by Bảo Hoa
It is not just normal, but a norm that it takes quite some time in Việt Nam for a new policy to “sink in” to the community after it takes effect.
We’ve heard so many implementing agencies explain delays in implementing a policy or low saying they are yet to receive “guidance” decrees or circulars. Eventually, though, they do take effect and people get used to it.
However, there are times this “lag” time can be used to critically examine a particular policy, in terms of its stated aims and potential to achieve it.
One such instance, I feel, is a new Health Ministry circular that mandates that parents and guardians of children under 72 months old should carry their ID cards when they go to the hospital.
Most of the parents I talked to at the National Children’s Hospital on Tuesday did not know of this rule, just as I did not know I had to buy insurance for my motorbike until I ran a red light, got pulled over, and was asked to present the insurance papers.
The Health Ministry circular, issued December last year and taking effect on March 1 this year, requires doctors to write the identification number of a parent or other legal guardian on all prescriptions for outpatients under 72 months old.
Cao Hưng Thái, deputy head of MoH’s Department of Medical Examination Management, explained that the ID number will be used by doctors when writing out prescriptions. Just one out of ten parents with kids under 6 years that I spoke to said she might, just might, have heard of the new rule. The others had no idea, although three of them did carry their IDs, and a careful mother happened to have a photo of it on her phone.
Those who did not know were none to impressed with the new rule.
“My baby suddenly got a high fever today,” said Trần Thị Lành of Hà Nội. “I rushed him to the hospital, and at that time, I only thought of taking him and what he needs, not my identification card.
“My husband is always the one taking ID papers,” she added. “I would have never remembered bringing mine.”
Nguyễn Thị An of Hà Nội and her husband took their daughter to the hospital together, but neither bothered to carry their IDs.
“She had a fever, and we thought it would be a regular health check, so we didn’t bring [the cards],” An said. “The doctor did not request to see it when he was giving us the prescription, either.”
The parents’ laidback attitude towards identity documents is understandable since the State issues free health insurance cards for all children under 6 years old. Until now, these insurance cards were all that was needed when taking their children to hospitals.
So what’s the point of the new policy? Deputy head Thái of MoH’s Department of Medical Examination Management said that it aims to ensure safe use of medicine, help patients track their treatment expenses and uphold legality in medical services.
“Although it takes a little more time from the doctors, this is necessary in order to manage the process of prescribing and selling medicines, especially when antibiotic abuse and overuse are still common in Việt Nam,” he said.
Pharmacies would be held responsible if inspectors find they have sold medicines for prescriptions without identification numbers, as would the prescribing doctors.
“Most children patients under six years old are taken to hospital by their parents or relatives, so I think it is not difficult to include their information in the children’s prescriptions,” Thái added.
Yes, but would it serve the real purpose?
A Hanoian mother, Trương Thị Ánh Hồng felt the new rule was “unnecessary and complicated”.
“Suppose someone comes a long way from other provinces to Hà Nội and forgets to bring their card, what will doctors do then?”
It is also a difficult rule to implement. Doctor Nguyễn Tá Dũng from the Family Doctor Clinic in Hà Nội said his facility knew about the requirement but had not been able to comply. They did not know where to write the parents’ ID card numbers, he said.
“Neither our prescription form nor patient management system has a line for the ID number. And there’s no way we can write it by hand each time – it would be too time-consuming,” he said.
A new prescription form was issued alongside the circular, which has a space for the identification number. “But now we would have to modify our software to comply with that new form. Too much hassle,” he said.
More importantly, this requirement will not reduce out of prescription antibiotic sales at pharmacies, he said. “Not to mention the wholesale pharmacies – they can’t be monitored with these prescriptions,” he said.
As much as I appreciate the authorities’ aim to tighten control on medicine use, I think this is a well-intentioned idea that does not work.
On the one hand, it troubles parents whose don’t carry their identification cards everywhere they go and complicates the administrative procedures at hospitals. On the other hand, it does not strike at the root of antibiotic overuse, if that’s what the real aim is. Adding the identification numbers will only let inspectors know exactly who pharmacies sell antibiotics to, not prevent them from selling antibiotics without doctor’s prescriptions, which will anyway require another rule or set of rules. Antibiotic abuse is a serious enough problem that cannot be addressed with half-measures.
Actually the new ID rule would not even qualify as a half-measure. It would be a no-measure. And should be dealt with as such. — VNS