Roadmap to help people avoid paying out of pocket for medical examination and treatment

On December 29, 2023, the Mexican Government inaugurated the world's largest National Pharmaceutical Distribution Center, connecting the entire hospital system and medical facilities nationwide to deliver medical products completely free of charge to patients within a maximum of 48 hours, regardless of location across the country.

The above information made me curious and urged me to come to this country of 130 million people. If the Mexican leader's statement is true, this is truly a model for many countries, including Vietnam, to learn from.

But the reality is not as dreamy as it seems. Nearly two years after its establishment, Mexico's National Pharmaceutical Distribution Center has yet to meet the expectations of the government and, in particular, the poor.

Hoc Mon Regional General Hospital, HCMC (Illustration: Nguyen Duc Trinh)

That is understandable, because if we provide free medicine to the whole population, we need a huge budget and it will certainly be out of control. For example, the current generation of cancer drugs costs hundreds of millions of VND per course of treatment. If the drug is given for free, the abuse of prescriptions will cause any fund to be in deficit.

Mexico's health care system, which includes both public and private providers, faces challenges including supply-demand mismatches, long waiting times, and a significant portion of the population without health insurance (about 14%), resulting in patients having to pay a large amount of out-of-pocket costs for medical care (about 39% - 2024 figures).

All of these challenges are very similar to the Vietnamese health system. The differences are that Vietnam has a higher health insurance coverage rate (reported at 94.1% in 2024), more public hospital beds, and statistically shorter waiting times than Mexico.

However, an alarming figure is that the out-of-pocket spending rate of patients in Vietnam is slightly higher, at 39.6% in 2022 (no newer statistics available). This is an important criterion for orienting healthcare development in the coming time.

Unlike education, where tuition fees are set uniformly for each student, it is easy to calculate tuition exemptions. Healthcare is much more complicated. The amount paid for each patient varies widely, so it is difficult to exempt all hospital fees.

So how to reduce people's out-of-pocket spending on medical examination and treatment? The approach of Mexico sounds good, but in reality, it has not achieved the expected results. In my opinion, we need to coordinate two separate resources, the State and the Health Insurance Fund, to ensure that people receive health care, and do not have to pay out of pocket, while still developing high technology, ensuring that the insurance fund does not go bankrupt.

Vietnam needs to follow this general principle step by step, assessing the impact as it goes to move on to the next steps.

In the first phase, the State needs to pay for medical examinations (free public examinations) by paying directly to medical facilities according to the number of examinations each year. This can be called the National Medical Examination Support Fund - like a form of free tuition for high school students. Each patient is examined at a prescribed price (for example, 200,000 VND/examination) and the number does not fluctuate nationwide, so it is completely calculable.

Information technology and post-auditing will prevent the Government from abusing this free medical examination fund. Medical examination tests as well as inpatient treatment costs will still be covered by health insurance.

Public hospitals that want to increase their income must improve the quality of their services to compete fairly, increase the number of medical examinations as well as clinics, and provide on-demand services for the rich to increase their income for medical staff and reinvest in equipment; similarly, private hospitals must continuously improve the quality of their services to bring about economic efficiency.

Health insurance needs to design many levels of contribution to have different levels of payment. For example, expensive surgeries are still covered by health insurance 100% if contribution level is A, 75% if contribution level is B...

The current normal level is still maintained, but it is necessary to study raising the payment ceiling to help people not have to pay out of pocket for medical treatment.

On the other hand, it is necessary to create maximum conditions for companies to participate in this very primitive health insurance market in Vietnam; research and develop "Made in Vietnam" drugs and equipment or coordinate with foreign companies to reduce input costs of medical examination and treatment...

In addition, to avoid fund failure, it is necessary to closely coordinate with professional associations to ensure treatment indications; maximize the application of information technology in fund management. In particular, it is necessary to switch from payment to a penalty mechanism, terminating contracts when medical facilities repeatedly violate fund abuse.

The next stage, when everything is on track, the healthcare system will certainly operate according to international practices. That is, patients pay for health insurance, hospitals perform medical examinations and treatment, and insurance pays correctly and fully upon discharge. When there is no longer a need to "co-pay for medical examinations and treatment" - the amount that patients with health insurance must co-pay with the Social Insurance agency according to the % rate of the health insurance card, people will enjoy all the fruits of development in a civilized and sustainably developed society.

Author: Mr. Nguyen Lan Hieu is a cardiologist, Associate Professor, Doctor of Medicine; Director of Hanoi Medical University Hospital; member of the Foreign Affairs Committee of the 14th and 15th National Assembly.

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Source: https://dantri.com.vn/tam-diem/lo-trinh-giup-nguoi-dan-khong-phai-bo-tien-tui-khi-kham-chua-benh-20250322114652871.htm