Minister Dao Hong Lan: Unlimited health insurance drugs are cheap or expensive?

According to Minister of Health Dao Hong Lan, the choice of finished drugs covered by the Health Insurance Fund is not limited by type, cheap or expensive, domestic or foreign.

"Medicines selected for health insurance payment are based on disease models, patient needs and the fund's ability to pay," Ms. Lan said when explaining at the socio-economic discussion session at the National Assembly on the morning of November 1.

Health sector leaders said that from 2014 to now, the Ministry has updated the list of health insurance drugs five times; reviewed the current list to eliminate low-efficiency drugs; and assessed the ability to balance the health insurance fund. Vietnam is considered one of the few countries with a relatively complete list of drugs with more than 1,000 active ingredients, and not all newly invented drugs are automatically included in the list of health insurance drugs.

Poland admits that the shortage of drugs and medical supplies is not new, occurring in many countries and is especially serious after the Covid pandemic. The drugs in shortage are mainly used for the nervous system, cardiovascular system, anti-infective, anti-cancer, anti-toxic, digestive, vaccines and drugs made from human plasma and blood.

The main reasons are the scarcity of raw materials and active ingredients used for production, fluctuating prices, inflation, energy crisis; supply chain disruptions due to military conflicts, and high input costs. Companies lack motivation to produce drugs because they bring in little profit.

According to Minister Lan, drug bidding is currently carried out at all three levels: central, local and medical facilities. The shortage of drugs and medical supplies is due to the inadequate document system, difficulties in organizing procurement and bidding, untimely coordination, and some places still have a mentality of apprehension and fear of making mistakes.

Minister of Health Dao Hong Lan explains the problem of drug shortage — Minister of Health Dao Hong Lan explained the issue of concern to delegates on the morning of November 1. Video: *National Assembly Television*

The Ministry of Health has proposed that the Government submit to the National Assembly amendments to the provisions in the Law on Bidding, the Law on Prices, the Law on Medical Examination and Treatment, and resolutions of the National Assembly and circulars of ministries and branches to create a legal corridor. "The amended Law on Bidding, effective from January 1, 2024, will remove many obstacles in ensuring the supply and procurement of drugs and medical equipment," said Ms. Lan.

Previously, delegate Nguyen Lan Hieu (Director of Hanoi Medical University Hospital) said that the current difficulty of hospitals is not being able to buy good quality products and develop new techniques. Many medical supply companies are willing to change product information and invite low-priced bids to get through the narrow door to win bids at hospitals. Buying and selling medical supplies is "very confusing" with too many legal regulations, making it difficult to make purchasing decisions that meet the regulations of many ministries and branches.

To prevent this situation, Dr. Lan Hieu proposed solutions to promote warranty criteria, technology transfer, and grouping when bidding for medical supplies. Only good quality companies will accept warranty and maintenance for up to 5 years with training and transfer conditions. If these criteria are specified in specific documents, it will be very helpful for the medical industry.

Director of Hanoi Medical University Hospital Nguyen Lan Hieu spoke on the morning of November 1. Photo: National Assembly Media — Director of Hanoi Medical University Hospital Nguyen Lan Hieu spoke on the morning of November 1. Photo: *National Assembly Media*

The Director of Hanoi Medical University Hospital also pointed out the current situation that for many years now, the licensing of import and use of new instruments in Vietnam has been at a standstill. "I myself have had to take patients abroad for treatment because there are no imported instruments. Big companies, seeing the regulations on procedures and time to get a license, all shook their heads in dismay and even withdrew from Vietnam," said Mr. Hieu.

According to Mr. Hieu, purchasing at provincial hospitals is even more difficult because of too many approval and inspection steps. Purchasing depends on the Department of Health, Finance, and Provincial People's Committee. Fear of responsibility leads to procrastination, files are left on the table without being read, and when the deadline is over, they find some small errors to return to the facility. Therefore, he proposed to assign the main purchasing responsibility to the user of the bidding product, giving the hospital the right and responsibility before the law and the patient.

The issue of lack of medicine and medical supplies was also raised by many delegates to the leaders of the health sector at the discussion session on the afternoon of October 31. Delegate Nguyen Thi Ngoc Xuan (Deputy Head of Binh Duong Delegation) suggested that the Government have a mechanism to refund the cost to people who have to buy medicine and medical supplies outside, even though these are on the list of items covered by health insurance.

Delegate Pham Khanh Phong Lan (Deputy Director of the Ho Chi Minh City Department of Health) said that this issue had been raised by delegates in previous sessions, but the Government's report was still sketchy about how to handle it. Updating the drug list for patients in Vietnam is also very slow compared to other countries. For example, Japan only takes about 3 months, France 15 months, South Korea 18 months, but Vietnam takes an average of 2 to 4 years to add a new drug to the health insurance drug list.

The female delegate said that this would deprive people of their rights to health insurance and requested clarification of the agency's responsibility in paying for the money people have to spend to buy medicine.

Son Ha

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