Health insurance should not be considered as a "barrier against overload" of upper-level hospitals.

According to delegate Nguyen Anh Tri, in recent years, health insurance has been used as an "overload barrier" at the upper level, but the effectiveness has not been high and regulations need to be revised to use health insurance appropriately.

Risk of health insurance fund bankruptcy if operating as before

On the afternoon of October 24, the National Assembly met in groups on two draft laws amending and supplementing a number of articles of the Law on Health Insurance (HI).

Having been a doctor for many years, delegate Nguyen Anh Tri ( Hanoi delegation) acknowledged that for more than 15 years, since the Law on Health Insurance was enacted, Health Insurance has done a lot of things. Among them, there are two very important things: contributing to medical examination and treatment for the people, especially for patients with serious illnesses.

Không nên coi bảo hiểm y tế là — Delegate Nguyen Anh Tri - Hanoi National Assembly Delegation.

"A patient of mine once shared that after discovering the disease, calculating the cost of treatment made the "five-story house shake", but thanks to health insurance, people in general, especially poor patients, can be treated," said delegate Tri.

Second, health insurance shows people that they need health insurance to feel secure. In the past, people often evaded and did not buy health insurance, but now it has gradually decreased. This is the foundation for amending the law this time.

However, after 15 years of implementation, the Law on Health Insurance has many shortcomings and needs to be amended and passed in one session.

The first drawback is the risk of the fund going bankrupt if it continues to operate as the old law does. "With the payment method of limited contributions but unlimited payments, it would be strange if the fund did not go bankrupt," said Mr. Tri.

Sharing about the shortcomings of route transfer, according to Mr. Tri, although there have been changes, there are still many problems.

"Health insurance has been used for many years as an "overload barrier" at the upper level, but as someone working in the health sector, I oppose this because the results are not high. The consequences are not small and the most important is inequality in health insurance benefits," Mr. Tri emphasized.

He gave an example of a commune-level hospital that prescribes about 100,000 VND of medicine, but at the central level, if a disease is detected, the unlimited prescription can be up to 30 million VND, Mr. Tri said, and said that this is unfair.

Therefore, delegate Tri said that this should not be considered as a measure to prevent overload, but to prevent overload by reorganizing the health system so that if people get sick, they can go to the fastest, most complete, and best medical facility possible, with good doctors and good medicine; fairness and equality in benefits; techniques used, and payment levels.

Fear of removing referral papers, specialized hospitals will collapse

Also giving his opinion on the issue of health insurance connection, delegate Nguyen Tri Thuc, Deputy Minister of Health, Director of Cho Ray Hospital, completely agreed with the nationwide connection, without limiting the area of health insurance participation, people with health insurance cards can see a doctor at a primary health facility (basic level) anywhere in the country, regardless of the place of initial medical examination and treatment registration and enjoy full health insurance benefits according to regulations.

Regarding the proposal to remove referral papers in health insurance, in his personal opinion and that of many hospital directors, Mr. Thuc believes that referral papers should only be removed when performing initial examinations at the grassroots level. However, when transferring from the initial level to the specialized level, a referral paper must always be required.

According to Mr. Thuc, if referral papers are removed, patients will flock to specialized hospitals for examination and treatment instead of going to primary, primary hospitals.

"Patients with health insurance everywhere are flocking to Cho Ray, Bach Mai, Viet Duc, and Central Hue... if so, in just 1-2 years the grassroots health system will be destroyed because there are no patients and no funds to cover costs. This will go against the policy of developing the grassroots health system," said Mr. Thuc.

Along with that, hospital managers are very concerned. For example, with a special surgery (lasting 6-8 hours), the hospital only allows one surgery per day, not a second one.

If the doctor performs a second surgery, the risk of complications for the patient is very high due to overexertion.

"Now if we remove the referral form, patients will flock to specialized facilities, then with such patient pressure, doctors will have to operate more than 1 case, there will be many risks. Or now a doctor examines 20 patients/day, if we remove the referral form, there could be up to 200 patients waiting, no doctor can handle it. It will be a mess", Mr. Nguyen Tri Thuc expressed his opinion.

Therefore, Mr. Thuc proposed to amend Clause 3, Article 27 and Clause 3, Article 28 of the draft Law.

Accordingly, when a patient transfers from one medical facility to another for medical examination and treatment, a referral letter is always required.

The referral form summarizes the patient's medical information: what disease, what medicine is being used. Therefore, this form is very important for doctors at specialized levels. This is an almost mandatory professional requirement and is beneficial to the patient.

Patients do not have the expertise or in-depth knowledge of medicine, so they cannot convey complete information to the doctors who examine them later. This also aims to facilitate state management of health care and health insurance.

Proposal to transfer drugs between medical facilities

Acknowledging the comments and contributions, Minister of Health Dao Hong Lan said: "This draft Law amending and supplementing a number of articles of the Law on Health Insurance aims to review existing problems in the implementation of the health insurance policy with the highest goal of making it most convenient for health insurance participants, creating conditions for full and timely health care for the people.

According to Ms. Lan, in addition to creating favorable conditions for people to receive timely medical examination and treatment, there must be adequate investment so that provincial, district and grassroots hospitals can meet technical requirements and perform medical examination and treatment tasks, avoiding people having to travel from local to central levels for medical examination and treatment.

Currently, the Ministry of Health has effectively implemented measures such as directing the frontline, sending doctors to difficult lower-level areas, remote medical examination and treatment policies, etc.

In addition, the Socio-Economic Recovery and Development Program also focuses on grassroots health facilities but has not yet met all needs.

Regarding drug transfer, ensuring medicine and medical supplies for people is a requirement for medical facilities.

Ms. Lan affirmed that in reality, all the bidding packages we participated in can be purchased immediately. For example, Duc Giang General Hospital reported that it was able to purchase 95% of the drugs, while 5% of the drugs could not be purchased.

To resolve the unavoidable situation of not being able to buy medicine for people, at this time, the Ministry of Health proposes two mechanisms: First, in addition to removing the procurement bidding mechanism, add the transfer of medicine between medical facilities.

For example, if hospital A bought the medicine last quarter and now hospital B needs it, it can be transferred between hospitals and paid for by health insurance for the people, so that people do not have to go out to buy medicine, affecting the quality of treatment.

Drug transfer is a new content, one of the solutions to solve the problem of drug shortage.

Second, if there is no medicine transfer, people have to go out to buy medicine, then there is a payment mechanism.

"To be honest, doctors do not want people to go out and buy medicine because it is related to quality and treatment quality. Drug transfer is a new content and if it can be done, it will be a solution to the problem of drug shortage," said the Minister.

Source: https://www.baogiaothong.vn/khong-nen-coi-bao-hiem-y-te-la-barie-chong-qua-tai-benh-vien-tuyen-tren-192241024173736954.htm