Health service coverage remains high

Mr. Le Van Kham, Director of the Department of Health Insurance (Ministry of Health), said that the goal of Vietnam is to reduce the percentage of users paying medical expenses to 35% by 2025 and 30% by year. 2030.

Heavy burden on health spending

Although the health insurance has paid up to 18 million VND, the family of Mr. Nguyen Minh Tan (Nghe An) still has to pay nearly 20 million VND out of pocket for his relatives after the hip fracture surgery. According to Mr. Tan, with this money, the family can still take care of them, but if they accidentally get a serious illness at the cost of hundreds of million dong, it will be a big burden for the whole family.

Currently, people with health insurance have to pay for themselves, including: Services not covered by the health insurance fund; drugs, medical supplies, and technical services outside the list covered by health insurance; services not yet covered by health insurance such as: health check-ups, screening, assisted reproductive techniques, refractive error treatment, use of eyeglasses, dentures … Payment amount 5%, 20% total cost of medical examination and treatment depending on subjects according to the provisions of the Law on Health Insurance.

It is expected that from next July, the Ministry of Health will apply the capitation method of paying health care expenses covered by health insurance. (Photo for illustration only)

When taking medical examination and treatment at the wrong level, patients have to pay the costs of some drugs, medical supplies and technical services in the list of health insurance, but only 50% – 70% like some cancer drugs. . In addition, the patient has to pay the difference when the medical examination and treatment is requested.

Recently, the Ministry of Health has published some remarkable data on the payment of people for health services. Accordingly, a 2017 study shows that out-of-pocket spending is about 43% of total health spending.

This out-of-pocket spending level is much higher than recommended by the World Health Organization (WHO) of 20% and 2-2.5 times higher than developed countries (from 14% – 20%). . WHO assesses that families with such heavy health spending can easily go bankrupt and go to poverty. The cost level as recommended by WHO should be only 20% – 30% of the total expenditure.

According to Nguyen Thi Kim Phuong, WHO’s health finance expert, out-of-pocket health spending for Vietnamese people is high for many reasons, but the most important thing is to review the use of health services. is the reality reasonable yet. Ms. Phuong said 10 years ago, health insurance coverage in Vietnam was only 50% and out-of-pocket was about 49%, but now that coverage is nearly 90%, people’s out-of-pocket spending should be greatly reduced. but the reality is decreasing very slowly (43%).

Change the method of payment of hospital fees

Currently, each Vietnamese person examines an average of 2.1 times / year with an average amount of 129 USD / person (equivalent to nearly 3 million VND / person), of which 37% is medical expenses (equivalent to about 3 million VND / person). 1.1 million). With this level of spending, Vietnam ranks above Laos, Cambodia, and Myanmar, but below regional countries such as Indonesia, the Philippines, Thailand, and Malaysia. In which, Thai people spend about 6 million VND / person / year, the rate in Malaysia is 12 million VND / person / year.

Mr. Le Van Kham said that one of the reasons people still have to spend a lot of money when going to medical examination and treatment is because the current health insurance premium is still low, so many medical services are not covered by health insurance. Therefore, in order to reduce out-of-pocket expenses, there must be a roadmap to increase the payment rate as well as further expand the scope of payment, increase benefits when receiving medical examination and treatment. In addition, when increasing the health insurance premium, it is necessary to control effectively spending in hospitals.

Some opinions suggest that one of the important factors promoting the implementation of the goal of universal health care coverage and reduction of out-of-pocket health care spending is to develop modes of health service payment. suitability and control of medical examination and treatment costs and the quality of medical examination and treatment services.

Currently, most hospitals apply a fee-for-service method, patients using any service pay for that service. The advantage of this method is easy to implement and clear among stakeholders, increasing autonomy for health facilities, but the disadvantage is that it creates a mechanism to encourage facilities to oversupply medical services. , difficult to control costs, imbalance of revenues and expenditures of the health insurance agency.

In order to control spending of the health insurance fund, it is expected that from July next, the Ministry of Health will start applying the method of paying health insurance costs by capitation and by diagnostic group (DRG) for inpatients. Predetermined amount per disease diagnosis.

The model of diagnostic hospital fee payment for inpatients has been piloted by the Ministry of Health in Quang Ninh, Yen Bai, Can Tho …, initially showing very good results. The advantages of the method are increasing transparency between parties, increasing service quality, making quick and convenient payments, using funds appropriately, and limiting overload on the upline.

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