'Clearing the name' of patients and medical facilities

(Baonghean) - Patients abuse their health insurance cards to go to the doctor and get medicine many times, and medical facilities receive more patients than the prescribed quota. Is the fault entirely theirs?

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

In 2016, Nghe An ranked second in the country in terms of exceeding the Health Insurance Fund (HIF). Although all levels and sectors have taken action and implemented many corrective measures, the situation of exceeding the fund continues to be alarming. Nghe An Social Insurance (SI) forecasts that if the fund usage trend continues as above, in 2017, the total expenditure proposed by medical examination and treatment facilities will reach over 3,500 billion VND, exceeding the fund by about 1,700 billion VND.

Went to the doctor many times because... not sure

On the afternoon of April 19, Ms. NTT (residing in Dong Vinh Ward, Vinh City), who has a health insurance card with 80% coverage, had symptoms of abdominal pain and itchy rash, and went to Minh Hong General Hospital for examination. After charging her insurance card at the patient reception area, Ms. T was directed to examination room No. 1 of Dr. Le Thuan. After describing her symptoms, Dr. Thuan diagnosed her main disease as hemorrhoids, and ordered her to have an abdominal ultrasound and hemorrhoid examination.

In the ultrasound room, Dr. Ha Quang Phung concluded that Ms. T had a “right ovarian cyst” and returned the results to clinic number 1. Here, Dr. Thuan concluded that Ms. T had internal hemorrhoids and an ovarian cyst, and prescribed 30 packets of Merica, 60-tablet Futiamine, 10 Fexodinefast 120 mg tablets and 1 packet of Davac. In addition to the insurance costs, Ms. T had to pay an additional 43,000 VND.

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

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

The doctor prescribed 5 Fexodinefast 120 mg tablets and 1 tube of gensonmax 0.64 mg. The ultrasound doctor gave the following results, which Dr. Anh diagnosed as ovarian cysts, and sent her to the obstetrics department for consultation. At the obstetrics department, the doctor said "there is suspected internal bleeding, it is best to be hospitalized for re-examination and then surgery". Ms. T was confused and asked to go home to consult her family. At Vinh City General Hospital, Ms. T did not have to pay any additional costs.

On the afternoon of April 20, Ms. T continued to bring her insurance card to Dong Au Private General Hospital and was directed to internal medicine clinic number 119 of Dr. Nguyen Thi Ngoc. After presenting the old symptoms, the doctor ordered her to have an abdominal ultrasound. The results returned normal, except for "the right ovary has a hollow negative shape measuring 30mm" and the conclusion was "Right ovarian cyst".

Dr. Nguyen Thi Ngoc transferred her to the obstetrics department so that “a specialist could prescribe medicine”. The doctor also told her to “go back there (obstetrics department?) and ask them to prescribe some anti-itch pills”. At the obstetrics room 104, Dr. Pham Thi Le concluded that she had “menstrual disorders” and prescribed 20 vitamin C 500mg pills and 30 vitamin E pills. During this visit, Ms. T did not have to pay any additional costs.

Outpatient department staff check in patients.

Thus, in just 2 days, Ms. T went to 3 different hospitals with her health insurance card. With the same symptoms, each hospital gave different results and prescriptions, raising questions about the quality of medical examination and treatment services in hospitals of the same level? In fact, this is also one of the reasons leading to the situation of patients holding health insurance cards going to many hospitals of the same level in a short period of time.

The current situation of supply not meeting demand in many hospitals

Doctor Nguyen Hong Truong - Director of Vinh City General Hospital said: Up to now, Vinh City General Hospital is being "suspended" by Nghe An Social Insurance for payment of over 10 billion VND. Of which, up to 4 billion VND is for medical examination fees exceeding the level of 50 patients/8 hours. This norm is explained by Nghe An Social Insurance as being based on Decision 1313/QD-BYT dated April 22, 2013 of the Ministry of Health on promulgating guidelines for medical examination procedures at the hospital's examination department.

However, the Ministry of Health sent an official dispatch to the Nghe An Department of Health on October 31, 2016 stating: The regulation on examination frequency is a target of the health sector. This target is not a prescribed norm for a medical examination room for the Social Insurance agency to use as a basis for payment.

In fact, the Nghe An health sector is unlikely to achieve the target set by the Ministry of Health due to limited facilities and human resources. According to the report of the Nghe An Department of Health, the number of doctors per 10,000 people in Nghe An in 2016 was 7.6; in 2017 it is expected to be 7.7. This figure is 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 per 10,000 people). In 2017, Nghe An plans to increase by 300 beds, reaching 27.5 hospital beds per 10,000 people.

Waiting for medical examination at Vinh City General Hospital.

Although higher than the national average, Nghe An still has hospital overload, leading to the addition of more beds than planned. However, this overload occurs locally in some medical facilities, in contrast to a number of medical facilities that have fallen into a "sluggish" state after the route is opened.

Doctor Dau Huy Hoan - Deputy Director of Nghe An Department of Health said: The policy of connecting medical facilities ensures the rights of patients, creating healthy competition between medical facilities, but in reality, patients tend to skip commune-level health care to go to district-level health care. Even at the same level, some medical facilities attract more patients than others.

Statistics from Nghe An Social Insurance in 2016 also show the above-mentioned trend of “water flowing to low places” in the psychology of people going to see a doctor. In the first 9 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. In contrast, the number of medical examinations and treatments at district level increased by 82%.

PV Group