Higher fees double patients' concerns

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Higher hospital fees could prevent the poor from getting treatment and many question if increased fees will improve services

Patients wait to pay hospital fees at Ho Chi Minh City's Nguyen Trai Hospital. The Health Ministry is evaluating increasing hospital fees as they said current fees are too low to maintain services.

Holding a threadbare bag of clothes in her two arms, Nguyen Thi Lan huddled herself up near a cashier's counter at Bach Mai General Hospital to pay for the treatment of her husband's liver disease.

"We had to borrow a total of VND20 million (US$952) from all my relatives to pay for hospital fees and to buy medicine for my husband," said Lan, a farmer from Hanoi's Thuong Tin District, adding that her husband has no health insurance.

"I don't know how to get enough money to pay for his treatment in the coming days. If hospital fees increase, poor people like us may never dare to go to the hospital."

Lan is not the only one worrying about the anticipated hospital fee increase. A majority of poor people, especially farmers, and those in remote mountainous areas, do not have health insurance, and current healthcare fees are already a big burden.

On September 20, Health Minister Nguyen Thi Kim Tien said the ministry will set up a council to calculate health service fees before implementing increases through 2015.

The ministry requested public hospitals nationwide to calculate actual costs for each service and to report them to the council.

Tien said fees for 350 healthcare services will increase, three separate times, by 2012. Another increase will be implemented by 2015, when healthcare services fees will be calculated based on all expenses, excluding maintenance and salaries being subsidized by the government.

Starting in 2016, hospital fees will be calculated on every expense, according to the ministry.

Increasing fees

The health ministry said current hospital fees are based on a 1995 document and have become outdated. The consumer price index in July was triple that of 1995, so hospitals will face difficulties if the fees do not increase.

In addition, the state budget set aside for hospitals is still low, only VND40-50 million per sick bed each year, not enough to pay salaries, allowances and social insurance for hospital employees. Advanced technology and better equipment have also raised the cost of treatment, said the ministry.

Truong Quy Duong, director of Hoa Binh Province General Hospital, said the hospital should have set aside 3 to 5 percent of its projected spending to upgrade its infrastructure, and 5 to 7 percent to maintain machines and equipment. However, the hospital could not do this due to lack of funds.

Pham Song, former minister of Health, said it is right to increase hospital fees, as local income has increased since 1995. However, the average per capita income is still low, so it is necessary to carefully consider how high the hikes go.

Many poor patients are worried about their ability to pay if the Ministry of Health's proposal on increasing hospital fees is approved. Meanwhile, some others are concerned whether the quality of healthcare services will be improved in accordance with the fee hike.

Le Canh Nhac, deputy director of the Health Ministry's Legal Department, said the outdated hospital fees have hindered efforts to improve health care services.

He said the increase is being considered after one year of implementing the Health Insurance Law that stipulated the reimbursement for whole or partial expenses for many people.

According to a report by the Health Ministry released on September 20, public hospitals nationwide had revenue of VND3.15 trillion in 2010, three times higher than that of 2006. Health Insurance companies reimbursed VND3.26 trillion in 2010.

Heightened concerns

Facing a certain increase in hospital fees, many people are worried that poor people will have less of a chance to access healthcare services, which already lack quality in poorer areas.

Tran Duc Long, director of the Health Ministry's Legal Department, said around 62 percent of the country's total population of 86 million are health insurance policyholders.

"It means the other 38 percent will suffer the hardest," he said. "However, the increase will also hit some groups that are not fully reimbursed by health insurance."

The Health Insurance Law divides policyholders into groups that have their healthcare fees reimbursed between 80 percent and 100 percent.

Nguyen Minh Thao, vice general director of Vietnam Social Insurance, said higher hospital fees could help improve healthcare service quality, but affect 40 percent of local people, mostly the uninsured poor. Thus, it is necessary to increase the number of people having health insurance, so that all local people have the insurance by 2014, he said.

Doan Huu Nghi, director of E Hospital, said: "The quality of healthcare service will improve if hospital fees increase because hospitals are facing a shortage of funds to upgrade infrastructure and buy more equipment and machines."

However, many argued whether healthcare services would improve with an increase in fees.

"There is no certainty that healthcare services would improve due to fee increases," said Cao Van Sang, director of HCMC Social Insurance. "I don't believe that services will improve within three or five years because the root cause of bad services is overcrowding."

"A doctor examines about 100 patients a day, they cannot refuse some of them to improve service," he added.

He affirmed patients concerns that health insurance fees would increase following a hike in hospital fees.

"Health insurance fees can't go unchanged but the amendment will be based on groups. For example, compulsory health insurance will increase less than the voluntary category," he said.

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