Rising hospital fees and the risk of the health insurance fund collapsing.

(Baonghean) - According to the plan, from the end of August 2016 to the end of 2017, the inclusion of medical staff salaries in hospital fees will be implemented at public medical facilities nationwide and is expected to be divided into 5 phases.

The first phase will be implemented at the end of August 2016 in localities with approximately 95% of the population participating in health insurance. The second phase will be implemented in October 2016 in localities with approximately 90% health insurance coverage and low CPI impact. The third phase will be implemented in November 2016 in localities with 85% health insurance coverage. The fourth phase will be implemented in December 2016 in provinces with over 80% health insurance coverage, and the fifth phase in January 2017 in the remaining provinces. Thus, with over 80.3% of the population participating in health insurance, Nghe An will implement the adjustment of medical service prices from December 2016.

Mr. Le Truong Giang, Director of the Social Insurance Department of Nghe An province, stated: Basically, adjusting medical service prices according to the roadmap will not significantly affect the poor and near-poor because they already have health insurance covering all or most of the costs. For example, ethnic minorities, people living in island districts and communes, people with meritorious service to the revolution, and 9 million children under 6 years old... when they go for medical examinations and treatment, their costs are covered 100% by health insurance instead of 95% and a 5% co-payment as before. The near-poor also saw a reduction in co-payment from 20% before 2015 to 5% from 2015.

Medical examination and treatment for children at Nghe An Obstetrics and Pediatrics Hospital.

For approximately 24% of the population nationwide who are not yet covered by health insurance, the adjustment of medical examination and treatment service prices will not be affected in the initial phase. However, according to the roadmap for medical service pricing based on accurate and comprehensive costs, this will apply to those without health insurance cards. Therefore, to avoid additional financial burdens and reduce out-of-pocket expenses for medical examinations and treatments, people should actively participate in health insurance.

In addition, a nationwide unified increase in medical service prices will encourage hospitals to develop medical techniques that were previously unfunded due to low revenue, allowing people to access these services locally and have them reimbursed by social insurance, thus increasing the benefits for those with health insurance cards.

Once salaries and allowances are included in the price of medical services, the portion of the state budget previously allocated to medical facilities to pay salaries and recurring expenses will be redirected to support people's participation in health insurance, aiming to achieve universal health insurance coverage, with particular attention to vulnerable groups in society. The payment rates for technical services will be standardized across all medical facilities of the same category nationwide, ensuring patients receive fair and equitable medical services at all facilities, regardless of region.

All costs for medicines and medical supplies, especially direct costs such as depreciation, maintenance, and repair, will be gradually incorporated into the price of medical services according to a roadmap and covered by the Health Insurance Fund. Therefore, patients will not be charged additional fees that have already been included in the price of medical services.

However, the increase in medical service prices will lead to corresponding additional expenditures from the health insurance fund. As evidence, since March 1st, the price increases for over 1,700 medical services have resulted in increased spending from the health insurance fund. In the first six months of 2016, total medical examination and treatment costs increased by 40% compared to the same period in 2015, equivalent to over 8,500 billion VND. As many as 37 out of 63 provinces and cities exceeded their allocated medical examination and treatment budgets, with Nghe An alone exceeding it by over 344 billion VND. The increase in medical service prices is seen as a reason for the increase in unnecessary technical services. For example, previously, hospitals only ordered ultrasounds for 30% of patients visiting each day; now that number may increase to 50% to boost hospital revenue.

Therefore, to avoid the risk of the nationwide health insurance fund collapsing, the Social Insurance agency must continue to strengthen the management and supervision of the use of the health insurance fund at hospitals by promoting the application of information technology in the auditing process. On the part of the health sector, it is necessary to issue standards for medical examination and treatment, for example, setting a maximum number of examinations per day for each examination room, the number of ultrasounds per ultrasound machine, and the conditions for inpatient treatment... in order to both improve the quality of examinations and facilitate payment by the insurance agency. In addition, each citizen must be aware of the importance of participating fully and correctly in health insurance, knowing how to prevent diseases, seeking medical examinations, and using medical services when necessary...

Mai Anh(Synthetic)