Has the quality of medical examination and treatment improved?

Although the increase in medical examination and treatment fees is not considered to significantly affect the public, patients hope that increased hospital fees will also lead to improved quality of medical care, sufficient supply of medicines and medical supplies, and the protection of their health insurance rights.

Many hospitals are increasing the cost of medical examinations and treatments.

Recently, the Ministry of Health issued Circular 21/2024/TT-BYT regulating the method of pricing medical examination and treatment services and adjusting medical examination and treatment prices according to the basic salary level stipulated in Decree 73/2024/NĐ-CP. From now until December 31, 2024, medical examination and treatment facilities must implement the approval of medical examination and treatment prices in accordance with the authority stipulated in the Law on Medical Examination and Treatment.

Going through the procedures for medical examination and treatment at Hanoi Children's Hospital. Photo: Thanh Hai

The Ministry of Health announced that the base salary increased from 1.8 million VND to 2.34 million VND effective July 1st, therefore, medical facilities are adjusting their medical examination and treatment prices accordingly. To date, the Ministry of Health has approved medical examination and treatment prices for 25 hospitals based on the new base salary. The price adjustment only reflects the salary component from the base salary; the co-payment portion (at 20% and 5%) has not increased significantly.

To date, at hospitals such as Bach Mai, Agricultural General Hospital, Central Dermatology Hospital, Central Hematology and Blood Transfusion Hospital, Central Tropical Diseases Hospital, and Cho Ray Hospital (Ho Chi Minh City)... the consultation fee has been adjusted from 42,100 VND to 50,600 VND per visit. The cost of intensive care unit beds at special-grade hospitals has increased from 509,400 VND to 599,400 VND per bed per day, and type 1 beds from 273,100 VND to 327,100 VND per visit per day. The cost of consultations to determine difficult cases (expert/case, only applicable when inviting experts from other units to consult at the medical facility) remains unchanged at 200,000 VND per visit.

On the other hand, hospitals also adjusted thousands of technical services. At Bach Mai Hospital, nearly 10,000 technical service prices were adjusted... The National Institute of Hematology and Blood Transfusion adjusted over 1,000 technical items. Similarly, Cho Ray Hospital (Ho Chi Minh City) adjusted over 6,000 technical service prices, including those for anesthesia (excluding medication costs). Thong Nhat Hospital (Ho Chi Minh City) adjusted over 7,000 services.

 

The amended and supplemented Law on Health Insurance, passed by the National Assembly, contains many outstanding new points that bring benefits and convenience to health insurance participants. In particular, the Law stipulates that the Ministry of Health assesses the reasonableness of health insurance-covered medical examination and treatment services. This serves as the basis for the Vietnam Social Security sector to carry out health insurance audits…
Deputy Director General of Vietnam Social Security Nguyen Duc Hoa

It can be seen that when medical examination and treatment costs increase in line with the base salary, it will help hospitals generate revenue. Regarding the impact on the people, the Ministry of Health assesses that this adjustment will not significantly affect them. According to the Ministry of Health, the health insurance fund is capable of balancing this price adjustment. This is due to the difference between the annual revenue and expenditure of the health insurance fund (cumulative surplus in 2023), and the increase in health insurance fund revenue due to the adjustment of the base salary usually occurs earlier than the adjustment of medical examination and treatment service prices.

Regarding those participating in health insurance, the Ministry of Health stated that the poor, ethnic minorities, and those eligible for social welfare policies are 100% covered by health insurance and therefore will not be affected. Those who have to co-pay at a rate of 20% or 5% (meaning health insurance covers 80-95%) will find the additional co-payment amount to be minimal and manageable, as their incomes have also increased in line with the basic salary.

How are people without health insurance cards affected?

With medical examination and treatment costs increasing in line with the basic salary, many people are concerned about the quality of healthcare services; the financial burden of medical care when sick will become even heavier. Many opinions suggest that the increase in medical service prices based on the basic salary will significantly affect the people.

Provincial and district-level hospitals are less affected because most patients have health insurance. However, most patients (unless they are extremely poor) usually seek private medical services at central-level hospitals, where the costs are very high. Using health insurance outside their designated area might reduce the cost, but sometimes the examination can take two days, adding to the additional expenses for accommodation and meals.

