On August 20, discussing in the National Assembly's group, delegate Nguyen Lan Hieu - Director of Hanoi Medical University Hospital - proposed to abolish autonomy for grassroots hospitals in rural and mountainous areas.
According to the delegate, people in these areas mostly have low incomes, and hospital revenue in some places up to 99% comes from health insurance.
Meanwhile, recurrent spending autonomy is putting pressure on medical staff and may be one of the reasons why experienced people seek to return to the city or switch to the private sector.
This proposal of delegate Nguyen Lan Hieu is worth considering from the specific characteristics of grassroots healthcare.
Because autonomy only truly promotes efficiency when the unit ensures certain conditions. A large hospital in an urban area, with a large number of patients, many specialized techniques and the ability to develop medical services, may have more room to balance revenue and expenditure.
But hospitals in mountainous, remote and isolated areas are in very different circumstances.
These hospitals not only provide medical examination and treatment but also perform many tasks of community health care, preventive medicine, and support the operation of the commune level. The main target audience is local people, including many people in difficult circumstances and dependent on health insurance.
If requiring hospitals like that to balance their regular expenditures like units with more favorable conditions, it is very easy to create a vicious circle.
Few patients limit revenue sources, leading to difficulty improving the income of medical staff and staff. When capable doctors leave, the ability to deploy techniques and the quality of medical examination and treatment are affected. People tend to go beyond the tuyến, making hospital revenue even more difficult.
The effectiveness of a grassroots hospital cannot be measured only by the ability to self-balance revenue and expenditure. Because there are values that are difficult to show on the financial balance sheet, such as a doctor willing to stay in the highlands, an emergency case being treated promptly in the locality, or a poor person not having to travel hundreds of kilometers to the upper level for treatment.
Hospital autonomy does not mean that the State completely withdraws resources, but increases the autonomy of units in managing and using resources and organizing operations in accordance with the assigned level of autonomy.
Therefore, grassroots hospitals in rural, mountainous, and particularly difficult areas need a separate financial mechanism suitable to their tasks.
The State needs to have a mechanism to ensure resources for essential tasks such as human resources, training, maintaining professional activities, and at the same time create conditions for hospitals to improve the efficiency of using revenue sources.
Investing in hospitals and buying modern machinery is necessary. But equally important is to create a mechanism strong enough to keep doctors and medical staff.
Because ultimately, the goal of the hospital financial mechanism is not to make every hospital balance revenue and expenditure, but to ensure that people, whether living in cities or mountainous areas, have the opportunity to access necessary medical services right where they live.
Looking from a health economic perspective, investment in grassroots levels is not only a budget cost but also an investment that helps reduce the long-term health costs of society.
