On the morning of November 20, during the National Assembly's discussion in the hall on the results of supervising the settlement of voters' petitions sent to the 5th session of the 15th National Assembly, Deputy Nguyen Anh Tri (Hanoi), former Director of the Central Institute of Hematology and Blood Transfusion, made a remarkable statement on the issue of medical examination and treatment for people. The Deputy proposed to abolish hospital transfer papers to ease the suffering of patients; to abolish the list of drugs covered by health insurance.
“The list of drugs and medical supplies must be decided by doctors and the medical industry. If the patient uses any drug or treatment, and it is correct and effective, then health insurance must pay for it. Please do not have a list of drugs paid for by health insurance anymore,” the delegate said.
Explaining again, Minister of Health Dao Hong Lan said that the problem of solving hospital overload has been explained by many generations of Ministers of Health.
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Minister of Health Dao Hong Lan speaks at the meeting on the morning of November 20. Photo: QUANG PHUC |
With the Law on Medical Examination and Treatment, the old law stipulates that medical examination and treatment are divided into 4 levels, while the new law divides it into 3 levels, clearly stating the conditions for which level is allowed to examine and treat at which level, based on the ability of the facility and the patient's condition. Since 2014, the transfer from lower to higher levels had to be sequential, but by 2016, the district level was connected and by 2021, the provincial hospital inpatient health insurance line nationwide was connected (people with health insurance cards who receive inpatient treatment outside the provincial hospital system nationwide will enjoy the same benefits as the correct hospital system).
The Minister said that the transfer of facilities to facilitate people has been basically resolved, the remaining issue is whether people can go directly from district and provincial levels to the central level or not. The Minister of Health affirmed that the transfer of facilities must ensure that it meets the people's medical examination and treatment needs and the medical examination and treatment capacity of each level, avoiding overload when going to higher levels.
Currently, referrals are divided into two streams: from lower-level to higher-level facilities if the facility cannot meet the medical examination and treatment needs of the people; and from higher-level to lower-level facilities when the illness is stable, ensuring long-term treatment.
However, to reduce administrative procedures, the Ministry of Health will accept and is focusing on using electronic referrals to relieve difficulties for people.
Directly answering the question "Can we abolish referral papers?", the Minister of Health emphasized the role of referral papers very specifically, stating clearly the condition, treatment history as well as medical records, whether paper or electronic, is very necessary. The Ministry of Health is researching the use of electronic referral papers and electronic medical records to reduce procedures for patients.
Regarding drugs covered by health insurance, Minister Dao Hong Lan said that the list of health insurance drugs is regularly updated. In 2024, the Ministry of Health will issue a circular to update this list, ensuring enough drugs to meet the treatment needs of the people and to manage the health insurance fund. Vietnam is considered one of the countries with the best list of health insurance drugs provided to patients.
Delegate Nguyen Huu Thong (Binh Thuan) pointed out the current situation during the Covid-19 outbreak, units that borrowed goods, medical supplies, and disinfectants from suppliers and private enterprises have not yet paid due to procedural problems. The delegate requested the Government and the Ministry of Health to provide guidance soon. This is also the issue raised by Delegate Nguyen Lan Hieu (Binh Dinh), Director of Hanoi Medical University Hospital.
Explaining again, Minister Dao Hong Lan said that in the regulations on procurement and bidding, there are no regulations on borrowing, but in the context of an unprecedented epidemic, ensuring people's lives is above all and first of all, so in reality, there are advances and borrowings to ensure the needs for medical treatment and testing. Resolution 99 of the National Assembly assigned the Government to promptly take measures for this issue before December 31, 2024, but this is a difficult task, the Ministry of Health is coordinating with the People's Committees of provinces and cities to implement. The Ministry of Health has issued 2 official dispatches requesting localities to report on the borrowing situation.
Synthesis from 48 localities and 7 ministries and branches shows that the amount of borrowing is about 1,693 billion VND, of which 754 billion VND is borrowed for drugs and biological products, and 939 billion VND is borrowed for test kits. From there, the Ministry of Health classifies the forms of borrowing, such as whether there is a contract or not, whether there is a price negotiation or not... to have a thorough handling plan. The Ministry is currently assigning units to develop a plan.
“Because there are no legal regulations, the Government will report to the National Assembly Standing Committee for a handling mechanism to remove difficulties for hospitals,” said the Minister of Health, emphasizing that the revised Law on Medical Examination and Treatment has included the form of borrowing and advance payment of medical equipment and supplies, and units are providing detailed instructions for this for long-term implementation.
Regarding the shortage of drugs and medical supplies in some medical facilities that many delegates are concerned about, Minister of Health Dao Hong Lan said that recently, the National Assembly and the Government have supported the removal of mechanisms and policies to ensure the procurement of drugs and supplies. The Minister cited that while other fields require 3 quotations, with drugs and medical supplies, sometimes only 1 quotation is needed; in necessary cases, not the lowest price can still be purchased if clarified by the scientific council. Or the Law on Bidding (amended) has many specific procurement mechanisms. The National Assembly's Resolution also removes obstacles to the supply of drugs and medical equipment.
The Minister said that currently, the problems related to supply sources and policy mechanisms have been resolved, however, there are still problems when many officials at the grassroots level are still confused about the implementation of bidding, the decentralization of authority at the local level is still inadequate, not ensuring the shortening of procedures, leading to a prolonged time. In fact, at the local level, many establishments assign bidding units but the officials directly implementing the bidding are doctors, not clear about the procurement mechanism, so the process is still confusing. Then there is the issue of decentralization and delegation of authority, such as the Ministry of Health decentralizing all procurement to units within the ministry.
Meanwhile, some localities have decentralized units to purchase up to 100 million VND, if higher, they must submit to the Department of Finance and the province for approval, which takes longer. Therefore, the Minister suggested that the People's Committees of provinces and cities review to ensure management but still give initiative to the facilities and units in the implementation process.
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