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Experts discuss rise in healthcare costs

Update: February, 20/2012 - 09:56

After extended debate, the Government has approved the Ministry of Health's proposal to increase prices of 400 health services this year by up to five times their current rate. The cost of a hospital bed will rise from US$0.95 to $7.60. Viet Nam News reporters Thanh Hai and Thu Trang spoke to experts and industry insiders about the issue.

Why has the Ministry of Health proposed increasing the price of more than 400 medical service fees now? Do you think it's reasonable?

 

Nguyen Nam Lien
Deputy Director of the Ministry of Health's Planning and Finance Department Nguyen Nam Lien

Among the current 3,000 medical services on offer, around 350 have been set since 1995 and 2,700 others were set six years ago. All of them are out of date and need to be revised or supplemented. Many new expenses have arisen recently such as medical waste treatment, hygiene requirements and HIV transmission prevention. Prices of services were calculated on the basis of being performed manually. Now, those services are performed using advanced, modern methods that are more expensive. That's why more than 400 service prices have increased with an average increase of 13-14 per cent.

Health insurance services currently cover 60 per cent of the country's population. Without the price adjustment of medical services, the health sector would have no financial resources to offer health examination and treatment services for health insurance users, let alone improve the quality of services. Fewer payments from health insurance is synonymous with low quality service that would create further inconveniences to patients and discourage people to seek help through health insurance services.

Deputy chairman of Viet Nam National Assembly's Committee for Social Affairs Nguyen Van Tien

I think the price increase for hospital fees is coming too late, which has caused inconvenience for both practitioners and service users, while limiting the health sector's development.

It's late because the Party and the National Assembly's resolution proposed to adjust hospital fees five or seven years ago was not implemented. These current changes will be the basis for us to develop the health sector based on the whole population's health insurance.

However, because of some residents and some sectors misunderstandings, the fees have been adjusted after a long delay, which affects people with health insurance cards. The health insurance fund should have paid for their care, however, money from the health insurance fund was paid based on the low fees, thus the quality of service was poor.

In the past years, the number of people covered by health insurance has increased, thanks to the health insurance law, whereas hospital fees have stayed the same since 1995, which has led to the health insurance fund's balance of some thousands of billion dong. If the balance is not used appropriately, the health insurance system will develop a bad reputation.

Lecturer at the Ha Noi Medical University and doctor at the Viet Nam National Heart Institute Pham Thi Tuyet Nga

The increase is necessary as old hospital fees have become outdated.

However, increasing hospital fees is a delicate issue, especially for poor people, so I think the increase should be calculated and considered carefully. The health sector should impose increases step-by-step and one service at a time, not 400 health services at the same time.

Hoang Van Tu, 46, from northern Hung Yen Province

 

Hoang Van Tu
I am taking care of my wife at the Bach Mai Hospital -she has a lung disease and has just suffered a traffic accident.

On average, I have to pay about VND200,000 (US$9.5) per day in the hospital. My family can be considered middle class in the province, but I still have to borrow money from relatives and friends when my wife is hospitalised. Thus people who are poorer than me will of course meet a number of difficulties when paying hospital fees.

I think that increased hospital fees are reasonable, as the old ones were issued a long time ago and they are not suitable for current market prices. Doctors are human being like others - they have to work and of course they should receive income appropriate to the work they do.

The health sector promised that the increased prices will accompany improved services. Are you optimistic about this promise when many people complain about doctors' medical ethics and stretched hospital resources, where four patients sometimes have to share one bed?

Tien: The quality of health services can be broken down into three basic elements: health infrastructure and equipment, manpower and the health fund. When hospital fees increase, the health fund will be improved and the health sector will have more money to buy equipment.

 

Nguyen Van Tien
The State budget invested billions of dong from bonds to improve hospital staff and infrastructure, especially at district and provincial hospitals in poor areas and hospitals specialising in infectious diseases, tuberculosis, cancer and mental health. Also, the number of medical workers being trained is double that compared with 5-7 years ago.

The increased hospital fees, together with the improvements being made, will increase the quality of health services.

