Why not expand health insurance to private facilities to reduce overload?

Upper level hospitals are always overloaded, some places abuse services, leaving health insurance patients with no other choice. But...

Patients with health insurance who registered for an ultrasound at the Ho Chi Minh City Oncology Hospital on the morning of November 11 were informed by hospital staff that the appointment would be postponed to the morning of November 12 because the schedule was full. If they registered for the service, they would have an ultrasound the same afternoon - Photo: THU HIEN

After the article "Having health insurance but having to 'bite the bullet' to get medical services", many readers spoke up and said they had been in a similar situation.

Health insurance check-up: Test and ultrasound takes 2 days

Reader NVA said: "Two years ago, I took my child to a public hospital for circumcision. After buying a ticket and having an initial examination at 9:30, the staff in charge instructed me to fill out a form with three options:

One, if you use health insurance, make an appointment to come back 3 weeks later, be hospitalized for minor surgery and be discharged within 3 days. The remaining cost after deducting health insurance is about 2 million VND.

Two, if you use the 5 million VND service package, the minor surgery will be performed at 2pm on the same day and you can leave after 2 hours.

Dad, if you use the service but the head of the surgery department performs it for 8 million VND, it will be done at 11am and you can go home right away."

Account dan0****@gmail.com said: "I am an elderly patient who regularly comes for check-ups using health insurance (every 3 months).

On October 24, 2024, I had a follow-up visit. Because my house was far away, I took the first bus at 2am and arrived at the hospital at 6am.

I was scheduled for two things: a blood test and an ultrasound. At 10:20, I got the blood test results. The ultrasound was scheduled for 2:00 p.m. the next day, October 25, 2024.

Only two steps but it took two days!

It's true that the hospital examines patients from 5am, but that's for service. Patients with health insurance can only start seeing patients from 7:30am.

Buying health insurance but only going to see a doctor for common colds and coughs, the rest of the time having to go to a service clinic, reader Dong shared: "Once I had dermatitis, I went to see a health insurance clinic, all the dermatitis patients were examined by only one doctor. The doctor said that applying medicine in the health insurance list would leave scars, if I went to see a service clinic, I would be given better medicine."

Adding another perspective, reader Vu Kiet said that in many Western countries, people who go to work are automatically covered by health insurance, and the health insurance fee paid to the hospital is equal to the service price - market price, but if you want to be treated at a public hospital, you have to wait and make an appointment because the demand is too high. Therefore, anyone who wants to be treated quickly and immediately must go to a private hospital.

From the people's perspective, now that health insurance is available everywhere, patients can go to any medical facility for examination and treatment, of course they will tend to go to the place they believe is the most reputable. This also puts pressure on health insurance services at reputable public health facilities that provide health insurance examination and treatment.

From the perspective of public hospital managers, is it unreasonable that now that hospitals are financially autonomous, they have to provide good services at half the price of private hospitals? Meanwhile, procurement must be bid and budgeted for health insurance!

According to the 1990 account: "When people care more about their health, it seems that the health insurance fund cannot cover all costs. There must be a stratification of universal health insurance. Those who buy health insurance will have all their basic needs met, those who buy higher value packages will have better choices of medical equipment and supplies."

Expanding health insurance to private facilities to reduce overload

According to reader DD, because the upper level is always overloaded, some places abuse the service by opening "services", forcing patients to participate in the service, otherwise they have to wait. Meanwhile, the price of all medical examination and treatment services at the upper level is always higher than the lower level and there must be additional revenue to be able to recruit the best human resources.

Meanwhile, the lower level's revenue is low and it is difficult to provide services, so the revenue is getting lower and lower, leading to difficulty attracting human resources... patients are flocking to the higher level, making it even more overloaded.

Considering that "the problem is that many people cannot accept waiting, whether they are mildly ill, seriously ill, or need monitoring. And when they go abroad to make appointments for weekly or monthly check-ups, there is no response", reader TC suggested that the long-term solution should be to improve the efficiency of primary health care to avoid overloading the upper level and expand health insurance to more private facilities.

This gives patients more choices, avoiding having to travel from the countryside to the province or being confined to just one or two large facilities.

According to reader Truong Kiet, if comparing health insurance with services, it must be understood that most hospitals must be autonomous or aim for autonomy in revenue and expenditure. If they want to retain doctors and nurses, they must increase their income. If they want to increase their income, only services can provide additional income, because health insurance is too low to be enough.

If doctors don't have a good income, they can't improve their skills. Whether they have health insurance or services, it's the same.

And according to VT reader: "We need to review the way insurance calculates fees when paying medical staff, surgery fees, plaster casts...".

Source: https://tuoitre.vn/sao-khong-mo-rong-bao-hiem-y-te-cho-co-so-tu-nhan-de-giam-qua-tai-20241128173916974.htm