Increasing hospital fees creates momentum to improve the quality of medical examination and treatment

(Baonghean) -It is expected that from August 1, 2012, the new hospital fees will be widely applied in many localities. In Nghe An, since the beginning of May, the joint sector of Health - Finance - Social Insurance has established a team to develop hospital fee unit prices for each technical category. Accordingly, the proposed average increase is about 70% compared to the maximum increase of Circular 04.

Up to now, for 17 years, the hospital fee framework in our province as well as in the whole country has been applied according to Circular 14/TTLT dated September 30, 1995 of the Ministry of Health - Finance - Labor, Invalids and Social Affairs - Government Pricing Committee. It is not until now that the above price framework is considered outdated, the Ministry of Health has also intended to increase hospital fees at least 10 times but has encountered fierce opposition from public opinion so it still has to apply this price framework. However, the Ministry of Health's determination to increase hospital fees last year received support from many ministries, branches and strong voices from all hospitals, many of which said: If hospital fees are not increased, hospitals (district level) will have to "close" and the "stagnation" of hospital fees for so long is extremely unreasonable and ridiculous... According to research, leaders of hospitals, both public and private in the province, all said: Increasing hospital fees is a legitimate demand and should have been implemented a long time ago. There are many services at hospitals that "the more you do, the more you lose": Medical examination with the maximum fee applied at provincial hospitals is 3,000 VND/visit, at grade 3 hospitals is 2,000 VND/visit, which "is not enough money for paper and ink"; hospital bed fees from 8,000-18,000 VND/day only cover a small part of electricity, water, and cleaning costs; A series of other obstetric and surgical procedures are also in a state of having to compensate for losses. District hospitals, even at Nghi Loc Hospital near the city, also have more than 120 loss-making categories.

Many surgeries are losing money at public hospitals.

However, many people expressed concern about the increase in hospital fees and questioned the quality of medical services after the price increase. According to the health sector, this has been carefully calculated; the new price framework presented at this session of the Provincial People's Council has detailed and reasonable analyses that do not affect the interests of the majority of people. In the 7 factors that make up hospital fees, including medicine, blood, infusion fluids, and supplies directly serving patients; electricity, water, environmental protection costs, waste treatment; maintenance, repair of medical equipment; salaries and allowances for medical staff; hospital construction investment costs; costs of purchasing high-value equipment; and scientific research training costs, only the 3 direct cost factors (mentioned first above) are currently calculated, not taking into account other factors. Therefore, the new hospital fee is only calculated based on the principle of collecting a portion of the hospital fee, aiming to calculate correctly and sufficiently, but not really calculating correctly and sufficiently. The adjustment of medical service prices this time only helps hospitals improve their ability to provide medical services to patients, but does not increase the income of doctors and nurses as many people infer, because the construction of hospital fees has not taken this factor into account.

The goal of this hospital fee adjustment is to provide hospitals with funds to carry out medical examination and treatment in accordance with the regulations of the Ministry of Health, contributing to improving the quality of services, ensuring the rights of patients with health insurance cards for the reasons given: This hospital fee adjustment is a very urgent requirement because the medical service prices issued for many years have only been calculated partially, not fully. Meanwhile, the basic salary has increased 6.9 times, the price of input materials serving the health sector has also increased according to the market. This greatly affects the quality of medical examination and treatment when with limited income, patients have to buy more medicine and some other costs while the contribution level has also increased according to the annual salary increase (3% to 4.5%/year). The low quality of medical services discourages people from participating in health insurance. Also because the price is only calculated partially, the State subsidizes not only the poor, but also the rich. Insufficient revenue means medical facilities do not have money to purchase equipment, affecting the enthusiasm of staff.

Thus, when hospital fees increase, the payment of patients and the health insurance fund will increase. Accordingly, when applying the new hospital fees, health insurance will pay in full, patients do not have to pay any other expenses other than the co-payment of health insurance (depending on each health insurance subject) to the hospital as at present. Moreover, when examining at the commune health station, health insurance will also pay 100%, examination at the district level and above will only have to co-pay 5%. In fact, the increase in hospital fees will cause this co-payment to increase and patients will be more or less affected.

This increase in hospital fees will not have much impact on people in difficult circumstances, ethnic minorities in remote areas because the State has a support policy. Specifically, the Government has supported the purchase of health insurance for the poor at 95%, near-poor at 70%, and co-payment at 5%. In addition, the Prime Minister has issued Decision 14 adjusting the medical examination and treatment fund for the poor. Poor ethnic minorities living in difficult areas who have serious illnesses will be partially supported with food, travel, and medical treatment. As for other subjects, they are already covered by health insurance.

This adjustment of hospital fees will have a certain impact on the health insurance fund. This has been predicted by the Government and there are plans to overcome it. In Nghe An, according to the leaders of the health sector, the sector will have specific implementation instructions, strengthen the direction, inspection and supervision of the implementation at medical examination and treatment facilities on the implementation of hospital fee prices in order to continuously improve the quality of medical examination and treatment to ensure the rights of patients, prevent abuse of health insurance cards (use of drugs, tests, diagnostic imaging...); strengthen propaganda, mobilization and implementation of the roadmap for universal health insurance by 2014.

Before the draft of the inter-sectoral hospital fee increase is approved, more than ever, people are looking forward to new changes in the health sector, creating trust for the people. Only then will the hospital fee increase policy be truly convincing and receive higher support from public opinion.

Thuy Vinh