The price list of medical examination and treatment services is made public for patients to refer to at the University of Medicine and Pharmacy Hospital in Ho Chi Minh City, on the morning of March 18 - Photo: TU TRUNG
According to the provisions of the Law on Medical Examination and Treatment, from 2024, the total cost of medical examination and treatment services will include 4 components: labor; direct costs; depreciation costs of medical equipment, fixed assets and management costs.
Most new hospitals are calculated for labor costs and direct costs, the other two components are not calculated.
Mr. Bui Minh Trang (Director of Ho Chi Minh City Heart Institute)
Medical service prices will increase by about 30%?
It is expected that from July 2024, labor costs, direct costs, and management costs will have to be fully included in the price of medical examination and treatment services. Thus, management costs (including maintenance and repair of medical equipment, fixed assets, environmental protection costs, infection control, training costs, scientific research costs, quality management costs, etc.) will be included in the price of medical services.
The Ministry of Health assesses that the adjustment of hospital fees will also be balanced with people's ability to pay, harmonizing the interests of service providers and users, the timing factor as well as the Government's roadmap. In order to be able to correctly calculate the full cost components of medical examination and treatment services, the Ministry of Health has developed technical and economic norms for medical examination and treatment.
Previously, the Ministry of Health informed that this norm would be completed in the third quarter of 2023 for submission to all levels for consideration, and is expected to be applied from 2024 when the revised Law on Medical Examination and Treatment officially takes effect. However, this progress has been delayed.
Most recently, the Ministry of Health informed that it is building a new price list of 10,000 medical services in the direction of calculating correctly and fully, and in March will issue technical economic norms as the basis for calculating prices.
Speaking with Tuoi Tre, Mr. Nguyen Ba Viet, Director of Quang Ninh General Hospital, shared that he is looking forward to the guidance on technical economic norms in the direction of calculating correctly and sufficiently that the Ministry of Health is building. According to Mr. Viet, the Ministry of Health has recently coordinated with hospitals to build prices according to the technical list and the hospital has also participated.
Issuing prices in the direction of correct and sufficient calculation is a legal corridor for hospitals to follow regulations to calculate hospital fees, especially prices for services and medical examination and treatment upon request.
According to Mr. Viet, if all the components of the medical service price structure (4 components) are taken into account, the services will increase by about 30%. However, calculating the correct price is not easy. Therefore, the hospital is also waiting and hoping that it will be more convenient to build prices for these medical categories.
"Calculating the full components will include management costs, asset depreciation, scientific research, and information technology. Human costs are based on the salary level set by the Government, which is not difficult to build.
However, maintenance and depreciation of machinery will have to be calculated very carefully. For machinery with high value, depreciation and maintenance costs will be higher... Therefore, there will be a big difference in the categories after calculating correctly and fully," said Mr. Viet.
Mr. Phan Van Bau (Director of People's Hospital 115)
Specialist Doctor 2 Nguyen Thanh Huy (examination department, Ho Chi Minh City Heart Hospital) reads the results to the patient on the afternoon of March 18 - Photo: PHUONG QUYEN
Will it be applied from the end of 2024?
Speaking at the annual meeting of the Northern Regional Hospital Directors Club last weekend, Ms. Doan Thi Kim Dung - Department of Price Management, Ministry of Finance - shared how to calculate hospital fees "correctly and fully" according to the new Law on Medical Examination and Treatment, which will take effect from July 1, 2024.
The new method of calculating hospital fees will be applied according to the provisions of the current Law on Medical Examination and Treatment and the Law on Prices. Four groups of costs used to calculate prices include labor (salaries, wages appropriate to the type of service provided); direct costs used for medical examination and treatment (blood, medicine, infusion, medical supplies); equipment depreciation and management costs.
Accordingly, Ms. Dung said that management costs are the latest component of medical service prices that will be added to hospital fees this time, in the direction of calculating the full service price. With the addition of management costs, the new hospital fees will be calculated based on 3/4 of the components that make up the service price, with only fixed asset depreciation costs being included later.
The management costs include the costs for information technology that have not been previously included. However, the adjustment of hospital fees will also be balanced with people's ability to pay, harmonizing the interests of service providers and users, the timing factor as well as the Government's roadmap.
According to Tuoi Tre's research, the Ministry of Health is building a new price list for 10,000 medical services in the direction of calculating correctly and fully with 3/4 of the above components. In March 2024, the Ministry will issue technical economic norms as the basis for price calculation.
