Many opinions say that the health sector is in dire need of a serious policy assessment to solve the problem of autonomy.
Public debt of tens of billions of dong occurs
Currently, many public hospitals across the country are facing financial difficulties when revenue is not enough to cover expenses, leading to unpaid salaries, social insurance, medicine, medical supplies, etc. Solving the difficulties for district-level hospitals when implementing 100% financial autonomy is a very difficult problem.
For example, in Quang Nam, medical facilities such as the Thang Binh District Medical Center, Quang Nam Provincial Traditional Medicine Hospital, Dong Giang District Medical Center and Hiep Duc District Medical Center... are proposing to stop or adjust and reduce the level of financial autonomy.
The reason is that after becoming autonomous, these medical facilities encountered difficulties in business operations (the number of patients coming for examination and treatment decreased sharply), revenue was not enough to cover expenses, leading to debt, especially long-term debt to staff salaries. This forced many doctors and nurses to quit their jobs or change jobs to make a living.
In recent years, at the hospitals: Huong Khe District General Hospital, Duc Tho District General Hospital, Ha Tinh City... there has been a public debt situation of up to tens of billions of VND. According to the leader of Huong Khe District General Hospital, the total debt is up to more than 25 billion VND.
Of which, the debt for medicine and supplies from 2019 to present is more than 17.5 billion VND; the debt for shift duty, surgery, and procedures of staff is nearly 2.5 billion VND; the debt for examination fees at commune health stations in the area is 1.8 billion VND... The situation of "business" losses leading to debt after autonomy not only occurs in Quang Nam but is also a common problem in many other localities across the country. The provinces of Ninh Binh, Quang Binh... have continuously appeared in the press recently with similar stories.
In Hanoi, it can be seen that since becoming financially autonomous, the income of officers and employees of Xanh Pon General Hospital has increased significantly, but to do this, the unit has encountered many difficulties when the price of medical examination and treatment services (KCB) is not calculated correctly and fully. Director of Xanh Pon General Hospital Nguyen Duc Long said that the price of medical examination and treatment services applied according to Circular No. 13/2023/TT-BYT of the Ministry of Health (stipulating the price framework and pricing method for KCB services on demand) has many shortcomings, but has expired. The hospital is waiting for new instructions, hoping that new instructions will be issued by the Ministry of Health soon.
Referring to this issue, Director of Ba Vi General Hospital Pham Ba Hien said that in the recent period, the hospital has requested job transfers and resignations for 27 medical staff, including 14 doctors. One of the reasons for job transfers is that the lives of medical staff are not guaranteed. The leaders of Ba Vi Hospital hope that in the coming time, policies for employees and medical staff at grassroots medical facilities will be taken into consideration so that they can work with peace of mind.
“The revenue of Long Bien District Health Center is very limited, mainly from health insurance, the price is according to the regulations of the City People's Council, the Ministry of Health, the Ministry of Finance (the price of health care is very modest). Every year, in addition to reducing the staff, the budget for the district health centers is also cut according to the general roadmap. Therefore, the life of the health center's medical staff is extremely difficult" - Director of Long Bien District Health Center Do Thu Ha said.
The representative of the Hanoi Department of Health pointed out that in reality, public service units in the past have been mainly mechanical, while the number of grassroots health workers is still lacking, their qualifications are limited, and their remuneration policies are not satisfactory. In addition, there is no mechanism to attract staff to the grassroots health sector, especially those with high professional qualifications.
Revenue is not enough to cover expenses
Sharing the same view, according to Associate Professor, Dr. Tang Chi Thuong - Director of the Ho Chi Minh City Department of Health, after many years of implementing autonomy, hospitals still face difficulties due to the fact that hospital fees have not been calculated correctly and sufficiently. Up to now, there is also the worry of having to calculate the source to increase salaries for employees according to regulations. In reality, most hospitals at the district level and grassroots health care facilities are facing great difficulties. The facilities lack funding to ensure operations. On the other hand, the problem of health insurance debt at grassroots health care facilities has not been paid attention to and resolved.
According to medical experts, to solve and overcome this problem, health insurance needs to pay hospitals and medical facilities according to prices depending on the technology that the unit uses as well as the equipment used in accordance with the technology, people and qualifications.
In addition, through professional activities, hospitals and medical facilities collect funds to implement autonomy, which is lacking. Analyzing this issue, Professor Nguyen Anh Tri - Member of the 15th National Assembly said that because the price list of medical services of medical facilities regulated by the local People's Council is not suitable for the technology, techniques, and qualifications of the patients, leading to lower income, the revenue is not enough to cover expenses. Therefore, this issue needs to be resolved.
To resolve difficulties for medical facilities, the Ho Chi Minh City Department of Health proposed that the Ho Chi Minh City People's Committee soon approve the sustainable autonomy project for public hospitals in the area, with a mechanism to support hospitals; and propose that the Ho Chi Minh City People's Council soon approve the salary reform source deduction level down to 10% or 16%, depending on the level of autonomy.
According to Associate Professor, Dr. Pham Thanh Binh - Chairman of the Vietnam Medical Trade Union, the 30% increase in basic salary is an effort and endeavor of the State. However, 80% of medical facilities are implementing service prices with 4/7 factors. The cost of drugs, consumables, goods, salaries, wages... increases annually due to increasing market prices but medical service prices do not adjust in time. Therefore, the Vietnam Medical Trade Union proposes to soon issue a price structure with all factors, calculating correctly and fully, helping hospitals have a basis to pay salaries according to the new adjustment level. There are many things to discuss about the financial difficulties of medical facilities, including central hospitals, after becoming autonomous. First of all, measuring results by the autonomous mechanism has shown that most public medical facilities still cannot compete with private medical facilities. It is understandable when considering the different conditions between these two types.
In addition, public health autonomy is currently in a state of confusion, revealing many shortcomings. The most pressing issue is that when private hospitals are autonomous, they have the right to decide hospital fees, while public hospitals are not yet given this right, leading to financial and personnel difficulties. Therefore, the health sector is in dire need of a serious assessment of the public health autonomy policy from competent central agencies to find a solution to the problem of "the more autonomy, the more debt" at health facilities.
Bach Mai Hospital has developed a price plan for the Ministry of Health to review and decide on changes in medical examination and treatment prices. It is expected that the price of medical examination and treatment under health insurance will increase by about 15 - 20% with more than 8,000 services and techniques. The salary fund of Bach Mai Hospital will increase by 10 - 12 billion VND/month with salary payment according to the new regulations. If the Ministry of Health is slow to approve the price of medical examination and treatment under health insurance according to the new salary structure, the hospital will face financial difficulties.
Ms. Nguyen Thi Hanh - Finance and Accounting Department, Bach Mai Hospital
Autonomy is necessary, however, autonomy is implemented at central and provincial hospitals. At district level, medical facilities do not implement autonomy, but these grassroots medical facilities must be provided with state funding to operate. It is time to review the autonomy of grassroots medical facilities and ensure state funding for grassroots medical facilities to operate.
Professor Nguyen Anh Tri - Member of the 15th National Assembly
Source: https://kinhtedothi.vn/tu-chu-benh-vien-de-khong-om-no.html
Comment (0)