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Final review meeting of the study “Assessment of actual benefits and out-of-pocket payments of the insured at public health facilities”
On the 1st of October 2014, Health Strategy and Policy Institute organized a final review meeting of the study “Assessment of actual benefits and out-of-pocket payments of the insured at public health facilities”. Principal researchers of the study are Dr. Hoang Thi Phuong and Dr. Khuong Anh Tuan. Dr. Hoang Thi Phuong, Deputy Head of Health Economics Department, the principal researcher, was representing results of the study. Objectives of the study: i) To describe the services currently covered and not covered by HI at public health facilities and ii) To determine the direct medical costs incurred by the insured1 at public health facilities and the reasons why they have to pay. The study used a cross-sectional design and in-depth interviews, group discussions with key informers in 3 provinces/cities: Quang Ninh, Ha Nam and Can Tho. 1402 bills of insured outpatient and 1327 bills of insured inpatient prior to April 30, 2012 (before the issuance of Circular 04/2012/TT-BYT on prices of 447 health services) at general hospitals at district, provincial and central level were collected and analyzed. The study showed that there were some services in the HI benefit package that insured patients still had to pay for. This was primarily due to lack of consistency, updates, and guidance in some legal documents and policies on HI (e.g. Decision 23/2005/QĐ-BYT, Decision 36/2005/QĐ-BYT, Circular 31/2011/TT-BYT, Decision 21/2008/QĐ-BYT). On the other hand, there were also delays in policy implementation at the local level (e.g. delay in approval of service prices for hospitals). In general, the payment made by insured inpatients accounted for high proportion of total medical cost of 30.3% at all levels and of 38.1%, 26.8% and 12.5% at central, provincial and district level respectively. In total direct medical costs incurred by the insured, the payment for inpatient services not covered by HI fund at central and provincial hospitals accounted for the highest share. It was 67.9% at central hospitals and 50.1% at provincial ones. At district hospitals, insured patients only paid co-payments as regulated. In contrast, for outpatient services, insured patients at all hospital levels only paid for the regulated co-payment. Expenditures of drugs, blood transfusions and infusions, consumables; procedures, surgeries, and paraclinical tests accounted for the major proportion of total payments made by insured patients. The volunteer groups made up the greatest proportion of total direct medical cost incurred both inpatient and outpatient services, other groups had insignificant proportions. Recommendations: It is necessary to review, update, supplement or consistently revise the list of health services, drugs, and consumables that are covered by HI fund at each hospital level in order to ensure benefits for insured patients and minimize the OOP payments. The study was approved by the scientific board for its scientific method, practical and useful results. The research team would then finalize the report based on comments of scientific board. Dr. Tran Van Tien, chairman of the scientific board, was briefing comments of the board members and making conclusion. ________________________________ [1] The direct medical costs incurred by the insured include i) the regulated co-payment (5%; 20%; 30%; 50%; 70%) and ii) payment for healthcare services not covered by HI fund (payments for difference between the hospital price and HI price, services are included in the scope of HI but not covered by HI fund and services are not included in the scope of HI)
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