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An unhealthy move by the health sector

Update: January, 14/2015 - 09:50

by Khanh Van

The devil's in the details, they say.

It seems that our policy-makers have a habit of stumbling over some important details when they come up with solutions, and when this happens, the problem refuses to go away.

A new amendment to the health insurance law says that health-check and treatment fees will not be paid for outpatients who go to hospitals or clinics at a "higher" level than the ones with which they are registered.

This means that outpatients registered to have health check-ups and treatment at district or provincial level hospitals will not have their expenses covered by the health insurance fund if they go to central-level hospitals on their own initiative without recommendations from local doctors.

The new regulation, taking effect from the beginning of this year, is aimed at reducing overload at central-level hospitals, which is a long-standing problem facing the health sector, officials explained.

However, many health insurance card holders are unhappy with the new rule. They say it is unfair and affects the quality of healthcare that they are, or should be entitled to.

I also think that the new regulation may not meet its objective and can end up affecting patients' interests.

Why do patients spend time and money to travel hundreds of kilometres to get health examinations and treatment at prestigious hospitals in big cities like Ha Noi and HCM City?

And after they reach the hospitals, why are they patient enough to stand in a long queue, waiting for their turn?

The answer is simple, and has been obvious for a long time. There are fundamental problems with healthcare in remote and rural areas, including a lack of equipment and shortage of doctors and other professional staff.

Let us take eye-care, for example.

The rate of ophthalmologists is about 1.4 per 100,000 people in rural areas, compared to the national average of 6.5. Out of 697 districts nation-wide, just 211 have ophthalmologists or paramedical personnel trained in eye-care. Half the staff at commune-level healthcare clinics have received no eye-care training.

A nation-wide survey by the Ministry of Health in 2013 revealed that doctors were not dispersed rationally at district level hospitals and clinics, which some having more than others irrespective of actual need.

The survey also fund that most commune-level clinics had only about 60 per cent of the necessary equipment.

There is a rational reason for people in rural areas flocking to big cities for health examinations and treatment.

Pham Thi Cuc, from the northern province of Ninh Binh, 100km away from Ha Noi, said she decided to go to Bach Mai Hospital in the capital city in the hope that her problem – leg pain caused by narrowed arteries – can be "fully" cured.

"I was treated at a local hospital for a long time, but the pain would reduce, never go away. It not only affected my health but also cost me a huge amount of money over a long time," she said.

"I decided to go to Bach Mai Hospital, which has more modern devices and equipments and skillful doctors," she said.

Pham Van Hoa from the central province of Ha Tinh said he was surprised to hear about the new regulation. He said patients deserve the quality healthcare that central-level hospitals provide.

"We buy health insurance so that we can get financial support to get access to such services. This rule is therefore a disadvantage for people in rural areas like us, compared to those living in big cities," he said.

"We would not waste time and money to travel a long distance to go to central hospitals if clinics in rural areas offered similar quality," he said.

Hoa has hit the nail on the head. Even if the new regulation does initially help reduce overloading at central-level hospitals, it will do so by hurting some people, financially as well as medically.

Furthermore, will it provide a lasting solution?

Doctor Nguyen Dinh Phu, Deputy Director of the 115 Hospital in HCM City, said that when patients found health clinics and doctors in their localities failing to meet their demand, they would surely find ways to go to central-level hospitals again.

Doctor Nguyen Thi Ngat, who used to work for Bach Mai Hospital, said the model that the new regulation targets had been widely applied in other countries, but these had a well-developed network of family doctors and well-equipped clinics at all levels.

Policymakers should think of the impact of their solutions on everyone that will be affected, especially low and middle-income populations in rural areas. If the solution is not fair to all sections of society, it will not solve any problem.

It is time the Government put more investment in improving healthcare at commune, district and provincial level facilities, and ensure that policies encouraging doctors to work in rural and remote areas have more teeth.

If core issues and details are bypassed, all solutions will end up toothless. — VNS

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