Broken arm, bought plaster cast from outside, is it covered by health insurance?

Patients have faced many difficulties in the past year due to a shortage of medicine and medical supplies - Photo: HA QUAN

On October 17, Tuoi Tre Online published an article "Broken arm, got a cast under health insurance but ran out of cast, what did the hospital say?".

In it, a reader reported, "Last September, my child unfortunately broke his leg. I took him to a hospital in Hanoi for examination and treatment. After examination and X-rays, the doctor ordered that my child's leg be put in a cast.

However, the doctor said the hospital was out of plaster cast so he instructed me to go to the hospital pharmacy to buy plaster cast for the doctor to apply. The reason the hospital said was that the insurance drug was temporarily out of stock!"

The cost of the cast has been included in the price of the technical service of casting.

Many readers wonder if gypsum powder is covered by health insurance?

Reader Parent said: "My child also had a cast put on, but the hospital said the cast was not covered by insurance and had to be paid for separately."

"The Ministry of Health needs to review which drugs and supplies should be included in the health insurance payment list. It is unreasonable that plaster casts are not covered by health insurance" - reader Tu Sai Gon commented.

Speaking with Tuoi Tre Online , the leader of Hanoi Social Insurance said that according to Circular 22/2023 of the Ministry of Health, the price of medical examination and treatment services under health insurance is unified among hospitals of the same rank nationwide.

Technical services such as molding and plastering have specific prices and do not include the note “not included…”. That is, the cost of plastering has been included in the price of the technical service for plastering.

"We have asked this hospital to report the current situation and causes of the shortage of medical supplies, including powder used in technical services related to plastering at the hospital," said the leader of Hanoi Social Insurance.

The social insurance agency also requested local hospitals to review and urgently purchase and bid for the supply of drugs and medical supplies for medical examination and treatment. If necessary, hospitals shall purchase in accordance with the provisions of Clause 4, Article 23 of the Bidding Law No. 22/2023.

Specifically, for bidding packages, the procurement content does not exceed 50 million VND, the head of the purchasing agency or unit can decide as long as it ensures savings, efficiency and self-responsibility.

Thus, with these packages, hospitals do not have to prepare, appraise, approve contractor selection plans, bid package estimates, nor sign contracts with suppliers. However, the above hospitals must ensure full invoices and supporting documents.

This is a bid package used in urgent situations that hospitals can use to meet the treatment needs of health insurance participants, ensuring the rights of patients.

Gypsum powder is covered by health insurance, fiberglass powder is not yet.

The leader of the Department of Health Insurance (Ministry of Health) said that there is still a local shortage of drugs in some hospitals.

Regarding the level of health insurance payment for broken bone plaster, the leader of the Health Insurance Department said that the list of drugs and supplies covered by health insurance has been clearly stated. Of which, some types of plaster are included in the list of health insurance payment, some types of plaster have not been added to the list.

According to Tuoi Tre Online 's research, this list clearly states that the cost of straightening and applying plaster casts for broken bones, including solid plasters and self-rolling plasters, will be covered by direct costs and salaries.

In particular, direct costs included in the technical service price include costs for clothes, hats, masks, sheets, pillows, mattresses, mats, fabrics; stationery; medicine, infusion, chemicals, consumables, replacement materials used in the process of performing technical services...

For broken bones, the specific payment level is specified for each part such as broken arm, forearm...

Currently, plaster cast used in fracture casts is covered by health insurance. Fiberglass and plastic casts are not yet covered by health insurance.

The leader of the Health Insurance Department also said that he has asked hospitals to clearly understand the list of health insurance payments to ensure appropriate advice, treatment and patient rights.

"The Ministry of Health has also issued many documents directing hospitals to ensure the supply of drugs for examination and treatment for health insurance participants. However, there are also some objective reasons leading to drug shortages, such as supply disruptions, incomplete procurement procedures...

Recently, the Ministry of Health has also issued many solutions to ensure the rights of health insurance participants.

Most recently, the Ministry of Health has issued a circular guiding direct payment when patients have to buy medicine and medical supplies themselves. In addition, the draft revised Law on Health Insurance also adds regulations on drug rotation at medical facilities.

These are temporary solutions expected to address the shortage of drugs and supplies in hospitals.

It is expected that on January 1, 2025, insurance participants will be paid directly by the social insurance agency. With this regulation, hospitals will not abuse the regulation of ordering people to buy medicine and supplies themselves, but must prove that the lack of medicine and supplies is due to objective reasons.

Patients will be paid health insurance benefits if hospitals cannot meet their needs for medicine and supplies during treatment," said the leader of the Health Insurance Department.

Source: https://tuoitre.vn/gay-tay-tu-mua-bot-ben-ngoai-de-bo-bot-thach-cao-co-nam-trong-danh-muc-bao-hiem-y-te-chi-tra-20241022095302702.htm