Regulations needed to ensure efficiency of public hospitals

Doan Xuan Tien, Deputy Auditor
General of the , made the statement at a workshop
entitled Autonomy mechanism to public
hospitals and the role of the State Audit of Vietnam (SAV) held recently
in Hanoi.

He said the dearth of regulations
meant hospitals still relied on the State budget and could not cover their
expenses or find funds to invest in equipment and other facilities to improve
health care services.

According to Nguyen Nam Lien, Director
of the Planning and Finance Department under the Ministry of Health (MoH), as
many as 160 public hospitals independently controlled their regular
expenditures by the end of last year.

Another 1,364 hospitals with
partial financial autonomy could control between 80 and 90 percent of their
regular expenditures.

Nguyen Truong Son, Deputy
Minister of Health, said positive results had been recorded in providing
autonomy to a number of health facilities.

Autonomy helps reduce State
spending, while the quality of health care services is improved, meeting
patients’ demand, according to the official. Most have been
proactive in mobilising private investment to upgrade their medical equipment.

Statistics from the ministry
showed that State expenditure for the health sector decreased over the past
three years. The State budget allocation for hospitals in 2018 was 3.9 trillion
VND (137 million USD) lower than in the previous year.

While applauding the increasing
number of hospitals with budget autonomy, Lien also pointed out shortcomings
which need to be solved.

In accordance with the Law on the
management and use of State Assets and Government Decree No 151, if public
hospitals want to purchase medical equipment or facilities, they have to join
with investors and undertake procedures like a business. This was not
appropriate, he said, adding that many health facilities seek upgrades to
improve care, not to increase revenue.

Regarding the results of SAV
inspections at public hospitals, Chief Auditor from the SAV Le Dinh Thang said
there was a pattern of hospitals collecting more than the allowed amount of
money and abusing high-tech medical services and medicine. These incidents
worsen the financial burden on poor patients and uninsured people and reduce
their access to care.

According to Thang, a number of
centrally run hospitals are expanding in-demand health care services to collect
more fees. Many of the services could and should be conducted at the provincial
or district level to improve funding for these lower level hospitals.

Nguyen Trong Khoa, Deputy Director
of the Medical Examination and Treatment Department under the MoH, said a
number of problems had been revealed during the Vietnam Social Insurance and
the MoH’s joint examination of health insurance and treatment.

A number of health facilities had
intentionally prolonged patients’ treatment and unnecessarily prescribed expensive
medicines, he said.

“We saw some doctors made five or
six diagnoses in a medical record during an inspection at a hospital,” he was
quoted by Kinh te & Do thi (Economic
and Urban Affairs) newspaper as saying.

Khoa emphasised the need to
improve the management capacity of hospitals to minimise problems relating to
professional skills and financing.

To solve difficulties for
autonomous hospitals, participants at the workshop agreed it was necessary to
allow them to make independent decisions on buying equipment and medicine
according to their demand to ensure efficiency. The building of regulations to
avoid abusing treatments and medicines as well as assure reasonable prices was
also a must.

Pham Dinh Cuong, an economic
expert, said hospitals should be clear on what they could do and what they
could not do while exercising their right to autonomy.

Bui Sy Loi, Deputy Chairman of
the National Assembly Committee for Social Affairs, suggested the Government
complete mechanisms on financial autonomy for public hospitals to prevent
negative effects on health care when the market economy is applied at
hospitals.

He also called for increased
State spending for health care to ensure sufficient investment in preventive
care and health care at a grass-roots level.-VNS/VNA