P.V.S., 48, from Tan Son Nhat Ward, took his mother to Thong Nhat Hospital for a follow-up examination for underlying conditions including diabetes, hypertension and lupus. His mother has been receiving treatment for chronic conditions there for nearly 20 years. This time, she had to postpone her appointment because the doctor monitoring her condition had already reached the health insurance patient quota.

Although they were advised to switch to another examination room, the elderly woman still wanted her familiar doctor to continue monitoring her condition to ensure continuity in her treatment plan. The mother and son decided to leave and return the following week, planning to arrive earlier.

Under health insurance reimbursement rules, insurance covers 100 percent of examination fees when a doctor treats up to 65 patients per eight-hour workday. For consultations exceeding 65, social insurance agencies reimburse only 50 percent of the rate from the 66th patient onward. If the threshold violation persists for up to three months, social insurance ceases reimbursement entirely for visits beyond the 65th patient.

What do physicians say?

A dermatologist at a top-tier hospital in Hanoi noted he can manage 90 to 100 patients daily while maintaining quality standards.

"Patient volume depends on physician experience and condition complexity. For simple conditions like allergic dermatitis or skin cancer screenings, a central-level doctor routinely manages 80 to 100 patients daily. Meanwhile, complex systemic or autoimmune diseases require extended medical histories and detailed consultations, limiting volume to 30 or 40 patients," he explained.

In his view, limiting the number of consultations out of concern that doctors might rush through examinations is not necessarily appropriate. Nor is it reasonable to assume that seeing too many patients automatically means providing poor-quality care, because no doctor wants to rush through an examination; the appropriate number depends on the type of illness.

He proposed that central-level hospitals, where patient volumes are high, should be allowed to increase the number of patients per doctor by another 20-30 percent a day to make better use of each physician's capacity.

Dr Nguyen Trung Cap, Deputy Director of the National Hospital for Tropical Diseases, said the rule under which the social security agency reimburses 100 percent of the examination fee for only up to 65 patients per doctor is too inflexible. Information technology and artificial intelligence (AI) can help doctors save time on paperwork and manual searches, thereby increasing productivity while maintaining the quality of examinations and consultations.

Dr. Nguyen Khuyen, Director of Van Dinh General Hospital in Hanoi, said the limit of 65 patients per examination room is “just enough” to ensure the quality of examinations and consultations.

The hospital receives around 800-1,200 outpatients a day. It operates 36 examination rooms, ensuring that the number of patients does not exceed 65 per room during an eight-hour shift, avoiding the risk of having costs rejected by the social security agency.

However, during outbreaks of diseases such as hand, foot and mouth disease, measles and dengue fever, the total number of patients can surge to 1,400-1,500 a day. Examination rooms for infectious diseases can then handle as many as 100-120 patients each.

The hospital has to arrange additional consultations outside regular hours, open more examination rooms and deploy doctors from inpatient departments to outpatient care.

This is also the approach adopted by the National Children's Hospital, which receives 4,000-5,000 outpatients a day. 

Dr. Cao Viet Tung, the hospital's Deputy Director, said that on peak days, especially during disease outbreaks, the hospital operates more than 100 examination rooms.

“If we see that a clinic still has 80 patients waiting, the department and hospital have to respond immediately by deploying additional doctors and opening more examination rooms,” Dr. Tung said. This allows the hospital to avoid having health insurance payments rejected while ensuring patients receive medical care.

During an eight-hour working day, a doctor can see a maximum of 65 patients, giving each patient more than seven minutes. Within that time, the doctor must review medical records, take the patient's history, conduct an examination, order paraclinical tests such as laboratory tests, ultrasound scans and imaging, review the results, make a diagnosis, prescribe medication, enter data and explain the findings and treatment to the patient.

“Depending on the illness, a medical examination and the ordering of appropriate tests may take only two minutes. More importantly, however, doctors need time to interact with patients, take their medical history, explain their condition and provide thorough advice,” Dr. Tung explained.

Thanh Huyen