VietNamNet Bridge – Social Insurance Department head Pham Luong Son spoke to Thoi bao Kinh te Viet Nam (Viet Nam Economic Review) about quota-based health-insurance payments. 

Do you think quota-based health insurance payments are suitable to the current situation as many people say it helps to minimise overspending by insurance funds?

The payment is adjusted yearly depending on medical costs for the year before. The health centres will be allocated enough funds to take care of those who take out insurance.

The quota-based payment system is not applied for diseases that require costly treatment such as heart surgery and treatment for cancer and haemophilia.

Applying this kind of payment, hospitals can manage insurance fund actively, raise the responsibility of involved parties and patients don't have to deal with so many procedures when hospitalised or discharged from hospital.

Does this mean hospitals have a more decisive role in spending insurance funds and is there the risk of hospitals at lower levels keeping patients on instead of transferring them to higher-level hospitals?

With patients who require medical treatment that is beyond the ability of the doctors at the lower levels, no hospital wants to keep patients like these because it poses a high risk to the patient's life and the reputation of the hospital.

However, medical costs at hospitals at higher levels [national/ central or provincial hospitals] are much higher than those at district and communal hospitals, putting financial pressure on patients at big hospitals.

In some cases, hospitals at lower levels don't transfer patients to hospitals with higher expertise because they fail to predict the development of the patients' disease.

Moreover, to avoid overspending of the health insurance fund, the national/provincial hospitals have maximum payments for patients transferred from lower levels based on real costs of the year before. So, the hospitals have no chance to push up medical costs too high. The Health Ministry and Viet Nam Social Insurance are implementing a pilot programme on a payment method that varies according to types of diseases to avoid abusing insurance funds

 How have quota-based payments been implemented so far?

As scheduled, this payment method is implemented at district hospitals. In 2010, 10 per cent of district hospital nation-wide have implemented this.

This year, it expanded to 30 per cent and by 2015, there will be two kinds of health insurance payments, quota-based payment and disease-based payment.

[Now, there are three kinds, including service-based payment, which means the insurance fund pays for all medical services and medicine.]

Now, all district hospitals and health centres in northern Hai Duong Province apply quota-based payments. In Ha Noi, Thanh Nhan Hospital has a pilot implementation programme and it will expand this by the third quarter of this year.

So far, the country has about 400 health centres at the district level, accounting for one fifth of all district centres, that are implementing the quota-based payment system, helping to limit overspending of health insurance funds.

Do patient benefits suffer as a result of hospitals being able to decide on how to spend the funds on their own?

Social insurance offices still supervise hospitals in this area to ensure benefits to patients. Moreover, hospitals will focus on offering good services to improve the quality of medical examinations and treatment while reducing costs.

The longer the duration of the treatment, the more money hospitals have to spend. The hospitals also have to calculate medical treatment costs so that the quota will not be reduced for the year after.

When applying service-based payments, in some hospitals, patients are asked to take many services. This is a way for hospitals to take back their investment in facilities but it is also a waste of insurance funds.

However, when applying quota-based payments, hospitals need to take into account which services to offer and how to use the fund effectively.

VietNamNet/Viet Nam News