The healthcare sector closed the year 2018 with remarkable achievements, with various adjustments made to medical service prices improving public healthcare.
Minister of Health Nguyen Thi Kim Tien granted an interview to Vietnam News Agency’s reporter on the issue. Financial autonomy in state-owned hospitals has raised considerable concern from society. Can you explain the Ministry of Health (MoH)’s policies to ensure the benefits of both medical institutions and patients? As we know, the autonomy mechanism has promoted state-owned hospitals’ motivation and creativity in their organisation and effective use of human resources and finances, contributing to improving the quality of healthcare services. The hospitals will be able to mobilise non-state capital to develop infrastructure and equipment, and reduce state budget spending. However, autonomy has shown several limitations, including assigning more subclinical services, lengthening the time of hospitalisation, saving human resources and reducing costs to enhance the difference of budget collection and spending.
Therefore, the MoH is building solutions to enhance autonomy mechanism in state-owned hospitals. Which measures will be carried out in the near future? The ministry has classified autonomous hospitals into four groups: those that have stable, sufficient revenue to cover expenditures and have some left to invest in facilities, equipment and human resources; those that can handle expenditures only; those whose revenues can partly cover expenses, and; finally, those that are entirely dependent on the State budget. The first group use non-state capital to make investments or they receive state money for investment but since they become autonomous, they have to invest on their own, except in special cases.
In addition, the ministry has built a complete legal corridor, which attaches the responsibility of heads of the hospitals in managing assets, finance and human resources. Autonomy handover must be in accordance with the hospitals’ financial capability. If a hospital has strong financial power, it will be more autonomous in organisational structure and finance. Autonomous units must be able to ensure regular spending and investment, and they must have a management board to decide important issues of the hospitals. The ministry is targeting autonomous medical units who are able to build and issue healthcare service price mechanisms coupled with an evaluation system of hospital quality. Any hospital that receives a good rating for its service quality will get a higher price coefficient, and vice versa.
Many people are raising a lot of questions related to the differences in service prices at state-owned hospitals. When will the MoH issue a circular stipulating ceiling prices for medical services in all state-owned hospitals?
A circular giving detailed instructions for the building of prices for healthcare services is being developed by the MoH. It will stipulate principles for calculating prices, which cover costs and rational accumulation for re-investment. Heads of hospitals are responsible for developing and determining the prices of healthcare services and price listing in line with regulations. Regarding clinics that use state-invested infrastructure and equipment, hospital leaders are allowed to decide levels of collection, below the maximum prices issued by the MoH. The circular will be issued and put into effect in early 2019.
Could you please explain the MoH’s policies to handle issues related to payments in accordance with the healthcare insurance payment norms to ensure the benefits of patients while lessening pressure on hospitals?
The health sector is the pioneer in shifting to fee-for-service mechanism, and it is working for a common price mechanism for all hospitals. There are several challenges ahead to deal with as there are some hospitals with costs higher than common norms while many have costs below the standard band.
The MoH has made adjustments to economic and technical standards and prices of several technical services, making them suitable with actual costs. Under the Prime Minister’s guidance, the MoH is working with the Ministry of Finance and the Vietnam Social Security to reach agreement on instructions for healthcare insurance payment, assuring the benefits of patients, the Vietnam Social Security and hospitals while complying with legal regulations on service prices and facilitating conditions for hospitals’ development. What is the focus of the health sector in 2019?
This year, the sector will implement programmes to improve the efficiency of the clinics’ operation and public health. It will work to prevent disease outbreaks, carry out target programmes on health and population, control the differences in sex ratio at birth, and promote healthcare services for the elderly, among others. The sector will also continue to complete medical service prices, enhance autonomy and promote decentralisation. The move aims to expand healthcare insurance coverage, bolster public-private cooperation in the sector and help private healthcare to develop.