From the case of a boy in Nam Dinh who 'had to pay to receive emergency care': Is it necessary to pay in advance for hospital fees?

Even though no relatives took him to the emergency room, Mr. C. was still taken to the operating room to have the bullet removed. Photo: Bich Nhan

In fact, many seriously ill patients who come to the emergency room without relatives or money are still treated immediately by hospitals in Dong Nai . However, the situation of many patients escaping from the hospital after treatment also puts hospitals in a difficult position.

“Saving lives is the top priority”

After being shot in the stomach, on the night of May 1, Mr. TMC (25 years old, residing in Vinh Cuu district) was taken by local people to Dong Nai-2 Hospital for emergency treatment, then transferred to Dong Nai General Hospital for further treatment due to the medical condition beyond his professional capacity.

Doctors determined that Mr. C. suffered an abdominal wound caused by a bullet and was not accompanied by any relatives. This was an emergency case, so the doctors and nurses examined him and performed paraclinical tests such as ultrasound and abdominal CT scan to determine the "path" of the bullet.

After that, patient C. was immediately taken to the operating room to have the bullet removed. "At this time, the patient's family had not yet arrived with the patient, but we continued the surgery to save the patient's life," said Master, Doctor Cao Thanh Tung, Department of General Surgery - Digestive, Dong Nai General Hospital - the person who performed the surgery on patient C.

Ms. Truong Thi Thu Phuong, the sister of patient C., added that when the family entered the hospital, Mr. C. was in the operating room. Currently, Mr. C. is recovering after surgery. “Without relatives by his side, my brother is still being treated normally by the doctors and nurses. As soon as we arrived at the hospital, my family paid the hospital fee in advance. At that time, the surgery was over,” Ms. Phuong said.

Head nurse of the General Emergency Department of Dong Nai General Hospital, Thi Tuyet Nhung, said that the case of patient C. is not rare. Almost every day, the department receives patients in serious and critical condition. These patients will be given priority for emergency care even if they do not have family members accompanying them or do not have money...

For other emergency cases, patients are also examined and have necessary paraclinical tests such as ultrasound, X-ray, CT scan or wound suturing... and are stable before requesting to pay the advance hospital fee. "We have a process and it is included in the hospital's grading scale. Every day, the hospital has cases of patients requesting approval for exemption from hospital fees due to homelessness, serious illness or difficult circumstances" - Ms. Nhung shared.

A patient with a heart attack is being treated at Long Khanh Regional General Hospital. Photo: Bich Nhan

In 2024, the family of Ms. Nguyen Thi My Hanh (residing in Bau Sen ward, Long Khanh city) also rushed her to the emergency room at Long Khanh Regional General Hospital due to an acute myocardial infarction. At that time, Ms. Hanh's family member was in a state of agitation, difficulty breathing... In parallel with the patient's emergency, the doctor had to explain the patient's condition to her family. Accordingly, Ms. Hanh's aunt had an acute myocardial infarction and needed cardiovascular intervention to save the patient's life.

With the family’s consent, the patient was quickly taken to the Interventional Cardiology Room to have a stent placed to overcome the “near-death” situation. Only when the patient was taken to the intervention room did the hospital ask Ms. Hanh’s family to pay an advance for the hospital fee because the cost of the stent placement was quite high.

“As soon as I got out of the ambulance, the doctors quickly took my aunt into the room to give her oxygen, intubate her and perform a bedside ultrasound. Seeing my family member seriously ill, I was extremely worried,” Ms. Hanh confided.

According to Decision 1313/QD-BYT in 2013 of the Ministry of Health, which regulates the collection of advance hospital fees from patients, the hospital is responsible for: checking health insurance cards and related documents; collecting advance hospital fees for cases of examination upon request or beyond the prescribed level...

In addition, according to Article 18 of the Law on Medical Examination and Treatment No. 15/2023/QH15 dated January 9, 2023, patients participating in health insurance are obliged to pay for medical examination and treatment costs beyond the scope of benefits and benefit levels prescribed by the law on health insurance. People without health insurance cards are also obliged to pay for medical examination and treatment costs according to the law.

Hospital… still worried

Of the total 150-300 emergency cases per day at Long Khanh Regional General Hospital, about 10-20% are seriously ill patients. Specialist Doctor 2 Nguyen Thi Lan Phuong, Head of General Planning Department, Long Khanh Regional General Hospital, said that the hospital has implemented the policy of not collecting advance payment for hospital fees at the Emergency Department. However, in reality, over the years, the situation of patients escaping from the hospital is not uncommon.

“After the examination, the Emergency Department doctor will have the patient do paraclinical tests such as ultrasound, tests or X-rays, etc., and the patient will “go home” immediately without paying. Or there are many cases where the patient is drunk and is given medicine by the doctors, and when the patient wakes up, he or she will go home without “forgetting” to pay the hospital fee. We have encountered this situation almost every day for many years,” Dr. Phuong shared.

A doctor explains to a patient's family about the patient's serious condition at the Emergency Department, Long Khanh Regional General Hospital. Photo: Bich Nhan

Meanwhile, the Ministry of Health also has regulations on the patient's obligation to pay hospital fees when entering the hospital, regardless of whether they have health insurance or not. Specialist Doctor 2 Le Thi Phuong Tram, Deputy Director of Dong Nai General Hospital, said that since 2017, public hospitals have been financially autonomous. Therefore, hospitals must use hospital fees to pay salaries and bonuses for medical staff or pay for medical supplies, medicines, etc. to pharmaceutical and medical equipment companies.

Dr. Tram said: “We do not require patients to pay in advance for every hospital admission. Depending on the specific condition of each patient, doctors and nurses will handle the case flexibly but still prioritize the patient's life above all else. However, in cases where high technology and high costs are used and family members are accompanying, we still have to request some advance payment to ensure hospital operations.”

When a patient escapes from the hospital, the hospital must pay for the patient themselves because there is no other way to handle it, especially for patients who do not have health insurance but must use high technology. Therefore, many hospital leaders believe that in order for doctors and nurses not to have to "balance their minds" between the problem of "saving people" or keeping the fund (especially in the current situation where public hospitals are financially autonomous), there needs to be a common fund for emergency cases.

No advance payment for hospital fees at the Emergency Department

After the incident of "requiring full payment of hospital fees before providing emergency care to a boy who had a traffic accident" in Nam Dinh, more than a week ago, the leaders of Long Khanh Regional General Hospital directed that cases admitted to the hospital in emergency conditions at the Emergency Department of this hospital do not need to pay an advance payment.

The hospital will collect money from patients in the following cases: hospital transfer, emergency examination to get a prescription and hospitalization (collect advance payment at the treatment department).

Bich Nhan

Source: https://baodongnai.com.vn/xa-hoi/y-te/202505/tu-vu-be-trai-o-nam-dinh-phai-dong-tien-moi-duoc-cap-cuu-tam-ung-vien-phi-co-can-thiet-khong-ce7227b/