New refunding policy to patients with health insurance may see complication

The Health Ministry has developed a draft Circular about medical payment for patients with health insurance, including the proposal to refund those buying medical supplies outside when a hospital cannot provide them.

Patients are buying medicine within the list allowed by health insurance in Cho Ray Hospital

Head Tran Thi Trang of the Health Insurance Department under the Health Ministry shared that the draft Circular stipulates a refund to patients with health insurance when they have to buy medicine and medical supplies outside as a results of a long-term shortage of such supplies in hospitals nationwide.

Accordingly, the Health Insurance Fund directly pays back the money that patients with health insurance use to obtain medicine and medical supplies outside when a hospital cannot provide them as long as the following conditions are satisfied:

  • The prescribed medicine and medical supplies for health insurance participants are within their rights;
  • At the time of prescription, the related medicine and medical supplies are not available at the concerned medical institute;
  • There is no medicine containing the active ingredients prescribed by the doctor.

For a refund from the Health Insurance Fund, patients need to display both the valid prescription and medicine or medical supply invoice to a social insurance office. The refunded amount is the same as the cost printed on the valid invoice issued by a medical supplier and within the limit of benefit of that insured patient.

Feedback from the community on this draft Circular shows much complication when implementing.

Pham Cong Tinh from Binh Duong Province shared that when his mother was hospitalized at Binh Duong Province General Hospital, he was continuously asked to self-prepare medical supplies such as gloves, medicine, needles, syringes, infusion tubes, and even antiseptic alcohol before his mother could receive medical care. Feeling frustrated and annoyed, he transferred his mother to University Medical Center – HCMC for serviced treatment.

He commented that the feasibility of the regulation above is not too high because many pharmacies sell medicine without a valid invoice, not to mention the medicine quality.

Agreeing with that, Nguyen Xuan Hoa from Nho Quan District of Ninh Binh Province shared that instead of stipulating that the Health Insurance Fund pay for medicine and medical supplies bought outside, it is wiser to allow hospitals to obtain those medicine and medical supplies to distribute to patients in need just like pharmacies. Then many complicated procedures can be eliminated.

The State should introduce a suitable mechanism for hospitals to flexibly and conveniently purchase medical supplies to answer the needs of their own patients while the bidding for large quantities of medical supplies is still in progress.

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