Good doctors move to higher levels, but the number of people going to primary health care facilities is decreasing.

Not detected early, chronic disease management at commune health

"The proportion of people coming to primary health care for primary health care and general health advice is low and is decreasing. There are many reasons, including issues with service quality, people's trust, policies and investment levels for communal health care," said Dr. Tran Thi Nhi Ha, Director of the Hanoi Department of Health, at a workshop on the quality of primary health care held on November 18 in Hanoi.

Effective control of chronic diseases at primary health care facilities helps patients avoid having to go to higher levels of care, prevents serious complications, and reduces hospitalization rates.

According to Ms. Nhi Ha, the reason why the quality of primary health care, especially at the commune level, has not been well received by the people is because "many policies have not really created conditions for primary health care to promote its potential and strengths, which leads to people continuing to bypass the line, incurring high costs for health care, upper-level hospitals continue to be overloaded and satisfaction will be difficult to improve".

Primary health care facilities are limited in professional development, lack good medicine and necessary equipment, while highly qualified doctors have moved to work in upper-level hospitals and the private sector, which is also a common difficulty for primary health care.

Currently, people are not examined, detected, managed, and monitored for chronic diseases such as blood pressure and diabetes regularly and continuously at commune health stations. Meanwhile, if left untreated, people will have to be hospitalized, affecting the quality of their health and incurring high treatment costs.

Agreeing with Ms. Nhi Ha's opinion, at the workshop, World Bank representative Ms. Dao Lan Huong said that a study in Vietnam showed that about 30% of hospitalizations could be avoided if they received good health care at primary health care facilities.

Ms. Tran Thi Nhi Ha said that the Sister Hospital model piloted by the Hanoi Department of Health has improved the diagnostic and treatment capacity of grassroots health care.

There are 10 groups of diseases with the highest hospitalization rates. If well controlled at the primary health care level, about 80% of hospitalizations due to these diseases will be reduced.

The "Sister Hospital" model between Xanh Pon General Hospital, Ba Vi District General Hospital and Ba Vi District Medical Center has been piloted by the Hanoi Department of Health. Through the application of information technology, Xanh Pon General Hospital provides comprehensive, daily professional support to many medical units at the district and commune levels at the same time, achieving remarkable results.

Specifically, at Ba Vi District General Hospital, a one-way medical examination process without keeping health insurance cards has been implemented; an emergency unit and a neonatal unit have been opened; thrombolysis technology has been transferred and a 2.5-hour cerebral infarction case has been successfully treated...

Ba Vi District Medical Center has built a truly effective health management model for people right in the community.

Director of Health Department Tran Thi Nhi Ha

About 50% of the list of commune-level services has not been implemented.

Information on people's rights when examining and treating at commune and ward health stations, Mr. Nguyen Duc Hoa, The Deputy General Director of Vietnam Social Security said that the Law on Health Insurance is being amended, including measures to remove difficulties for grassroots healthcare, prioritize budget for health stations, and focus on health insurance payment policies.

Mr. Hoa noted that at the commune level, there are currently 182 technical categories covered by the Health Insurance Fund, but currently, commune health stations have not implemented about 50% of the categories, and have not received payment from the Health Insurance for about 50% of the technical categories within the scope of implementation. For commune health stations to be approved for payment, the health departments must approve the categories and ensure the conditions for implementing the techniques at the commune level. Therefore, the health departments need to improve the professional capacity of the commune level.

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