After June 1, medical service prices will increase 2-3 times for people without health insurance cards.

The increase in medical service prices for people without health insurance cards after June 1 is attracting public attention. So what is the basis and impact of the price increase? Mr. Le Van Phuc - Deputy Head of the Health Insurance Policy Implementation Department (Vietnam Social Insurance) further answered the press about this issue.

Increasing medical service prices will greatly affect people's awareness of participating in health insurance.

What is your opinion on the impact of increasing medical service prices according to Circular 02/2017/TT-BYT on people without health insurance cards?

-According to Circular 02 of the Ministry of Health, there are 3 groups of services for people without health insurance cards that have adjusted the maximum price frame. Including: price of medical examination and health check-up services; price of treatment bed day service; price of technical and testing services for hospital classes.

In these 3 service groups, both medical examination and bed-day treatment services have seen a sharp increase in price, 2-4 times higher than the current price. Specifically, medical examination fees have increased 4 times at regional polyclinics and commune health stations; and increased 2 times at grade 1 and grade 2 hospitals.

"Circular No. 02/2017/TT-BYT of the Ministry of Health, from June 1, 2017, public health facilities will officially apply new hospital fees for more than 1,900 medical services for groups of people without health insurance cards, and some medical examination and treatment services not covered by the health insurance fund. By adding salary costs and special allowances for medical staff to the price of medical services, and adjusting the costs of 3 direct factors, many medical services will have an increase of 2-3 times the old price and will be paid 100% by patients" - said Mr. Le Van Phuc.

This increase is very significant when patients have to be inpatients or have long-term treatment. However, the strongest impact on patients without health insurance cards must be the group of prices for technical services and tests for all hospital categories regardless of whether the patient is an outpatient or inpatient, or has short-term or long-term treatment.

With 1,916 services having their prices adjusted to increase in this Circular, although the adjustment level is mainly around 20-30%, a few have an increase of double compared to the current price, the absolute amount of many services is up to hundreds of thousands; even up to millions of VND for one appointment, because the unit price of technical services already has a high cost structure!

For example, coronary angiography or cardiac catheterization, cardiac chamber imaging under DSA increased from 5.1 million VND to nearly 5.8 million VND; cardiovascular imaging and intervention under DSA increased from 6 million VND to nearly 6.7 million VND; abdominal endoscopy increased from 575,000 VND to 793,000 VND, esophagogastroduodenal endoscopy with biopsy increased from 220,000 VND to 385,000 VND...

According to Circular 02, only the price of medical examination and treatment bed days are different according to the hospital class, the remaining technical and testing services are implemented at the same price at all hospitals nationwide. Joint Circular No. 37/2015/TTLT-BYT-BTC, regulating the unification of prices of health insurance examination and treatment services between hospitals of the same class nationwide, is also implemented according to this principle.

So, what is the basic difference between people with and without health insurance cards after the above adjustment in medical service prices, sir?

- The basic difference between people with health insurance cards and those without is that health insurance patients have had 80 to 100% of their costs covered by the health insurance fund, depending on the beneficiary. Meanwhile, patients using the service will have to pay 100% of the total cost of medical examination and treatment.

"According to the new regulations, the maximum examination fee at special-class hospitals and grade 1 hospitals is 39,000 VND/visit; grade 2 is 35,000 VND/visit; grade 3 is 31,000 VND/visit and grade 4 hospitals/regional clinics, commune health stations is 29,000 VND/visit. Similarly, the maximum price for intensive care treatment days at special-class hospitals has also doubled to 677,100 VND; grade 1 hospitals is 632,200 VND; grade 2 hospitals is 568,900 VND. For emergency resuscitation and anti-poisoning bed days, the corresponding levels are: 362,800 VND/day, 335,900 VND/day, 279,100 VND/day; at grade 3 hospitals it is 245,700 VND/day and at grade 4 hospitals it is 226,000 VND/day..." - Mr. Le Van Phuc said.

The amount of money that patients without health insurance have to pay in addition to the current price will be a significant amount. In particular, for patients who need to use high-tech services, the 100% out-of-pocket cost is very high, for example, the maximum cost for PET/CT scans is up to more than 20 million VND; the cost of PET/CT simulation radiation therapy is nearly 21 million VND...

Is the basis for the increase in medical service prices as above satisfactory, sir?

- In fact, this price increase roadmap has been "delayed" a lot according to the Health Insurance Law, because after 1 year, the price of medical services for about 20% of the population who do not have a health insurance card will catch up with the price of those who are receiving health insurance treatment.

Currently, people who have not participated in health insurance when going to see a doctor or receive treatment are still paying a lower price than the group of people with health insurance cards, because the price of medical services for people without health insurance cards only includes 3 direct cost elements: Cost of medicine, infusion, chemicals, consumables, replacement materials for medical examination and treatment; costs of electricity, water, fuel, waste treatment, environmental protection; Cost of equipment maintenance, repair, purchase of replacement tools and instruments.

Not to mention, the prices of these medical services are still regulated in Circulars with prices that are quite "outdated" compared to current prices such as Joint Circular No. 03/2006/TTLT-BYT-BTC-BLDTBXH issued in 2006, Joint Circular No. 04/2012/TTLT-BYT-BTC in 2012.

Meanwhile, in the past year, the Health Insurance Fund has paid most of the costs for people receiving health insurance treatment, including medical service prices, including salaries and allowances, according to Joint Circular No. 37/2015/TTLT-BYT-BTC, which regulates the unification of health insurance treatment service prices among hospitals of the same rank nationwide.

Why is there a time lag for this group of people, sir?

Because the Government wants to create the necessary transition time for those who have not participated in health insurance to fulfill their responsibilities in the policy of universal health insurance.

Even if the current medical service prices are adjusted, they only include 4/7 cost elements. The roadmap for calculating the correct and full cost of medical services is still being implemented, and medical service prices will continue to increase according to the roadmap.

In addition to changing the health financing mechanism, the Government will shift to direct investment for people through support for health insurance participation instead of pouring budget into hospitals.

To ensure financial benefits in health care, people need and should participate in health insurance. That is also the provision of the Health Insurance Law which has been in effect for more than 2 years.

"As I said, with Circular 02, we will create more fairness in implementing the general policy when the price of medical services is the same when provided to both people with and without health insurance cards. The price increase will certainly have an impact on people's awareness of participating in health insurance, making the importance and meaning of health insurance clearer" - Mr. Le Van Phuc.

Thank you!

According to Dantri