Is referral for medical examination and treatment difficult?

Is referral for medical examination and treatment difficult?

(Chinhphu.vn) - In the opinion of Ha Nam voters, for the application of health insurance, on the insurance card, it is recorded as a national value but it is very difficult for people to seek medical care and to be transferred. Voters hoped to have a health insurance regime more fair and convenient.

Regarding this issue, The Ministry of Health responds to voters as follows:

For the referral, the Ministry of Health has issued specific documents such as hospital regulations issued together with the Decision No. 1895/1997 / QD-BYT dated September 19, 1997 of the Minister of Health sacrifice; the Circular No. 14/2014 / TT-BYT dated April 14, 2014 of the Minister of Health regulating the transfer between medical examination and treatment facilities; the Circular 37/2014 / TT-BYT dated November 17, 2014 of the Minister of Health guiding the registration of initial medical examination and treatment and transfer of medical examination and treatment services for health insurance and some other relevant documents.

In Article 5, the Circular No. 14/2014 / TT-BYT regulates medical examination and treatment facilities to transfer patients from lower levels to higher levels when meeting the following conditions: The disease is not suitable to the capacity in diagnosis and treatment and the list of techniques of the medical facility approved by a regulatory authority in healthcare or, the disease is suitable to the capacity in diagnosis and treatment and the list of techniques of the medical facility approved by a regulatory authority in healthcare but, due to an objective reason, such medical facility is not qualified to provide diagnosis and treatment. Depending on the list of techniques approved by a regulatory authority in healthcare, if the directly superior facility does not have suitable medical techniques, patients shall be transferred to a higher-rank facility; Before the patient is transferred, a medical consultation shall be held to appoint the receiving facility (excluding rank 4 clinics and medical facilities).

Thus, according to Point a, Article 5 of the Circular No. 14/2014 / TT-BYT, the decision of the patient is transferred from the lower level to the higher level when: The disease is diagnosed outside the technical list of the medical facility. medical treatment has been approved by a competent state health agency; The disease is directly treated by a doctor to determine that it exceeds the professional capacity of the medical establishment. However, it is highly dependent on the capacity, qualifications, and prognosis of each physician for specific medical conditions to determine whether or not the disease is eligible for referral or not. each sick person. In fact, in the case of not being able to predict the extent of the disease, the lower level medical examination and treatment facility believes that it is necessary to monitor the progress of the disease to see if it is beyond its ability to treat, leading to the retention of people. disease in the lower level for too long, slowly transferred to the higher level.

Example: A child who is under 5 years old comes to a medical facility with a diagnosis of childhood pneumonia / diarrhea, this disease is within the ability of the lower level to treat; but after a period of treatment the disease can cause sudden respiratory distress / depression without anticipation. To determine if the medical facility keeps the patient in the lower level for too long, delaying the transfer to the higher level is difficult. Through the studies, the evidence as well as reports of hospitals sent to the Ministry of Health have not recorded the phenomenon of keeping patients mentioned above. In fact, no medical facility wants to keep patients beyond their ability to treat because the risk of complications can occur.

According to the regulations of Vietnam Social Security, hospitals are allowed to deploy and pay health insurance for technical services approved by competent authorities (the Minister of Health approves the actual technical list currently under the Ministry's Hospital, Director of the Department of Health approves the technical list for implementation at the Hospital under the Department). If within the approved technical catalog the hospital transfers the sick person to the higher level, it will be deducted from the hospital's health insurance fund, affecting the hospital's revenue. This may lead to the phenomenon of keeping patients sick so as not to reduce the hospital's revenue.

To overcome this situation, the Ministry of Health has some solutions such as: Strengthening the direction, inspection and supervision of the implementation of regulations on referral issues for medical examination and treatment facilities; Improving professional and technical capacity of lower level medical examination and treatment facilities; Promoting the implementation of the project of satellite hospital, satellite faculty, high technology transfer (regardless of state hospitals and private hospitals); considering this as one of the basic solutions for training high-quality medical staff in the lower level, at the same time promoting the effectiveness and efficiency of the existing hospitals; Promoting the quality assessment of hospitals (regardless of state hospitals and private hospitals) according to the set of criteria for assessing hospital quality, proceeding to classification of hospital quality, attaching service payment rates Medical equivalent to the quality of the hospital.

Formulating and submitting to the Government’s Prime Minister schemes: Recognizing the results of medical examination and treatment among medical establishments; comprehensively improving the quality of medical examination and treatment for all levels. Continous strengthening and perfecting the grassroots health system. Changing mechanism of payment of health insurance settlement.

Currently the Ministry of Health cooperates with Vietnam Social Security to amend Decree No. 105/2014 / ND-CP dated November 15, 2014 detailing and guiding the implementation of some articles of the Law on Health Insurance accordingly, proceeding to effectively apply the methods of payment for medical examination and treatment expenses covered by the Health Insurance Law included: Per capita payment is the payment according to the norms of medical examination and treatment costs and payment rates. on each health insurance card is registered at the medical examination and treatment facility for health insurance for a certain period of time; Payment by service price is payment based on the cost of drugs, chemicals, supplies, medical equipment, medical technical services used for patients; Payment in case of illness is payment according to the pre-determined medical examination and treatment expenses for each case according to the diagnosis.

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