Although the Ministry of Health has just issued a circular as a basis to support health insurance patients when they have to buy medicine outside, the difficulties of patients still exist.
The Ministry of Health has just issued Circular 22/2024/TT-BYT regulating the direct payment of medicine and medical equipment costs for people with health insurance cards who go to see a doctor or receive treatment. The Circular, which takes effect from January 1, 2025, is considered a means of helping tens of millions of patients nationwide.
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| Health insurance patients still have to face the worry of buying medicine outside. |
However, it is not easy for patients to pay for the medicine they have spent, especially since not all medicines and medical supplies purchased from outside can be paid for.
According to the guidance of Circular 22/2024/TT-BYT regulating the direct payment of drug and medical equipment costs for people with health insurance cards going to see a doctor or receive medical treatment, cases where the health insurance fund pays for drug and medical equipment costs directly for people with health insurance cards going to see a doctor or receive medical treatment include: Drugs on the list of rare drugs; medical equipment of type C or D, except for in vitro diagnostic medical equipment and personal specific medical equipment.
Regarding this, according to pharmacist Nguyen Thanh Hien, Head of Pharmacy Department, Viet Duc Friendship Hospital, there are times when the hospital cannot ensure medicine and supplies for patients.
Most of the drugs in short supply are not on the list of rare drugs. Many patients lack drugs and the hospital cannot transfer them to another hospital because it is the last line of treatment and the patient's condition is serious...
Currently, the hospital is lacking Albumin and an immune-boosting drug. For a surgical hospital like Viet Duc, Albumin will make surgery very difficult. On October 18, the hospital opened a bidding package, there were 30 groups of drugs that no unit bid for.
Previously, in 2022, no unit bid for Albumin for Viet Duc Friendship Hospital. Currently, the hospital's patients are having to buy Albumin from outside.
From another perspective, a representative of Lao Cai General Hospital commented that if the hospital lacks medicine and patients have to buy it outside at drug retail establishments, the purchase price will be higher than the winning bid price at the hospital.
So when the patient pays with health insurance, will they be paid at the outside price? For a patient with long-term treatment, the difference in price purchased outside is quite large, so how will this difference be resolved?
Also talking about the existence of Circular 22, at the National Assembly forum, delegate Tran Chi Cuong (Da Nang) said that Circular 22 on direct payment of medicine and medical equipment costs for people with health insurance cards when going to the doctor has not resolved existing problems.
The reason is that the Draft Law on Health Insurance only stipulates that the drugs to be paid for are in the list of rare drugs. The list of rare drugs only has more than 400 active ingredients, while the number of active ingredients paid for by the health insurance fund is currently 1,096 types, not including some traditional drugs, drugs according to other circulars of the Ministry of Health...
In addition, the demand for rare drugs is lower than usual. Thus, Circular 22 stipulates that payment for rare drugs only does not completely solve the problem and does not ensure the rights of health insurance participants.
Clause 2, Article 2 of Circular 22 stipulates that “Type C and Type D medical devices, except for in vitro diagnostic medical devices, personal specific medical devices, and medical devices on the list of medical devices issued by the Minister of Health, are purchased and sold like ordinary goods according to the provisions of Decree No. 98/2021 and Decree No. 07/2023.
Thus, Circular 22 only partly solves serious and specific cases such as stent placement, screw surgery, etc. In reality, there are many medical devices of type A or B that are frequently used and are very necessary in medical examination and treatment such as gloves, infusion lines, syringes of all kinds, and needles that are not directly paid for.
With so many poor patients currently having to pay out of pocket for medicine, it can take a long time to get health insurance, so where do they get the money to pay, while many people have to borrow?
Regarding this question, according to Ms. Tran Thi Trang, Director of the Department of Health Insurance, Ministry of Health, poor patients pay in advance to buy medicine and supplies, then make payment procedures with the social insurance agency later.
According to regulations, the payment period is no more than 40 days from the date of diagnosis and prescription by the doctor. This is a new step instead of the current situation where patients have not been paid.
This also reduces the situation of off-prescription, the state management agency and insurance will detect cases where inappropriate prescriptions are still given to patients to buy outside. Patients will have less difficulties.
However, when doing procedures, we have to wait, it takes time, causing difficulties for poor patients. This is undesirable, so the Ministry of Health will try to find other solutions to gradually overcome this situation.
In the draft revised Law on Health Insurance, the Ministry of Health has amended the provisions of Article 31 that when medical facilities lack medicine, they do not force patients to go out to buy medicine but instead allow hospitals to transfer medicine to each other, or hospitals must buy directly, call back and pay directly to the social insurance agency. This is also a humane approach when building the Law.
According to the Director of the Department of Health Insurance, the Ministry of Health is urgently developing decrees and circulars. When the revised Law on Health Insurance is passed by the National Assembly and takes effect, the Ministry of Health will have instructions on payment from medical examination and treatment facilities to social insurance agencies soon, responding to urgent situations, not allowing patients to spend their own money to buy and then pay to social insurance agencies.
It is expected that the revised Law on Health Insurance will take effect from July 1, 2025. The Ministry of Health will have time to develop a guiding circular to submit to the Government and in a short time, patients will improve the situation of having to pay out of pocket to buy medicine outside.
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