Lien: The quality of medical services is reliant on many factors. The idea is that the adjustment of medical service prices will improve the quality of those services. Hospitals will have more money to buy medicine and facilities that meet the required demand. They also have more money to upgrade facilities, buy bed sheets, patient clothes and through that, improve hygiene and create a positive environment for patients. We think that the quality of health examinations and treatment will be improved after a period of implementation of the new policy.

Nga: Everybody knows that to have the best health services possible, the first and the most important factor is that the service supplier can recoup the expenses it spends supplying the services. Increasing service prices is only one of many factors needed to improve the quality of service, so we cannot equate the price increase directly with an increase in quality.

 

Pham Thi Tuyet Nga
The quality of health checks is a collective notion. The increase in health service prices will create better conditions for doctors and nurses to carry out health treatment, whereas their attitude and manner belongs to human nature. Medical ethics depends on each individual doctor.

Do people know that medical workers stay awake all night when they are on watch to give emergency aid to dozens of patients and only receive VND10,000-30,000 (US$0.47-1.4) in pay? How can they carry out this work professionally?

After a few years of increasing the prices, infrastructure and equipment in hospitals will be somewhat improved, and hospital overcrowding may be reduced. But we are unlikely to improve doctors' and nurses' professional skills immediately. It will take doctors and nurses a long time to receiving training and update their medical knowledge and understanding of new technology.

Tu: I agree. If health service prices are more expensive, it means the services will become better.

To reduce the hospital overcrowding, I think the State should diversify health services in district and provincial hospitals so the number of patients going to central hospitals will be reduced.

There are fears that out-of-pocket medical expenses such as accommodation and travel fees make up a large amount of costs associated with health care, sometimes more than hospital fees. What do you think?

Tien: By the middle of last year, about 62 per cent of the population bought health insurance. When they go to hospital, the health insurance fund will pay their fees, including treatment involving modern technology and expensive medicine. They have to pay only part of the fees. When hospital fees change, at least 62 per cent of the population will not be discharged from hospital early because of a lack of money to pay fees.

People without health insurance cards are not poor or from ethnic minorities, as the latters receive annual health insurance cards from the State. They may be farmers or people living near the poverty line and people who receive an average income.

Residents will still have to pay the same expenses apart from hospital fees whether the hospital fees increase or not. The health finance sector should be responsible for limiting the number of residents going to central hospitals. For instance, 30-40 per cent of women going to the National Hospital for Obstetrics and Gynaecology have a natural childbirth, so they can go to their local communes' medical stations.

Lien: The Government of Viet Nam currently provides free-of-charge health insurance cards for all poor people. Using the card, the poor will be paid 100 per cent of the costs arising from their health examination and treatment at the communal level and 95 per cent of health care fees from district and higher levels by the health insurance fund. This is a great policy from the Government to subsidise up to 95 per cent of health care fees for the poor.

Previously, people just above the level of poor were subsidised 50 per cent of health insurance card fees by the Government. In order to encourage people to use health insurance services, the Government recently decided to raise the rate of the subsidy of health insurance fees from 50 to 70 per cent. So, they only have to pay 30 per cent of health insurance fees. Using the health insurance card, they also have to pay 20 per cent of health examination and treatment fees as regulated in the Health Insurance Law.

Other groups, such as people who have made significant contributions to the country, ethnic and minority people and children under the age of six, also receive 100 per cent of health examination and treatment fees from the health insurance fund.

The Ministry of Health has also recently proposed the Prime Minister revise the government's Decision 139 on health examination and treatment for the poor. The health sector has asked the Government to further support health treatment fees for disadvantaged patients or patients with dangerous diseases such as cancer, people relying on dialysis treatment and heart surgery patients. The health ministry also proposed establishing a fund for patients requiring serious treatment who have no money to pay medical service fees.

Nga: I heard the Ministry of Health proposed the Government set up a fund to assist poor patients and ethnic minority patients.

Moreover, I think the ministry should issue regulations punishing hospitals that deliberately collect extra fees besides hospital fees.

Tu: I hope that right after the new hospital fees are applied, the State will issue a policy to encourage poor people seek treatment in hospitals, as many poor people have not dared to go to hospitals despite requiring serious medical attention.

Moreover, the State should have measures in place to tighten control of medicine prices. I buy the same medicine from different pharmacies and find that each store has their own price. — VNS

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