Speaking with Tuoi Tre, an expert from the Ministry of Health said that according to the new method of calculating service prices, 3/4 of the components, the new price will increase by about 5% compared to the current price.
Around July, a draft of the new price will be submitted to apply around the end of 2024. With the new price, this expert believes that the health insurance fund is capable of balancing it, but adding a fourth factor, fixed asset depreciation costs, to hospital fees still requires a roadmap because the fund with a collection rate of 4.5% of basic salary cannot compensate.
"Over 93% of people have health insurance, the new way of calculating hospital fees has a notable point that the health insurance portion paid to the hospital will be more accurate and sufficient, the hospital will increase its revenue to pay salaries for doctors and nurses and improve service quality. The portion that patients have to pay together (5-20% of service fees) will also increase, but will be at 5% of this 5-20%," he said.
In fact, the current cost of medical examination and treatment is only calculated correctly but not fully. The reconstruction of a new price list for 10,000 medical services by the Ministry of Health is expected, but it should be noted that the components that create this price are not yet complete.
Mr. Pham Thanh Viet (Deputy Director of Cho Ray Hospital)
People receive medical examination and treatment at the Ho Chi Minh City Orthopedic Hospital - Photo: DUYEN PHAN
Not calculating all costs correctly
From July 1, 2023, the adjustment of medical examination and treatment service prices will be implemented according to the basic salary (the basic salary increases from 1.49 million to 1.8 million VND/month).
According to Circular 22 of the Ministry of Health, effective from November 2023, regulating the prices of medical examination and treatment services under health insurance (HI), more than 1,900 price lists for medical examination and consultation services have been adjusted to increase by about 9% compared to the level issued in 2019. In particular, the consultation price to determine difficult cases performed by experts remains at 200,000 VND/case.
The price of hospital bed services increased by about 10 - 14%, technical and testing services mostly increased slightly by about 1 - 4% compared to the previous price, some services increased by up to 10% (such as ultrasound).
Hospitals assess that the increase in health insurance examination and treatment prices only meets the salary payment for civil servants when the basic salary increases. Over many years, hospital fees have not been calculated correctly and sufficiently to meet the needs of hospitals.
According to current regulations of the Ministry of Health, hospital fees paid by health insurance only include 4/7 elements of service price structure (not including management costs, asset depreciation, training and scientific research, information technology...).
Meanwhile, the cost of medicine, consumables, goods, salaries, wages... increases every year due to rising market prices, but medical service prices cannot be adjusted in time, thus affecting the revenue and expenditure balance of hospitals.
A hospital leader in Hanoi shared that with the current hospital fee calculation, it is difficult for hospitals to develop infrastructure investment and train high-quality human resources. "Although the plan was to calculate the full price of medical services in 2018, the hospital is still waiting for 2024," he said.
Will serve patients better?
According to the Ministry of Health, when hospital fees are calculated correctly and fully, hospitals will have resources to invest in equipment, infrastructure, and improve the quality of medical examination and treatment services. Patients will also be fully paid by health insurance, instead of having to pay for the depreciation of infrastructure and hospital management as is currently the case. Correctly and fully calculated hospital fees will gradually reduce out-of-pocket expenses from people.
Some hospital leaders also said that the positive impact of calculating the full price of medical services has been talked about a lot. Hospitals have more resources and expenses to improve medical care services, invest in infrastructure and medical equipment to serve the needs of the people.
Speaking to Tuoi Tre, Mr. Dao Xuan Co, director of Bach Mai Hospital, affirmed that if hospital fees are calculated correctly and sufficiently, the quality of services will certainly improve because the hospital has investment resources for facilities, equipment and medical staff. Of course, due to the ability to balance the fund and the people's payment, this adjustment will have a roadmap.
"Investing in better information technology will help manage medical examination and treatment better, making it more convenient for patients. Connecting medical facilities will help connect test and imaging results, saving costs. Better hospital data can also connect with medical facilities abroad to improve the quality of treatment," Mr. Co shared.
According to Mr. Co, hospitals in other countries are investing 1-3% of their revenue in information technology, while previously hospital fees in Vietnam did not include this part. In the upcoming hospital fee structure, there will be an investment in information technology of hospitals.
However, a hospital leader in Hanoi expressed concern about urban areas that have invested in infrastructure and expensive machinery with large depreciation costs. If the full cost is calculated, hospital fees will be very high. Therefore, according to this person, it is necessary to calculate carefully and have specific regulations and price frames for regions.