Regarding this issue, Ms. Tran Thi Trang, Director of the Health Insurance Department of the Ministry of Health, stated that no country lacks a referral mechanism. If patients with minor illnesses continue to seek treatment at higher-level facilities on their own, it will lead to overcrowding. Therefore, if patients with common illnesses, serious illnesses, and life-threatening diseases all bypass these higher-level facilities, they will ultimately be negatively impacted.

This situation will inadvertently reduce the quality of treatment due to higher risks of complications and adverse events. Furthermore, even minor illnesses are referred to higher-level hospitals, wasting patients' time and increasing social costs, travel expenses, and ultimately increasing the burden on the health insurance fund.

Currently, service quality is a vital issue for hospitals. Therefore, hospitals affirm that, regardless of price increases, they will always improve the quality of medical examination and treatment services to meet patient satisfaction. According to experts, increasing medical examination and treatment service prices in line with the basic salary is a driving force for rapidly expanding universal health insurance coverage.

However, whether the increase in medical service prices will lead to an increase in the number of people participating in health insurance depends on the efforts of the authorities and the people. In reality, the current health insurance coverage rate in our country is over 93%, with the remaining group without health insurance cards (about 7-8% of the population) only affected by the portion of payment based on the price of medical services. Therefore, the Ministry of Health encourages people to actively participate in health insurance to enjoy more benefits when receiving medical treatment.

Minister of Health Dao Hong Lan emphasized that adjusting health insurance prices is not an increase in individual costs but depends on the adjustment of the basic salary. Currently, the Government has adjusted the basic salary by 30%, leading to an increase in health insurance contributions for most groups. This also serves as the basis for the Ministry of Health to adjust medical service prices to ensure they are calculated accurately and comprehensively, contributing to improving the quality of medical services.

Previously, many hospitals argued that a "proper and comprehensive" pricing structure for medical examination and treatment services was necessary to provide hospitals with the resources to invest in improving hospital quality. Associate Professor Dr. Dao Xuan Co, Director of Bach Mai Hospital, stated that on average, the hospital examines and treats approximately 6,000-8,000 patients per day, and sometimes even more than 8,000 patients.

The cost included in the price of medical examination and treatment services comprises seven factors. However, currently, most hospitals only include four out of seven components; costs such as infrastructure depreciation, equipment depreciation, major repairs, fixed asset depreciation, asset maintenance, and costs for training, scientific research, and management are not included in the price of medical examination and treatment services.

At Bach Mai Hospital, the new medical service prices only account for 4 out of 7 factors. Most services at the hospital are currently charged according to the health insurance rates established nearly 20 years ago, which are now outdated. For example, an ultrasound service currently costs 49,500 VND at the hospital, but other facilities that use a pricing structure that includes all factors charge between 200,000 and 300,000 VND…

This shows that, along with providing good regular medical examination and treatment, when public hospitals provide good on-demand medical services, some people will not have to go abroad for treatment, saving resources for the people and the country. The Ministry of Health also believes that when hospital fees are calculated correctly and fully, hospitals will have the resources to invest in equipment and infrastructure, and improve the quality of medical services. Accurately calculated hospital fees will gradually reduce out-of-pocket expenses for the people.

 

The increase in medical examination and treatment service fees based on the basic salary is essentially acceptable. With an 80% reimbursement rate and a 20% co-payment, a hospital bed costing approximately 270,000 VND would cost patients 54,000 VND; when it increases to 327,000 VND, people would have to pay more than 65,000 VND, an increase of over 10,000 VND.

However, it is crucial to ensure an adequate supply of medicines and medical supplies for treatment. Recently, when receiving treatment at K Hospital, patients still had to buy medicines and supplies outside the hospital even though these services were covered by health insurance. Therefore, it is important that when increasing health insurance contributions and hospital fees, the rights of health insurance participants are protected.

Ms. Nguyen Huong Giang (47 years old, Bac Tu Liem district, Hanoi)

Source: https://kinhtedothi.vn/hang-nghin-dich-vu-y-te-tang-gia-chat-luong-kham-chua-benh-co-tang.html