Increasing hospital fees - towards real costs

(Baonghean)As expected, from October 1, Nghe An will officially apply new hospital fees in medical facilities. Accordingly, the average increase in medical examination and treatment service prices in our province in all categories is 73% compared to the maximum recommended level, in which the testing group has the highest increase (nearly 80%). The health sector affirmed: The increase is necessary and will be "mutually beneficial", the most important thing is that the new hospital fees will aim at real costs.

People worry!

With the expected increase in hospital fees this time, the most affected subjects are those without health insurance cards. Therefore, the choice of Mr. Thai Van Thuan (Do Luong) after being diagnosed with nasopharyngeal cancer and having to undergo surgery at K Hospital (Hanoi) is to... postpone the surgery to wait for the card. He said: "I know that the sooner the surgery is, the better, and moreover, I have to "wait in line" for a long time to get my turn for surgery. I just have to wait for the card to be completed before having surgery."

Mr. Thuan's concern is also the common concern of 30% of people in our province who do not have health insurance cards.

Another issue that many people are concerned about is the quality of medical examination and treatment, and the quality of services at medical facilities after the new hospital fees are applied. Ms. Nguyen Thi Nhu, a patient at Nghe An Oncology Hospital, said that she and other patients have to endure sleeping in pairs or threes in one bed in the hallway, even spilling out into the hospital's yard and garden because the hospital's facilities cannot meet the needs of a large number of patients. "I wonder if increasing hospital fees will improve the current situation of sleeping in pairs or threes outdoors? It is unreasonable if we pay the same hospital fee for a bed in a single room as for a bed in a three-person room outdoors like this."

Mr. Phan Van Thu (Vinh City) took his wife to give birth at the provincial hospital and shared: My wife has been showing signs of labor pain for 2 days, but after the examination, the doctor said "she can't give birth right away". Because the department is too crowded with patients, the beds are all cramped, so the doctor advised his wife to walk in the hallway to... wait for the birth. Maybe the doctors are experts so they know that my wife's condition is normal, but my wife and her family are all worried. She keeps wondering if it's because I haven't given the "additional costs" to the doctors and nurses? He also said, if hospital fees increase, will people have to worry about "additional costs"?

What is the real price?

The increase in hospital fees will have certain impacts on poor patients with chronic diseases, incurable diseases that require long-term treatment, have insurance but have to pay co-payments, and especially on patients who do not have health insurance cards. However, the price increase will not be much compared to the actual cost that patients have to pay as it is now. For example, with a cesarean section, the hospital fee is paid at 450,000 VND, but the mother will only be stitched with normal thread, which can cause keloid scars and must come to remove the thread, so the mother has to pay an additional 180,000 VND for 3 good threads, buy more cotton, bandages, anesthetics... and the actual cost of the surgery is up to more than 1 million VND.

Or a difficult birth with a hospital fee covered by insurance of 150,000 VND, in reality the mother has to pay an additional 200,000 VND for anesthesia. If she wants good sutures and stitches without having to cut the sutures and not leaving keloid scars, she has to buy the sutures herself for another 60,000 - 80,000 VND, not to mention some costs for medicines and medical supplies purchased from outside. Or with the UIV kidney scan service, according to the old price, the insurance will pay 40,000 VND, but the patient has to buy the film, buy the washing medicine... nearly 200,000 VND more...

A patient also said that he had to have a lymph node biopsy, which would have cost only a few tens of thousands of dong according to the old hospital fee, but the hospital asked him to use a disposable biopsy needle that costs a few hundred thousand dong each. According to the doctor's explanation, the reason for this price difference is because in the past, lymph node biopsies had to be done manually, using the same needle for many patients, and being sharpened over and over again. Now, to ensure patient safety, the hospital asked him to buy a new needle. In addition, he also had to undergo an ultrasound and CT scan to determine the exact location of the biopsy.

