Burden of Healthcare Fee Rise

The information about hospital fee hike from the Ministry of Health not only increases burdens on patients but also reveals a lot of irrationalities.

 

Mr Pham Le Tuan, Director of Finance Planning Department under the Ministry of Health, said, in the past 10 years, the Ministry of Health has mentioned hospital fee hikes almost every year. This adjustment to hospital charges will affect most uninsured workers.

Many poor patients are struggling to pay hospital fees. Many patients at K Hospital, Viet Duc Hospital or Bach Mai Hospital told that they had to spend millions of Vietnamese dong for each treatment. Hospital fee hike seems to be very familiar to regular patients like Nguyen Thi Hang, a 63-year old lady in Dong Da district, Hanoi. She has had to pay high for medical services, not as stated in the price frame in 1995. She is now wondering whether this is the pretext for hospitals to raise service fees which are already very high.

 

Hang said “I have been treated in many hospitals and the check-up fee is already VND50,000 - VND70,000 each. Bed service fee is VND150,000 - VND350,000 a day. If the ministry continues to lift up the fee rates, this will be a very heavy burden for patients.”

 

According to a survey on treatment expenses in 170 critical cancer patients conducted by the Hanoi-based K Hospital, expenses covered by health insurance accounted for only 35.5 percent, personal finance for medicines was 13 percent, hospital fees made up for 6.5 percent and other expenses like meal and sheltering took up 45 percent. Another survey by the Vietnam Medical Economic Association showed that nearly 60 percent of poor households ran into debt because of medical expenses. Despite being treated in lower-level hospitals with smaller medical expenses, they are the heaviest financial burden for them in relation to all groups of patients.

Mr Vu Xuan Bang, Deputy Director of Health Insurance Policy Implementation Committee, said: “The current hospital fee rates are now low but the hike rates stated in the draft need reconsidering and recalculating. The pay of VND3,000 for a check-up is actually low but the pay of VND20,000 for each examination is a relatively high rate in a hospital consulting 800 - 1,000 patients a day. Is it enough for settling fees for electricity, water, stationery, doctor’s services, etc? A patient paying VND180,000 for bed use a day still has to share the bed with other ones.”

 

Bang added the Ministry of Health has reiterated that hospital fees currently contribute a part of hospitals’ expenses but the price structure includes wages for doctors and compensation for depreciation of materials and equipment. For example, the fee for treating a wound (with depth of less than 10 centimetres) is VND157,000. The doctor service is VND18,000 (over 10 percent). Even, the doctor service accounts for VND6,900 in the check-up pay of VND25,000. This means that health workers are paid twice, one from medical services and another from the State Budget.

 

Although the Ministry of Health has explained that hospital charges do not affect 53 million people with health insurance policies because they are paid off from 80 to 95 percent of the fees. However, in reality, insurance policyholders are poor or seriously ill and medical expenses are almost unaffordable to them. Thus, medical service charges increase, the value of their self-paid fees (ex-insurance amount) will increase accordingly. Anyway, they still lose more although they are insured.

 

However, a representative of the Health Ministry affirmed that the rise in service charges will concur with an improvement in service quality. Hospitals will have enough funds to provide better services and above nuisances will be brought to an end. Mr Nguyen Ngoc Hien, Deputy Director of Bach Mai Hospital, said: The newly proposed hospital fees only included direct expenses, not wages, training, asset depreciation, etc. He explained that a specialised bed in the Active Treatment Department costs VND1 billion and it is usually attached with ventilators, electric needles and oxygen tanks but a patient needs to pay only VND18,000 for a day of treatment here. Using this facility, even the new hospital fee rates are not enough, he analysed.

What will we get from higher hospital fees? Dr Nguyen Cao Luan, Head of Artificial Kidney Department, Bach Mai Hospital, said hospital fee hike will step up the implementation of medical insurance for policyholders and the health insurance fund will have enough resources for best services for patients. However, we need to set up the Poor Patient Support Fund whose finance is sourced from hospital fees to support poor patients to continue treatment, Luan added.

 

According to experts, the formation of such a fund is a lifebuoy for poor patients.

 

Recently, Health Minister Nguyen Thi Kim Tien said new price rates will be applied to 350 services but the changes will be made in a preset roadmap. Priority will be given to what is deemed more urgent. Minister Tien said the drafted hospital fee policy is being discussed and the ministry will set up an independent review council before it is launched. Medical service charges proposed by hospitals are just for reference. She asserted that the renovation to financial mechanism of the health sector must be accepted by the public and based on the spirit of equality in enjoyment of medical services.