system will have fewer and fewer patients, medical expertise and doctors at lower levels will increasingly "wither". There will be doctors at lower levels leaving the public sector, making the weak grassroots health system even weaker. Thus, the health system will be broken, from the central to the grassroots level, greatly affecting the socio-economic and social security.
In addition, the removal of referrals and hospital transfer papers will also have consequences for the insurance fund. For example, a patient with gastritis can be treated very well at a provincial hospital, but when this patient is treated at a central hospital, the cost of treatment will increase. Thus, the removal of referrals and hospital transfer papers also leads to the risk of bankruptcy of the insurance fund.
According to Minister of Health Dao Hong Lan: Solving the problem of referral to solve administrative procedures for people must also ensure the sustainability of the health system, avoiding overloading at a certain level. To reduce administrative procedures, the Ministry of Health is focusing on directing the use of electronic referral forms as well as electronic health management records.
Synchronize solutions
Are medical examination and treatment facilities making it difficult for people to transfer to higher levels or hospitals? Discussing this issue, Dr. Pham Dinh Luyen - Director of Quy Hop District Medical Center stated: "In the past, the unit as well as medical examination and treatment facilities in the province have complied with professional requirements in medical examination and treatment, transferring patients to higher levels to ensure safety, reasonableness and compliance with regulations when exceeding professional capacity."
According to the provisions of Clause 1, Article 5, Circular 14/2014/TT-BYT dated April 14, 2014 of the Ministry of Health,Medical examination and treatment facilities transfer patients from lower levels to higher levels when meeting the following conditions: The disease is not suitable for the diagnostic and treatment capacity and technical list of the medical examination and treatment facility approved by a competent State agency on health or the disease is suitable for the diagnostic and treatment capacity and technical list of the medical examination and treatment facility approved by a competent State agency on health but due to objective conditions, the medical examination and treatment facility is not qualified to diagnose and treat.
Based on the list of techniques approved by the competent State health agency, if the adjacent higher-level medical examination and treatment facility does not have suitable technical services, the lower-level medical examination and treatment facility will be transferred to a higher level... Before transferring, the patient must be consulted and have a referral indication.
The regulations on referral are very clear. However, many people, due to not understanding clearly, think that the medical examination and treatment facility is making things difficult and trying to keep the patient. Doctor Pham Vinh Hung - Deputy Director of Nghe An Oncology Hospital said: "If the hospital is not qualified to diagnose and treat, we will immediately transfer the patient to a higher level to ensure the patient's rights. If the hospital has the capacity to diagnose and treat the disease, we will encourage and persuade them to stay for treatment. When going to a higher level, the patient and his family will certainly spend more on travel, accommodation, and treatment..."
In Official Dispatch No. 4007/SYT-NVY dated December 7, 2023 of the Department of Health on the proper implementation of regulations on referral to facilitate people, the Nghe An Health Sector has directed medical examination and treatment facilities to strictly implement regulations on referral and hospital transfer; at the same time, requiring facilities not to "keep" patients; ensuring the rights of patients.
Dr. Nguyen Huu Le - Deputy Director of Nghe An Department of Health said: The inter-sectoral Health and Social Insurance of Nghe An also have additional solutions to create more favorable conditions for patients. Specifically, the inter-sectoral has assessed the capacity of each medical examination and treatment facility in the province to have general instructions on referrals, minimizing inconvenience for patients, for example: Transfer from health stations to provincial hospitals such as Nghe An Oncology Hospital, Hospital 4 - Logistics Department of Military Region 4 for patients who have been diagnosed with cancer; transfer to Nghe An Mental Hospital for cases that have a mental illness treatment monitoring book...
