Abolishing medical examination and treatment lines will destroy the health system in the long run.

Where will primary health care go?

Currently, patients receiving treatment at district and provincial hospitals who want to be transferred to higher-level hospitals must apply for a referral letter. However, many patients believe that this is a procedural hassle and have proposed to abolish the referral letter.

Talking to Nguoi Dua Tin on the sidelines of the National Assembly, National Assembly Deputy Nguyen Tri Thuc - Director of Cho Ray Hospital, Ho Chi Minh City delegation said that there are two opinions on this issue.

People think that why do they need a referral? It's very inconvenient and they can go to any facility they want.

He and doctors at upper-level hospitals personally believe that if the referral system is abolished, upper-level hospitals will benefit. Because all patients will flow to upper-level hospitals, but this is a short-term benefit. However, in the long run, it will disrupt the health system and bring no benefits.

Dialogue - Abolishing medical examination and treatment lines will destroy the health system in the long run — National Assembly Deputy Nguyen Tri Thuc - Director of Cho Ray Hospital talks with Nguoi Dua Tin in the hallway of the National Assembly (Photo: Hoang Bich).

“The structure of Vietnam’s healthcare system is very good, reaching out to villages, communes, districts, provinces, and then to the central healthcare system. This is a widespread, comprehensive healthcare network. The current issue is to fully utilize the functions of each position,” said Mr. Thuc.

At the same time, analyzing, if we do not transfer to another level, there will be problems, for example, a patient with a common condition, can be treated at a lower level but has the mentality of having to go straight to a central level hospital such as Cho Ray, Bach Mai, Viet Duc... for examination and treatment, that will lead to economic consequences for the patient...

Besides, when everyone is transferred to the central level, where will the future of grassroots healthcare go?

Primary health care will increasingly have no patients and its expertise will gradually decline, eventually leading to its elimination. Meanwhile, the upper level will gradually become overloaded and unable to serve patients. “Because it is impossible for a doctor to examine thousands of patients in one day,” Mr. Thuc stated.

Therefore, the Director of Cho Ray Hospital believes that eliminating referral papers will only benefit an individual, for a certain period of time, but will cause many consequences, and the healthcare system will be paralyzed in the long term.

Must create trust for people

So what is the solution so that patients no longer have to ask for referral papers, to avoid overloading upper-level medical facilities, and to prevent patients from rushing to upper-level facilities just because they are sick?

Mr. Thuc believes that the fundamental solution is that lower-level healthcare must ensure expertise and create trust among the people. When people have trust in the grassroots healthcare, they will not have to go anywhere. Building trust requires a long-term process.

Dialogue - Abolishing the medical examination and treatment system will disrupt the health system in the long run (Figure 2). — The fundamental solution is that lower-level healthcare must ensure expertise and create trust among the people (Photo: Pham Tung).

“I have proposed many times that we should transfer the upper level medical staff to the lower level. Doctors from the central level rotate to the provincial level, provincial level rotate to the district level, district level rotate to the commune level, commune level rotate back to the upper level to study, creating a cycle. And there will be no need to worry about insufficient medical staff,” Mr. Thuc added.

When the circle rotates evenly, there will always be enough skilled and qualified medical staff, creating trust for the people. At that time, people will go to the grassroots medical facilities.

Admitting that grassroots healthcare lacks human resources and offers inadequate incentives, Mr. Thuc believes that the healthcare sector alone cannot solve these problems.

Therefore, rotating doctors from higher levels to lower levels, on the one hand, transfers techniques and knowledge to colleagues, and on the other hand, allows doctors to learn a lot of knowledge that can only be obtained at the grassroots level.

“A 6-month rotation is not too long, does not affect a person's career, is very good for society, for the people, why don't we do it?”, Mr. Thuc wondered.

Improve conditions and quality of medical examination and treatment

Speaking in the National Assembly lobby, National Assembly Deputy Nguyen Anh Tri (Hanoi delegation) said: "I have said many times that this type of paper issuance needs to stop. We must move towards patients being able to choose where they want to receive medical examination and treatment."

According to Mr. Tri, except for issues that exceed the scope and require expert opinions, upper-level hospitals need to receive information about professional issues to continue treating patients, not to do administrative procedures to go to higher-level hospitals.

However, Mr. Tri also emphasized that with the current information technology conditions, patients do not need to request a referral, information is still updated. Doctors at lower levels can update information and then transfer it to higher levels by computer, mobile phone... Doctors at higher levels can grasp the patient's information.

Not only data, information but also X-ray images of the patient. Therefore, these are things that must be done to avoid inconvenience and hassle for the patient.

Regarding concerns that if the procedure for transferring patients to higher levels for examination and treatment is canceled, there will be a risk of patients being transferred to higher levels for examination and treatment, Mr. Tri said that this is a constant worry.

"For this reason, there is a regulation that people must register for initial medical examination and treatment. This is correct, but from a vision perspective, I think this is a crude management method that is no longer appropriate. Thus, it is using administrative measures to prevent patients from transferring to other facilities," Mr. Tri analyzed.

"Why do all medical facilities have to improve their professional qualifications, have good doctors, and have reasonable prices... so that people can go to the nearest and most convenient place for medical examination and treatment, without having to go to a higher level?" Mr. Tri asked.

At the same time, it is believed that if the improvement of qualifications, conditions and quality of medical examination and treatment at primary health care facilities is implemented, the problem of patients being transferred to other facilities will be solved .

Source