Increased hospital fees and the risk of 'breaking' the Health Insurance Fund

(Baonghean) - According to the roadmap, 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 a population participating in health insurance of about 95%. The second phase will be implemented in October 2016 in localities with a health insurance rate of about 90% and a low CPI impact. The third phase will be implemented in November 2016 in localities with a health insurance coverage rate of 85% of the population. The fourth phase will be implemented in December 2016 in provinces with a health insurance rate of over 80% and the fifth phase will be implemented in January 2017 in the remaining provinces. Thus, with more than 80.3% of the population participating in health insurance, Nghe An will adjust the price of medical services from December 2016.

Mr. Le Truong Giang - Director of Nghe An Social Insurance said: Basically, adjusting the price of medical services according to the roadmap does not affect the poor and near-poor much because the health insurance covers all or most of it. For example, ethnic minorities, people living in island districts and communes, people with revolutionary contributions, 9 million children under 6 years old... when going for medical examination and treatment, the health insurance covers 100% of the cost instead of paying 95%, co-paying 5% as before. The near-poor also have their co-pay reduced from 20% before 2015 to 5% from 2015.

Examination and treatment for children at Nghe An Maternity and Pediatrics Hospital.

For about 24% of the country's population who have not participated in health insurance, in the first phase, they will not be affected by the adjustment of medical examination and treatment service prices. However, according to the roadmap for medical service prices in the direction of correct and full calculation, it will be applied to people without health insurance cards. Therefore, in order to avoid the burden of additional payments and reduce out-of-pocket expenses when performing medical examination and treatment, people should actively participate in health insurance.

In addition, increasing the price of medical services uniformly nationwide will encourage hospitals to develop medical techniques that were previously not funded due to low revenue, helping people enjoy these services right in the area and be paid by social insurance, increasing the benefits of people with health insurance cards.

Once salaries and allowances are included in the price of medical services, the part of the State budget that is still allocated to medical facilities to pay salaries, regular expenses, etc. will be transferred to support people participating in health insurance, in order to achieve the goal of universal health insurance, with attention paid to vulnerable groups in society. The payment price of technical services will be unified at all medical examination and treatment facilities of the same class nationwide, and patients will be provided with fair and equal medical services at all medical examination and treatment facilities, regardless of region.

All costs of medicines, medical supplies, especially direct costs such as depreciation, maintenance, repair, etc. are gradually included in the price of medical services according to the roadmap and paid by the Health Insurance Fund. Therefore, patients will not be charged additional costs that have been included in the price of medical services.

However, the increase in medical service prices will result in additional expenses from the health insurance fund. The proof is that since March 1, more than 1,700 medical services have increased in price, leading to increased expenses from the health insurance fund. Over the first 6 months of 2016, the total cost of medical examination and treatment has increased by 40% compared to the same period in 2015, equivalent to more than 8,500 billion VND. Up to 37/63 provinces and cities have spent more than the allocated medical examination and treatment fund, of which Nghe An alone has exceeded by more than 344 billion VND. The increase in medical service prices is considered the cause of the increase in unnecessary technical services. For example, in the past, a hospital only ordered 30% of patients to have an ultrasound, but now that number can increase to 50% to increase the hospital's revenue.

Therefore, to avoid the risk of "breaking" the health insurance fund nationwide, the Social Insurance agency must continue to strengthen the management and supervision of the use of the Health Insurance Examination and Treatment Fund at hospitals by promoting the application of information technology in appraisal work. On the part of the health sector, it is necessary to issue standards for medical examination and treatment, for example, regulations on the maximum number of examinations per day for an examination table, the number of ultrasounds for an ultrasound machine, the disease condition for inpatient treatment... to both increase the quality of examination and facilitate the payment of insurance agencies. In addition, each person must be aware of fully participating in health insurance, in accordance with regulations, know how to prevent diseases, go to the doctor, use medical services when necessary...

Mai Anh(Synthetic)