Le Van Phuc, Head of the Department of Health Insurance under the Vietnam Social Insurance spoke with Dtinews about proposals to increase medical treatment fees.
Unreasonable increases
Are there any more provinces applying new health service fees besides Bac Ninh? What do you think about the proposals to increase fees?
Bac Ninh is so far the first and only province to apply new higher health service rates. Over 20 other provinces and cities have received approval from the local departments of Health, Finance and Social Insurance and are only waiting for approval from their people’s councils. In addition, 10 others are still considering new rates. Nearly 20 provinces and cities have sent their proposals to the Vietnam Social Insurance but their proposed rates are too high and have been rejected.
Could you specify the rates proposed by the provinces and cities?
10 of 50 provinces and cities proposed too high rates (90-100% of the cap defined by the Ministry of Health), 15 others proposed increases of 85-90% of the capped rate.
According to the Ministry of Health’s instructions on this issue, the increase in health service rates in an area must based on the current healthcare infrastructure, equipment, personnel and the socio-economic development of that locality.
However, remote and mountainous provinces including Cao Bang, Lao Cai, Dak Lak, Son La and Vinh Long have proposed higher rates than others. Their proposed rates are near to the maximum rate cap which was only allowed to be applied at large hospitals such as Bach Mai, Cho Ray, and Hue Central Hospital. Meanwhile, other provinces with similar conditions only proposed modest rates, such as Lang Son (78% of the cap), Bac Giang (71%), and Lai Chau (70%). Hanoi and Haiphong only proposed the rates of 73% and 72% respectively.
Moreover, the cap rate defined by the Ministry of Health is only applied at hospitals which serve 35 patients per examination desk. Therefore, it is unfair for patients if hospitals which cannot offer such service ratios still apply high rates.
How will the higher health services rate affect health insurance funding and patients?
When raising health services rate, 35- 40% of the population who do not have health insurance card will be the most heavily affected. Even those with health insurance cards will also be affected because they still have to pay from 5-20%. As such, people in low-income areas will face lots of difficulties if these proposals are approved.
Overcrowd hospitals in big cities
In addition to its direct effect on the health insurance fund and patients, do you think these new rates will drive patients from these areas to hospitals in major cities?
I think definitely yes. For example, hospitals in Bac Ninh Province have raised their services fee to an average rate of 85% of the rate cap while those in Hanoi are only applying a 73% rise; and it is very likely that many people in Bac Ninh will come to Hanoi’s hospitals for examination and treatment.
What is Vietnam Social Insurance doing to curb the trend of raising service fees to the maximum rate in many areas?
The Ministry of Health will decide the rate at those hospitals under its management. At other localities, the provincial People’s Committee and People’s Council will take the decision.
At provinces and cities which have proposed large increases, we have directed provincial social insurance departments to report to the provincial People’s Committees about the unreasonableness of their increase and its effect to the people’s lives and health insurance funds. We have also sent letters to leaders of these provinces and cities, asking them to reconsider and decide on a reasonable rate. However, the provincial People’s Committee and People’s Council will make the final decision, and though we have sent a letter to Bac Ninh Province, they still approved the new high rate.
By August, 70% of localities will apply new health services rate and the health insurance funding will still be able to settle payments due in 2012. However, with this rate increase, it is predicted that many localities will overspend this fund by 2013 and it will need to ask the government to raise the health insurance rate.