Associate Professor, Dr. Le Dinh Thanh - Director of Thong Nhat Hospital in Ho Chi Minh City - said that now the upcoming universal health insurance policy will be implemented, and insurance policies will almost cover all hospitals. . Therefore, prescribing medication appropriate to each patient's condition is necessary, and social insurance needs to consider payment in detail.
However, according to Mr. Dinh Thanh, there is currently a situation where social insurance believes that hospitals prescribe too much medicine to patients. In particular, for terminal geriatric hospitals such as Thong Nhat Hospital, which receive difficult-to-treat patients with many underlying diseases, the use of medical supplies and equipment for treatment is difficult. per patient is often higher than for patients at lower level hospitals. "It is recommended that Social Insurance and the Ministry of Health review the issue of health insurance allowances for last-line units," Mr. Dinh Thanh added.
Regarding this issue, Military Hospital 175 (Ho Chi Minh City) also encountered many problems in payment and explanation to Social Insurance about annual expenses.
According to Major General, Dr., Meritorious Physician Tran Quoc Viet - Director of Military Hospital 175, in the first quarter of 2024, the total average cost for each outpatient and inpatient medical examination and treatment has increased. exceed 6%. This was reminded by health insurance in the first quarter of 2024, and the hospital ranked first in spending exceeding health insurance.
However, the average costs of secondary hospitals compared to final-level hospitals are different. Doctor Viet gave an example: for a case of respiratory failure, the patient often has to run ECMO, dialysis... The cost for these cases can be up to several hundred million VND. Therefore, medical examination costs according to ICD-10 (disease classification) at high-level hospitals will have a clear difference compared to lower-level hospitals.
“To overcome this cost gap, hospitals are forced to accept more patients. For example, instead of receiving 3,000 inpatients and outpatients every day, the hospital must increase to 3,500 cases, although the cost of some cases is only 100,000 - 200,000 VND, but it will compensate for cases with excess costs. High. This is an issue that we do not want to explain, because when explaining the costs incurred are higher than the total estimate, health insurance will ask questions and the explanation will be very difficult. We propose that the Ministry of Health issue clear regulations, not to equate final-level hospitals with lower-level hospitals," Dr. Viet emphasized.
Ms. Vu Nu Anh - Deputy Director of the Health Insurance Department (Ministry of Health) - said that currently 93.5% of the population participates in health insurance, with the total health insurance fund reaching about 120 trillion VND nationwide. On average, each person pays about 1,350,000 VND/year. However, spending on medical examination and treatment has generally not met expectations, even though the list of payments for technical services and drugs is very broad.
“According to current regulations, there is no longer an average calculation of inpatient and outpatient prescriptions. However, because the fund source is limited, notification and warning to medical facilities must still be done, because if spending exceeds the prescribed level, the fund will not be enough to meet the needs," Ms. Nu Anh said. know more.