Thus, besides the majority of people who are worried about the "price increase syndrome", there are also people who are more calm in accepting the news of increasing hospital fees: Whether or not the cost increases, the actual cost is another matter. For a long time, many people have had to endure price increases when accepting to go to medical examination services to receive better attitudes from medical staff and not have to wait in line. Many patients often have to pay hospital fees many times higher than the regulations, because they have to use high-tech testing machines, machines purchased in the form of "socialization". There are also many people who accept going to the wrong line, going to the wrong line (even though they have to pay a much higher cost than the right line) and going to private hospitals because they believe that, when going to these facilities, they will not have to pay other additional fees that will be much higher than the difference in hospital fees. Some people even expressed their opinion: How much is the hospital stay fee compared to other “extra charges” and “compensation”? Besides the supplies and equipment “included in the separate bill”, there are also expenses “not included in the bill”. Patients still tell each other about the compensation for a delivery at the hospital that can reach millions of dong, or the costs for a surgery that is not a small amount of money.

Towards real costs

Applying the new hospital fees, a cesarean section will cost from 1,350,000 VND to 1,400,000 VND, a difficult birth will cost about 470,000 VND, a tonsillectomy will cost 580,000 VND, a UIV kidney scan will cost 340,000 VND... equivalent to the actual costs that patients are currently paying.

It is clear that the old hospital fee has not changed for nearly 20 years, it is too outdated and unreasonable not only compared to the world but also compared to real life. "A doctor who studies for 6 years to graduate, if he wants to specialize, he needs a few more years, if he wants to be proficient, he also needs a few more years of practice, but if he examines a patient for only 2,000 - 3,000 VND/visit, which is not equal to someone pumping up a bicycle, it is too funny" - Doctor Le Van Tiec - Director of Vinh Traffic Hospital once shared. Hospital fees are "trampling", many district-level hospitals are in the situation of "the more they work, the more they lose", and other hospitals do not know where to get the resources to maintain and repair machinery and equipment, repair facilities, so they have to "scratch" to make up for it. Doctors have to examine hundreds of patients a day, a nurse has to be in charge of several rooms, spinning like a top, while the examination fee is not enough to pay for paper and pens, it is very difficult to be friendly with patients. All of the above not only damage the hospital's image, but also cause harm to patients.



Increasing hospital fees will give medical facilities the opportunity to invest and purchase equipment to better serve the needs of patients.

Doctor Bui Dinh Long - Director of the Department of Health said: Many patients think that if hospital fees increase, all problems related to medicine will also increase and the lives of medical staff will also improve.

In fact, the hospital fee adjustment does not increase the price of medicine, but the price of medicine is implemented through bidding. Increasing hospital fees is not to increase the income of doctors and nurses, but only to improve the ability to provide medical services of the hospital. When adjusting hospital fees, health insurance will pay all service costs, so patients only have to pay the prescribed fees (together paying 5% or 20% depending on the subject) and no longer have to pay the shortage that the hospital "loses" due to insurance not paying as before. The new hospital fee is calculated in a way that aims at real costs so that patients with insurance do not have to pay out of pocket when going to the hospital for examination and treatment. The health sector also explained and determined to implement: When the price is increased, all services that are included in the hospital price must not be required to be purchased by the people, except for special supplies, which must be clearly stated that they do not include these supplies.

Dr. Nguyen Van Huong - Deputy Director of Nghe An General Hospital said: "Increasing hospital fees will certainly give hospitals more resources to reinvest as well as maintain and repair equipment, helping hospitals to enhance high-tech services to treat patients. The increased health insurance payment ceiling will help patients pay for more high-tech services. The quality of public health services will be improved."

Doctor Nguyen Hoang Cat - Deputy Director of Nghe An Hematology and Blood Transfusion Center also shared: "Due to the lack of funding to improve the quality of services for patients, it is easy to lead to situations where hospitals require patients to pay more money or cannot perform the service but require patients to perform the service at other facilities, reducing or limiting benefits, causing inconvenience to patients with health insurance cards. If the new price is applied, I believe that the long-standing inconveniences will be reduced."

To effectively implement the roadmap for increasing hospital fees and ensuring patient rights, Director of the Department of Health Bui Dinh Long also said: "The Department will coordinate to effectively perform its supervisory role at medical facilities, while gradually directing the improvement of the quality of medical examination and treatment. And a requirement for medical facilities in the province is: Increasing service prices must mean increasing service quality."

Thuy Vinh