New regulations cause difficulties for hospitals and endocrine patients in Nghe An

Problems from new regulations

Previously, doctors with a practice license (practice certificate) in internal medicine could examine and treat endocrine diseases under health insurance, but now they cannot. Any medical facility that uses an internal medicine doctor to examine and treat endocrine diseases will have its payment or payment suspended by the Social Insurance agency... It is worth mentioning that the number of doctors with a practice license to examine and treat endocrine diseases in the whole province can be counted on the fingers.

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"The hospital has one doctor licensed to examine and treat endocrinology and diabetes. However, according to Circular 15/2018 of the Ministry of Health, that doctor can only examine a maximum of 65 patients per day. Meanwhile, every day at Quynh Luu District General Hospital, there are 100-120 endocrinology and diabetes patients coming for examination and treatment. From the 66th person onwards, the patient will have to return home or pay more for the examination because the health insurance only covers 50%. Patients who want to be examined, treated and enjoy health insurance as usual need to go very early."

Doctor Le Van Hoan - Deputy Director of Quynh Luu District General Hospital

Many medical examination and treatment facilities in the province currently do not have a single doctor with a certificate to practice examining and treating endocrinology and diabetes. Unable to refuse patients, many facilities have to use doctors with a license to practice internal medicine and general medicine to examine and treat patients with endocrinology and diabetes... These facilities said that the Social Insurance agency is temporarily suspending payment and disbursement for examination and treatment of endocrinology and diabetes.

Doctors said: According to the Law on Medical Examination and Treatment 2023; Decree 96/2023/ND-CP detailing a number of articles of the Law on Medical Examination and Treatment; documents of the Ministry of Health, doctors must practice in the correct specialty (listed on the practice license/practice certificate) to be able to examine and treat patients. If in the past, internal medicine doctors (studying 3 months of endocrinology) could examine and treat endocrine diseases, now if they want to examine and treat endocrine diseases and diabetes, they must have a license to practice endocrine examination and treatment.

The conditions for doctors to supplement their practice scope and renew their practice licenses under current regulations are very strict. Doctors must study a level 1 specialty in endocrinology (90% of current training institutions do not offer endocrinology majors); must study for a master's degree and have 12 months of practice in endocrinology. If they do not study a level 1 specialty or master's degree, only those with a 6-month specialized training certificate in endocrinology (from 2019 onwards) and those with a 9-month basic specialized training certificate in endocrinology, plus 12 months of practice time... are eligible to be granted a practice license in endocrinology.

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Currently, very few people are qualified to be granted a license to practice endocrinology, including at the grassroots, district, provincial and central levels. The new regulations have made it impossible for medical facilities to keep up. To keep up with the new regulations, it is estimated that medical facilities will have to spend an average of at least 2 years to send doctors for training once; it will take 5-7 years if they send doctors for rotational training... Thus, medical facilities will lack human resources and will not be able to meet the people's needs for medical examination and treatment."

Doctor Nguyen Trong Hieu - Deputy Director of Vinh City General Hospital

Need to resolve on the basis of patient rights

The suspension of payment and disbursement by Nghe An Social Insurance for medical facilities using doctors with incorrect specialties for endocrine examination and treatment is in accordance with the provisions of law and documents of the Ministry of Health.

Specifically, on December 26, 2023, the Ministry of Health issued Official Dispatch No. 8193/BYT-KCB regarding difficulties in payment of medical examination and treatment costs under health insurance in the field of medical examination and treatment practice to Vietnam Social Security.

According to the content of the document, "practitioners are allowed to perform specialized techniques that they have been trained in and have a document from a competent authority permitting them to perform that technique, but are not yet qualified to perform specialized medical examination and treatment that has been supplemented with specialized techniques."

Thus, doctors who have not been granted a license to practice endocrinology are only allowed to perform the techniques of this specialty but are not allowed to examine, treat, review medical records, prescribe endocrinology or diabetes. Endocrinology is different from internal medicine, so the scope of professional activities stated on the practice certificate and practice license is internal medicine examination and treatment, but will not be allowed to examine and treat endocrinology or diabetes.

The suspension of payment and disbursement is receiving many reactions from medical examination and treatment facilities. This issue was raised by medical examination and treatment facilities at the conference to review medical work in the first 6 months of 2024 and the conference to review 1 year of implementing the regulations on coordination in implementing health insurance policies and laws in the province for the period 2023-2025 of the Department of Health and Social Insurance of Nghe An.

According to the arguments of medical examination and treatment facilities: Based on Decision 3618/QD-BHXH dated December 12, 2022 of Vietnam Social Security on promulgating the Health Insurance Assessment Process; Decision No. 7603/QD-BYT dated December 25, 2018 of the Ministry of Health on promulgating a common code list applicable in the management of medical examination, treatment and health insurance payment, endocrine examination belongs to Internal Medicine Examination. Based on Official Dispatch No. 787/BYT-KCB dated February 2, 2021 of the Ministry of Health, endocrine examination belongs to the field of internal system.

Based on the current practice of postgraduate training in medical universities, "endocrinology" is a sub-system of the internal medicine department. The diplomas awarded for postgraduate training for master's, level 1 and 2 specialists are internal medicine specialties, there is no separate endocrinology specialty. At the central level such as the Central Endocrinology Hospital, Bach Mai Hospital, doctors are currently also licensed to practice internal medicine and perform endocrine examination and treatment.

Medical examination and treatment facilities request the Ministry of Health to review the content of Official Dispatch 8193 to specifically determine that licensed doctors are allowed to examine and treat diabetes, thyroid and endocrine diseases that have been trained. Nghe An Department of Health has a specific document sent to the Department of Medical Examination and Treatment, Ministry of Health to remove related difficulties and problems. Nghe An Social Insurance temporarily does not include this content in the work of appraisal, payment and settlement of health insurance examination and treatment, removing difficulties for medical units in the area, creating conditions for units to perform well the work of examination and treatment of diabetes, thyroid and endocrine diseases.

It is known that in the near future, the Health and Social Insurance sectors of Nghe An will continue to work to review the contents related to this content. The problem in the examination and treatment of endocrine diseases needs to be resolved soon legally and on the basis of the rights of the patients.