Minister of Health grilled on health care and medicine price control

Minister of Health, Nguyễn Thị Kim Tiến at a Q&A session yesterday. - VNA/VNS Photo An Đăng

Answering a question from Nguyễn Phi Thường, deputy from Hà Nội and other deputies about the abuse of health insurance, the minister said the ministry’s inspectors found the abuse occurred in many localities, involving both health care facilities and insured people.

She blamed the problem on the increase of healthcare services and said many people have taken advantage of a new regulation which allows insurance card holders to use any clinic or hospital without a hospital transfer from grassroots-level clinics as previously.

Some people visited health facilities for examinations between 20 and 30 times in a short period of time, Tiến said.

According to the minister, since implementing a government decree giving financial control to hospitals and clinics, card holders have benefited from better check-up services and treatment. However, hospitals have used techniques in diagnosis and treatment to intentionally prolong treatment to cash in on services.

To deal with the situation, she said, the ministry would tighten the health management process and strengthen supervision activities. It will work with Viet Nam Social Insurance to outline a ceiling expenditure and renovate the financial control models for health facilities.

Hospitals will be asked to link their medical examinations results with each other to eliminate redundant examinations, she said, adding that it this will be implemented at centrally-run facilities first before applying at all levels by the end of 2018.

Nguyễn Thị Minh, General Director of Việt Nam Social Insurance, said that abuse of health insurance has become popular.

For example, some patients stayed in hospital for up to seven days after a lense replacement surgery while normally a patient needs to stay two days after surgery, she said.

“In past years, district-level hospitals had bed occupancy rates of less than 100 per cent but it is reported at between 200 and 300 per cent at present in many provinces. This is abnormal,” Minh said.

This year, the health insurance fund is estimated to spend about VNĐ80 trillion (US$3.5 billion), an increase of VNĐ7 trillion ($308 million) compared with last year, she said, adding that the hike was also unusual.

In response to a question on human resources in the health sector, with personnel and skill shortages common, Tiến admitted that it was a shortcoming of the sector at grassroots levels.

This was why many patients wanted to be transferred to hospitals in provinces and cities, she said.

Tiến also said many doctors at grassroots levels wanted to work at higher level hospitals or private ones for better salary.

To tackle this, the ministry has devised policies to help outstanding students in medical universities work in local healthcare centres.

In addition, more satellite hospitals will be built and modern techniques and facilities will be transferred to provincial-level hospital to ease overloading at central-run hospitals.

Answering a question from deputy Trịnh Ngọc Phương of Tây Ninh Province about the price of medicine in Việt Nam, which is said to be higher than many countries in the region, Tiến said the medicine market in Việt Nam was stable after implementing bidding for medicine.

According to international health organisations, the price of generic drugs was 10 per cent lower than the average of six ASEAN countries namely Singapore, Malaysia, Thailand, Indonesia, Philippines and Brunei.

Medicine price is one of nine major groups in the Consumer Price Index. Assessment from international organizations is needed to confirm that medicine prices in Việt Nam are higher than other countries, she said.

Regarding medicine price control, the ministry has sent a report to the National Assembly, she said. The Ministry of Health has worked with the Ministry of Finance, the Ministry of Planning and Investment, and Viet Nam Social Insurance to amend regulations of the Law on Medicine Bidding, to enhance transparency, fairness and economic efficiency.

In response to questions raised by Dương Minh Ánh, deputy from Hà Nội, about over the counter medicine and the abuse of antibiotics in treatment, the minister said she took responsibility for the fact that people could use pharmacies without a prescription.

She promised that the health sector would solve the problem despite it being a hard nut to crack.

The ministry has issued many circulars on prescribing medicine and managing pharmacies in accordance with Good Pharmacy Practice standards but with little success, she said.

The ministry has assigned the Drug Administration of Việt Nam to pilot a management model which will be applied nationwide soon. There should be a complete renovation in the healthcare sector, Tiến said.

The shortage of inspectors in the field was hindering the management of medicine, she said, adding that it has just 300 staff nationwide.

On the abuse of antibiotics, the minister said, the ministry has submitted a strategy on the issue to the Government.

In the future, the sector plans to apply e-prescription and e-dossiers to use medicine more effectively.

Answering Nguyễn Chiến, a Hà Nội delegate about health worker’s ethics and attitude, Tiến admitted some doctors and nurses have poor attitudes towards patients.

To improve this, she said the health sector has introduced hotlines to receive complaints from patients.

Strict punishment has been applied to violators such as issuing warnings, cutting bonuses and even firing them.

In the first six months of the year, hospital managers issued warnings to 185 doctors and nurses who showed improper attitudes to patients, cut bonuses of 68 medical workers, transfered 13 others, removed one from a position and fired 5 people.

Speaking at the end of the session of Minister of Health, National Assembly Chairman Nguyễn Thị Kim Ngân said that the health sector has made positive changes, especially in treatment quality. Patient overloading at hospitals has been gradually improved thanks to measures taken at many health facilities and transfers from grassroots levels to central hospital have been reduced.

The NA chairman also pointed out shortcomings in infrastructure, management of facilities, the shortage of medical staff and the low capacity of health workers. People with minor ailments going to big hospital, causing overloading and waste at lower levels should be addressed, she said.

She pointed out that the abuse of health insurance, purchasing medicine without prescription and accidents in medical practice were issues that the health sector needed to tackle.