"Voluntarily" give up health insurance
In reality, many patients are forced to give up their health insurance. Present at the hospital fee payment area at the Orthopedic Hospital (HCMC), we recorded many cases of people continuously calling their relatives to "collect" money for urgent surgery, others asking for opinions on whether they agree to have the service surgery or accept a long wait.
Sitting next to us, Ms. Minh Ngoc (residing in Lam Dong province) was waiting for news of her son in the clinic. It was known that Ms. Ngoc's son had a motorbike accident. After being admitted to the hospital in Lam Dong, Ms. Ngoc was informed by the doctor that she had to have surgery, but could not schedule it immediately. Because of her concern for her son's condition, Ms. Ngoc's family transferred him to the Orthopedic Trauma Hospital for medical examination and treatment.
"In Lam Dong, whether it is a health insurance surgery or a service surgery, we still have to wait because it is difficult to schedule. The hospital will prioritize more serious cases such as traumatic brain injury or cesarean section, so our case still has to wait. We don't know how long we have to wait, so we decided to transfer to another hospital," said Ms. Ngoc.
According to the patient's family, because she had a referral letter, when transferred to a higher-level hospital, her child could still use health insurance for medical treatment. However, according to Ms. Ngoc's plan, in case she still had to wait for surgery if she used health insurance, she would choose to have the surgery done by service because she did not want her child to have to wait too long.
Six months ago, Ms. Minh Phung (living in Binh Duong) broke her arm. Ms. Phung's family chose the Ho Chi Minh City Orthopedic and Trauma Hospital for surgery, but had to wait 4 months for Ms. Phung to have surgery. "I went for a check-up today, I had surgery 2 months ago. Because I have health insurance, the surgery cost is only 3 million VND, but the wait is very long. I have to wait 4 months for surgery. If I want surgery right away, I can, but I have to choose a service, the cost is more than 10 million VND, where can my family get the money? So I just have to wait," Ms. Phung told us.
A representative of the Ho Chi Minh City Orthopedic Trauma Hospital said that every day the hospital has to perform 110-130 surgeries, and when overloaded, it can increase to 150 surgeries. The hospital regularly receives and handles serious and difficult surgeries, with surgery time of 3-5 hours/surgery, such as severe pediatric scoliosis, bone cancer, amputated limbs, etc. The operating rooms are all operating at full capacity. However, the number of patients waiting for surgery in clinical departments is still high. Due to the general lack of equipment in hospitals, when there is enough equipment, the number of patients needing surgery from other places has been concentrated, causing overload, which leads to long waiting times for patients.
Not only surgery but also many patients give up health insurance to use the service.
At Viet Duc Friendship Hospital, patient Tran Van Hong, 70 years old, from Nam Dinh, suffered a meniscus injury that made daily activities difficult. Mr. Hong went to Viet Duc Friendship Hospital for a check-up before the doctor decided on treatment. Although he had health insurance, Mr. Hong registered to see specialists and made an appointment in advance to reduce waiting time. "I am old, but my legs hurt and I have to wait for health insurance to see a doctor, I don't know how long. I had to give up health insurance to use the service," Mr. Hong said.
No distinction between service and health insurance
Mr. Hoang Trung Tuan, Deputy Director of the Department of Health Insurance (Ministry of Health) said that according to Circular No. 13/2023/TT-BYT, issued on June 30, 2023, experts and good doctors at public medical facilities must spend at least 70% of their working time examining and treating people with health insurance cards, people without health insurance cards but not using the requested services, and supporting lower-level facilities.
The aim of this regulation is to ensure that health insurance participants and those who do not use on-demand services have access to high-quality medical services, while improving the effectiveness of professional support for lower-level facilities.
According to the amended and supplemented Law on Health Insurance 2024, effective from January 1, 2025, health insurance participants are entitled to medical examination and treatment benefits without discrimination based on administrative boundaries.
According to Mr. Tuan, the basic principle is that health insurance participants are not discriminated against in accessing medical services. No discrimination in service types: People with health insurance cards have the right to access medical services in the health insurance payment list regardless of gender, age, social status or financial capacity; Fair treatment: Medical examination and treatment facilities must treat equally, without discriminating between service users and health insurance users; Open and transparent management: Medical facilities must publicize price lists and services applicable to all subjects. The use of drugs, medical supplies, and equipment must be based on clinical indications, regardless of payment type (health insurance or service); Digital transformation in management: Applying information technology will support unified management, avoiding the situation of prioritizing or abusing medical services for subjects not covered by health insurance.
“Implementing a non-discrimination between health insurance and services will help reduce inequality in health care and promote people's trust in the public health system. If there are cases of discrimination or lack of transparency in medical examination and treatment, people can directly report to the social insurance management agency or competent health agency for handling according to regulations,” said Mr. Hoang Trung Tuan - Deputy Director of the Department of Health Insurance (Ministry of Health).