"However, we still have to wait for detailed instructions on regulations and how to build new prices to have a basis for implementation and gradually overcome any problems," he said.
Have better conditions to serve patients
In 2024, the price of medical services/hospital bed will increase. In the photo: a doctor performs an ultrasound on a patient right on the bed at a hospital in Ho Chi Minh City - Photo: TU TRUNG
Talking to Tuoi Tre, several hospital directors in Ho Chi Minh City all expressed their "impatient" attitude towards the process of calculating the full price of medical services and they shared the wish that these fees be applied "as soon as possible".
Mr. Phan Van Bau - Director of People's Hospital 115 - said that calculating the full price of medical services will create conditions for hospitals to have surplus funds to reinvest in facilities, equipment, high technology, training, international cooperation and attracting human resources.
"All of this ultimately benefits the patient. One thing that is very important is that social policy must go hand in hand with ensuring people's payment sources by supporting insurance payments, especially for low-income patients, when applied at a fully calculated price," said Mr. Bau.
Mr. Bui Minh Trang - Director of the Ho Chi Minh City Heart Institute - said that the cost of information technology has just been included in the management fee by the Ministry of Health, but in fact it is appropriate to classify it as the cost of medical examination and treatment. Because information technology today has participated in each specific case when managing medical records, imaging, and hospital payment.
"Just for cashless payments (card swiping), we have to pay the bank nearly 1 billion VND per year. This is an invisible cost that cannot be asked to be paid by the patient, the hospital has to bear the loss and balance it itself" - Mr. Trang said.
And to maintain the operation of a hospital, according to him, management costs are increasing day by day. In addition to information technology, there are a series of costs that can be classified as management costs such as security, hospital hygiene, record keeping, and sending staff to training to improve the process and quality of medical examination and treatment...
"Management costs are actually of many types, not just information technology, and are often invisible rather than tangible like some other types of costs. If these costs are not calculated correctly and sufficiently, it will be very difficult for the hospital. The fear of investing and patchwork investment will cause development to fall into a vicious cycle," Mr. Trang analyzed.
However, with the adjustment roadmap from the Ministry of Health, according to Mr. Trang, even though only a few services are calculated according to the Law on Prices, in the current context "it is already great", and cannot be compared to the price of the market mechanism.
"When calculated correctly and sufficiently, it will help hospitals improve the quality of many types of services, thereby serving patients better. And when calculated correctly and sufficiently, if a unit is bad, it will no longer be blamed on the mechanism," Mr. Trang emphasized.
As a special-grade end-of-line general hospital in the Southern region, Cho Ray Hospital has repeatedly expressed its desire for medical services to be calculated correctly and adequately. Mr. Pham Thanh Viet - Deputy Director of Cho Ray Hospital - affirmed that it is necessary to understand that calculating correctly and adequately does not mean increasing hospital fees.
This is essentially adjusting hospital fees to be reasonable with the expenses that the hospital spends to maintain its operations but has not been included in the price of medical examination and treatment services. "In reality, the current medical examination and treatment costs are only calculated correctly but not fully" - Mr. Viet affirmed.
According to Mr. Viet, the revenue from patients is only a part of the hospital fees, which means that the revenue is negative. Therefore, paying for other services depends on the hospital's revenue, which means having to "cut" a part of the staff's money. Not to mention that there are some cases where patients (outside the scope of insurance) are hospitalized but do not have money to pay the hospital fees, the hospital is also having to "bear" by mobilizing support from benefactors.
"The reconstruction of a new price list for 10,000 medical services by the Ministry of Health is expected, but it should be noted that the components that create this price are not yet complete. For example, the regulation that the amount of medicine purchased is sold to the patient, but behind that are a series of costs incurred for bidding, human resources, packaging, stationery, storage, waste...", Mr. Viet said.
Don't be too perfectionist!
According to Mr. Viet, the hospital has not yet collected information technology costs, while it has to spend a lot of money on buying computers, software and management. This is causing difficulties for hospitals, the investment costs are more than the revenue.
Therefore, Mr. Viet proposed that there should be standard regulations on how to calculate fees in order to build a suitable price structure for each type of service. "When building a price structure, in my opinion, we should not be too perfectionist and issue any additional structure immediately, rather than not having any. Whatever is good for the hospital is what we get" - Mr. Viet said.
Source
Comment (0)