"Relaxing" health insurance benefits for patients who go beyond the prescribed level

(Baonghean) - The opening of the health insurance coverage line is considered a breakthrough of the revised Law on Health Insurance, demonstrating the determination to achieve the goal of universal health insurance. This not only ensures rights and creates maximum convenience for health insurance participants but also becomes a driving force to improve the quality of medical services as well as the spirit of serving patients.

"Half happy, half worried"

The Law amending and supplementing a number of articles of the Law on Health Insurance stipulates that from January 1, 2016, the district and commune-level medical examination and treatment lines within the same province will be opened. Accordingly, health insurance participants who have registered for initial medical examination and treatment at commune health stations, general clinics or district hospitals are entitled to medical examination and treatment at district-level medical examination and treatment facilities within the same province. Previously, at district-level hospitals, in case people went to the wrong hospital according to regulations, the health insurance fund would pay 70% of the medical examination and treatment costs. According to the amended Law on Health Insurance, starting from January 1, 2016, the fund will pay 100% of the medical examination and treatment costs for those within the same province. Thus, all subjects were previously only paid 70%, but if they were within the same province, they would be paid 100%. Implementing the open system means that when examining and treating health insurance, health insurance participants will have more convenience, not be limited by a single initial medical examination and treatment facility, and still be paid according to the prescribed benefits.

Brain tumor surgery at Nghe An General Hospital.

Ms. Nguyen Thi Nguyet, 63 years old, a resident of Nam Dan Town, was very happy to receive the information about the health insurance medical examination and treatment line. It was not until January 1, 2016 that the opening of the health insurance medical examination and treatment line at the district and commune levels officially began, but now Ms. Nguyet is very familiar with the new regulations of the law: "When the line is opened, patients with health insurance cards like me will have the right to go to medical examination and treatment at medical stations, district, city and town hospitals in the province as they like without being limited by any initial medical examination and treatment facility and will still be paid 100% of the medical examination and treatment costs by the Health Insurance Fund... This regulation creates initiative for patients in taking care of their health, without being limited to places of medical examination and treatment, avoiding hassles in paperwork and procedures as well as not being "held" by the hospital for treatment".

Doctor Ho Xuan Hung, Head of Nam Trung Commune Health Station, Nam Dan District, said: “In recent years, Nam Trung Commune Health Station has become a trusted address for medical examination and treatment for people in the 5 South region. People from Nam Trung, Nam Cuong, Khanh Son, and Nam Phu communes have gathered at the station for examination and treatment because the station has an ultrasound machine, full equipment, skilled staff, and proficient use of machinery... Each year, the station assists nearly 300 obstetric cases, examining and treating 10,000 people. Now that the route is open, the number of people coming for medical examination and treatment will certainly increase even more.” The joy of reputable medical facilities is to serve and treat many patients, which means that the hospital has more financial resources to invest in upgrading and renovating spacious facilities, purchasing equipment, developing comprehensive specialized techniques, focusing on training young staff with solid qualifications... However, along with the joy is also a great worry: There will appear many medical facilities without patients; many other medical facilities will be overloaded, facilities and medical services cannot serve well for such a large number of patients - at that time the rights of people with health insurance cards are not guaranteed.

Improve the quality of medical examination and treatment

When the “connection” is officially implemented, district-level medical examination and treatment facilities will face the law of elimination and self-elimination. Only medical examination and treatment facilities with quality services, highly qualified doctors and nurses, good service spirit, and convenient facilities will be selected and continuously developed. Fully aware of this, in recent times, many district-level hospitals in the province have been actively improving themselves.

With the goal of achieving the standards of a Grade II General Hospital, with 250 beds, in recent times, Vinh City General Hospital has made a new breakthrough in implementing advanced techniques such as: Laparoscopic surgery (appendicitis, gallbladder removal, ovarian cysts, ectopic pregnancy, endoscopic sinus surgery, extensive CT scan, digestive endoscopy...); thyroidectomy; colon tumor removal; liver cyst, kidney cyst, ovarian cyst removal with a multi-function ultrasound knife, retrograde endoscopic lithotripsy with Laser, Pharco surgery, tonsillectomy with a Plama knife... Along with implementing a comprehensive hospital quality management model, Vinh City General Hospital is trying to provide patients with the best technical services, contributing to minimizing the number of patients who have to be transferred to higher levels.

