Next year, will patients participating in health insurance have to pay for medicine?

Patients with health insurance cards who buy medicine at pharmacies that win the bid will be paid by the Health Insurance Fund if the hospital lacks medicine. Photo: DUC CHUNG

The situation of patients with health insurance cards having to pay out of pocket to buy drugs in the list of health insurance drugs has appeared for a long time, but it is only a phenomenon with a few types of drugs and the cost is not too much, so many patients "click their tongue" and ignore it.

Patients suffer double losses.

However, this situation has become common and "regular" when last year hospitals and localities could not bid for drugs and medical supplies. And the amount of money that patients have to spend is no longer a few tens or hundreds of thousands but millions or tens of millions. Thousands and millions of patients going to see a doctor or get treatment across the country have to buy drugs outside, and the amount will increase to a huge number, causing great damage to patients.

Mr. VHC ( Ninh Binh ) was transferred to the Central Eye Hospital for surgery, but like many other patients, he was referred to a private hospital because the Central Eye Hospital lacked supplies. He should have received most of the costs because the Health Insurance Fund would pay, but when he was transferred to a private hospital, the amount the Fund paid was only a small part of the service price. Therefore, he had to pay a lot out of pocket. A cataract surgery, if covered by health insurance, would only cost about 5 million VND, but if the surgery was performed at a private hospital, the cost would be 8-10 times higher. These are just common diseases so the cost is not high, but if the disease is serious, the cost will be very high. A mother whose child had leukemia had to undergo chemotherapy, and by the 5th infusion, the hospital ran out of medicine and was forced to prescribe medicine not listed on the health insurance list. Each infusion costs from 7-10 million VND, and there are even more expensive chemicals, but the patient is forced to buy them.

According to the Law on Health Insurance, medical facilities and medical examination and treatment facilities must ensure adequate medicine for patients. However, when asked, doctors only explained that the hospital did not have medicine, while hospital leaders blamed the "mechanism" for not being able to bid for medicine. When asked about it with the Social Insurance Agency, they were told that the Law stipulates that medical facilities must pay for medicine for patients if they prescribe them to buy medicine outside. However, medical facilities and hospitals have not been instructed on how to pay. Meanwhile, patients still have to suffer double losses, having to spend money to buy health insurance cards to be covered when going to the hospital, and having to spend money to buy medicine, buy medical supplies...

Where to buy medicine covered by Health Insurance Fund?

To address this issue, the Ministry of Health is drafting a Circular regulating the direct payment of medicine and medical supplies for patients participating in health insurance. The draft Circular is being discussed with relevant agencies and units and widely solicited for public opinion for early implementation.

Ms. Tran Thi Trang, Director of the Health Insurance Department (Ministry of Health) said that according to the draft Circular, the Health Insurance Fund will pay the cost of medicine and medical supplies directly to patients with health insurance cards or pay the cost of medicine and medical supplies to medical examination and treatment facilities that meet a number of conditions such as: Medicines and medical supplies prescribed to patients are within the scope of benefits of health insurance participants; patients are diagnosed, prescribed and prescribed medicine and medical supplies but at the time of use, the active ingredients of the medicine and medical supplies are not available at the medical examination and treatment facility. In addition, when patients have to buy medicine and medical supplies from outside, the draft stipulates that they must buy them at pharmacies that have won the bid at a certain medical examination and treatment facility.

Explaining more specifically about this detail, Ms. Vu Nu Anh, Department of Health Insurance, said that the draft circular does not stipulate that people must buy medicine directly at the pharmacy of the hospital where they registered for medical examination and treatment, but can buy it at any hospital pharmacy and any unit that wins the bid for medicine and medical supplies. Thus, there are two places where patients can buy medicine to be paid by the Health Insurance Fund: the pharmacy at the hospital where the patient is examined, or the winning pharmacy (at another hospital, or outside the winning bid). "Such a scope is very broad compared to the present when people can only receive medicine at the medical examination and treatment facility where they registered for health insurance examination and treatment," said Ms. Nu Anh. The representative of the Department of Health Insurance also affirmed that the applicable conditions must be cases where there are objective reasons why the medical examination and treatment facility has not been able to buy medicine to supply to the patient. If the reason for the lack of medicine is subjective to the hospital, it will not be paid.

According to the draft circular, medical examination and treatment facilities are responsible for guiding people to other hospital pharmacies and the winning pharmacy to buy drugs and medical supplies. In order not to burden doctors, information will be shared in the medical facility system, doctors will know where there are drugs to guide people. This circular is expected to be issued in 2024. The time for patients to buy drugs outside the health insurance is paid for up to 40 days. To make payment, the patient or the patient's relative must present to the social insurance agency the prescription, medical supplies prescribed by the doctor along with the invoice for the purchase of drugs and medical supplies. The cost that the health insurance agency pays directly to the patient is equal to the cost recorded on the patient's legal invoice provided by the hospital pharmacy or the supplier and according to the benefit level within the scope of the health insurance participant's benefits.

Many people asked, in case of buying medicine outside before the Circular takes effect, will they be paid? The representative of the Department of Health Insurance said, although the draft has not specified when the medicine will be paid, but after the effective date of the Circular, if the patient has complete documents and procedures, the Social Insurance agency will pay.

QUYNH HOA

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