VietNamNet Bridge – The Ministry of Health has proposed increasing medical fees for 350 health services, raising concerns for low earners and those without medical insurance. Health Minister Nguyen Thi Kim Tien and deputy general director of the Viet Nam Social Insurance Nguyen Minh Thao spoke to Tin Tuc (News) and Thoi bao Kinh Te Viet Nam (Viet Nam Economic Times) about ways to deal with the effects of increased medical fees.

* Health Minister Nguyen Thi Kim Tien

Can you tell us why the Health Ministry saw fit to propose an increase to medical fees?

The current hospital fees were calculated on a 1994 framework which is outdated. Currently, the Government is subsidising medical costs for both the poor and the well-off. The well-off demand better services which national hospitals are unable to provide because the fees are too low to produce enough funds to raise the quality. This explains why the public is always dissatisfied with domestic hospitals. 

How does the ministry plan to minimise the negative effects this proposed rise in fees will have on the poor?

Increased medical fees would not affect those covered by medical insurance – office workers, retirees, social beneficiaries; households that are classified as poor, ethnic people and children under 6.

Those who are near the threshold of being poor would receive further assistance as part of the country's efforts to universalise medical insurance by 2014. The health sector would implement many solutions to support them, such as increasing the assistance level from 70 per cent for hospitals fees instead of the current 50 per cent in 2012. This would benefit groups such as students and farmers.

However, many people do not realise the importance and benefits of medical insurance. For example, a patient only has to pay part of the fee for heart valve surgery that could cost up to VND70 million (US$3,300).

Besides, the Health Ministry would mobilise efforts from philanthropists, civil organisations and the media to implement programmes that would assist the poor and the near-poor. The ministry would also create a mechanism that would transfer charity funds directly to the assisted. We would also come up with a list of businesses and philanthropists for each area and supporting money would be given to those in that area who were not covered by medical insurance.  

Can patients expect to receive better medical services?

The ministry issue a guidance on establishing a ministerial project to increase the level of patient satisfaction. It will also establish an independent quality assurance committee. Medical insurance will cover treatment at those hospitals and medical entities that pass quality assurance tests.

However, many provincial and district hospitals do not have enough funds to improve their services, considering that many patients avoid local hospitals. We need to understand medical insurance plays a critical role in whether medical services can be improved, but it takes time and planning. Only with a universal medical insurance can we have a stable financial source to make sure medical treatment is delivered effectively and fairly.

* Deputy General Director of the Viet Nam Social Insurance Nguyen Minh Thao 

How will the expected increase in healthcare cost affect the general population and those who are under the national medical insurance programme?

We're very much concerned about how to extend the coverage of the national medical insurance programme. An estimated 38 per cent of the population does not have medical insurance. This has always been a major challenge, considering most of them are near-poor households, farmers or temporary workers, those who do not have a stable income.

As the Government considers hiking medical fees, it's absolutely critical to increase Government subsidies for medical insurance, heading towards universal medical insurance.

The National Insurance of Viet Nam is suggesting that if medical fees are calculated accurately, the Government can transfer part of the money normally allocated for hospitals to directly cover medical costs for patients buying insurance. Without medical insurance, increased medical fees would become a major burden for residents, especially those who generally have low incomes.

Increasing medical fees would also affect those who are already in the medical insurance programme because they would have to pay about 5-20 per cent of the medical costs. This would particularly affect those who have to seek permanent treatment for diseases such as cancer, diabetes and kidney problems.

Another solution would be to fix the ceiling payment level for patients who are covered by medical insurance. The rest would be paid by medical insurance.

The Ministry of Health has also requested increasing the assistance level for nearly poor households to buy medical insurance cards, from the current level of 50 per cent to 70 per cent in 2012. In reality, many localities have already upped this level to 80 per cent but residents still show little interest in medical insurance. Is there a better solution for this problem?

The proposal to increase the assistance level for nearly poor households already reflects the Government's significant efforts. This level cannot be increased.

We will work to increase resident awareness of medical insurance as an effective way to protect each person in case of illness and also the responsibility of each person to contribute to the welfare of the community.

Besides, we can draw further financial support from local budgets and social organisations. With all of these efforts, I believe we can increase the percentage of residents in the medical insurance programme. 

Would the increase in medical fees deplete the national budget for medical insurance?

It would definitely affect the medical insurance fund. We are working with the Ministry of Health to figure out the effects of increasing medical fees on the security of the medical insurance fund. If necessary, we will suggest to the Government a possible increase in insurance fees.

We are also discussing with the health sector about the possibility of revising the category of medicines that can be paid by medical insurance and standardising medical procedures. Without over-prescribing medicines, we can save thousands of billions of dong for the medical insurance fund. 

The health sector is expected to finalise the plan to increase medical fees for governmental submission by the fourth quarter. Do you think we will have enough time to assess the situation?

The Ministry of Health has established a committee to review and assess the current level of medical fees. The committee also includes representatives from the Finance Ministry and the Viet Nam Social Insurance. The good news is that the Health Ministry has taken very careful steps in this process. We hope that increased medical fees will allow hospitals to develop while still protecting social security.

I think the committee can finish the work before December. This explains why it's hard to predict now how many types of fees would be increased and to what extent.

VietNamNet/Viet Nam News