Similarly, Thanh Chuong General Hospital is also promoting the application of specialized techniques to gradually meet the needs of high-quality medical examination and treatment of the people. Doctor Nguyen Hai Linh, Director of Thanh Chuong General Hospital said: With many suitable solutions such as receiving techniques transferred from higher levels, contracting with higher-level hospitals on training and transferring technical packages, organizing training courses, currently, the hospital's doctors have truly mastered many techniques such as: endoscopic surgery of all kinds, cataract surgery by phaco method, orthopedic trauma. In addition, the hospital has also fully invested in equipment and machinery to meet the needs of a second-class medical unit such as endoscopes, high-frequency X-ray machines, color ultrasound, hydraulic multi-function operating tables, and infant incubators.

Quynh Luu General Hospital has deployed smart cards for patients with health insurance (long-term 2-3 years) since 2014. Doctor Nguyen Hoai Nam, Director of the hospital, said: When patients come for examination, they only need to bring this electronic card without having to bring their health insurance card. The card is encrypted and synchronized with the computer system that stores all the patient's medical information. Using the card has helped patients avoid waiting, increasing the time doctors spend on diagnosis and contact with patients. To date, the hospital has made more than 26,000 smart cards for patients... It is known that the management system, plus this convenient software, the hospital only invested about 140 million VND.

By 2021, the "unblocking" of health insurance-covered medical examination and treatment will not only stop at the district level but will be "completely opened" to all provincial and central medical examination and treatment facilities. Therefore, provincial hospitals are also making rapid movements to meet the people's medical examination and treatment needs. In 2014, the Northwest General Hospital successfully deployed and applied many new techniques such as emergency blood filtration, neonatal mechanical ventilation, neonatal jaundice blood exchange, bacterial culture techniques to make antibiotic susceptibility tests, helping patients enjoy high-tech services right at the nearest place; the Traditional Medicine Hospital upgraded and repaired its infrastructure, started construction of a new Pharmacy Department, and repaired and upgraded Internal Medicine Department A. In addition, the hospital also purchased additional equipment to improve the efficiency of medical examination and treatment such as a gastroscopy machine, CO2 Laser machine, and high-pressure oxygen system. Similarly, Nghe An Trauma and Orthopedics Hospital is also approaching research and treatment of complex diseases such as brain tumors, spinal tumors, and bone tumors to help patients avoid having to transfer to higher levels, reducing costs for patients.

Doctor Dau Huy Hoan, Deputy Director of Nghe An Department of Health, affirmed: The opening of the health insurance coverage line has been and will strongly promote the development of Nghe An's health sector. To ensure the rights and increasing needs of the people, Nghe An's health sector is determined to build a modern medicine, developing widely and in-depth; focusing on investment and development for lower-level health care, common diseases must be detected early, early care, not overloading the upper-level health care... Accordingly, the health sector continues to focus on developing commune-level health care. That is, continuing to update and improve knowledge for more than 5,000 village health workers; further promoting the construction of communes that meet the national criteria on health, striving to have about 80% of the total number of communes, wards and towns meeting the standards by 2020. At the district level, the health sector focuses on emergency treatment of common diseases and specializes in some areas that can be treated according to capacity. At the provincial level, hospitals will focus on high technology.

In the near future, when the "unified" health insurance treatment system is officially applied, there will certainly be issues that need to be adjusted, such as the development of commune-level health care, medical examination and treatment according to quotas... But it is certain that the "unified" health insurance treatment system will contribute to strongly promoting the quality of medical examination and treatment in Nghe An in particular and Vietnam in general.

Article and photos:Thanh Son