Self-medication to be reimbursed by health insurance: Patients’ benefits and safety must be given top priority

23/12/2023 07:35 AM

Health insurance patients who have to buy their own medication or medical supplies due to shortages at medical facilities will be reimbursed under a proposal by the Ministry of Health.

The patients have two options for purchasing medication and medical supplies under the proposal: at the hospital's pharmacy where the patient is receiving treatment, or at pharmacies that have won the bid to provide services at a certain medical facility.

To be reimbursed, the patients will need to provide a prescription from their doctors, as well as an invoice for the purchase of the medication or supplies.

However, the proposal has shown some inadequacies. Patients having to go out to buy medicine will encounter many difficulties.

They are susceptible to risks such as low drug quality and unreasonable prices which directly threaten the patient's treatment and life. Not to mention, in cases of serious illness or emergency without a relative accompanying them, or having to buy medicine at midnight, it will be difficult for the patients to buy medicine and medical supplies.

In spite of efforts, it is impossible for the social security agencies to make the reimbursement immediately after the patients buy the medicine.

It will take time for the social security agencies to make an assessment on medical expenses after the patients submit the after-treatment payment request documents.

The proposal has damaged the meaning of health insurance’s risk-sharing, causing a loss of trust among health insurance participants.

Buying medicine at a pharmacy. Source: Internet

The Government, the Prime Minister and the National Assembly issued a number of documents to address the drugs and medical equipment shortages.

The National Assembly issued the Law on Bidding No 22/2023/QH15, effective from January 1, 2024, which serves as an important legal basis to enhance the autonomy and self-responsibility of agencies, organisations and businesses in selecting contractors, removing bottlenecks in bidding in the health sector. The law allows the appointment of contractors to purchase drugs and medical equipment in case of emergency patient care or to maintain the operation of healthcare facilities in urgent cases, avoiding harm to public lives and health.

The Government issued Decree No 07/2023/ND-CP dated March 3, 2023, amending and supplementing a number of articles of Decree No 98/2021/ND-CP dated November 8, 2021, of the Government on Medical equipment management; Resolution No 144/NQ-CP dated November 5, 2022, on ensuring drugs, medical equipment and payment of health insurance medical examination and treatment costs, among others.

The Ministry of Health issued Circular No 14/2023/TT-BYT dated June 30, 2023, to remove obstacles in bidding for medical supplies and equipment.

According to Decree No 146/2018/ND-CP dated October 17, 2018, of the Government, medical facilities must ensure the supply of drugs, chemicals, and medical equipment in accordance with the scope of professional activities.

To maintain operating funds for medical facilities, from the beginning of each quarter, the social security agencies have paid down a specific sum. Healthcare facilities are responsible for using these funds to provide adequate medicine and medical equipment for health insurance participants, not allowing the patient to pay the cost of medicine and medical equipment themselves.

To create favourable conditions for patients to ensure health insurance benefits and treatment safety, the Ministry of Health needs to direct medical facilities to take responsibility and ensure the supply of drugs and medical equipment in accordance with regulations.

Instead of applying to all cases, the Ministry of Health needs to study making reimbursement on special cases and issue payment instructions in which medical facilities are responsible for directly paying the costs. The social security agencies then will cover the costs based on the medical facilities’ reports./.