The cost of drugs and medical equipment is changing in a positive direction

This is an activity carried out under the framework of the Memorandum of Cooperation in the field of health insurance between the Vietnam Social Security (VSS) and the US-ASEAN Business Council during the period of 2022-2024. The seminar was attended by the Social Affairs Committee and the Science and Technology Committee of the National Assembly; the Government Office, relevant departments under the Ministry of Health, VSS; the Ministry of Planning and Investment; the Ministry of Finance, as well as some local health departments and social insurance agencies, the US Embassy and US companies in the fields of healthcare and science.

In his opening remarks, the Deputy Director General of VSS - Dao Viet Anh shared the expectation that international experiences will give us new perspectives and approaches to the procurement process, building the list of drugs and medical equipment, as well as methods of controlling drug and medical equipment prices.

Affirming that "the seminar is being held at a more appropriate time," former Ambassador Michael Michalak - Senior Vice President and Regional Managing Director, US-ASEAN Business Council said that this is also an important year for the healthcare sector in Vietnam when many important legal projects are being developed, such as the Law on Pharmacy and the Law on Procurement.

According to statistics from VSS, the implementation of the health insurance policy in Vietnam has achieved many results. Currently, the health insurance coverage rate is 92% of the population, and the rights of health insurance participants are increasingly guaranteed and expanded. They can access more good quality drugs, medical equipment, and high-tech services within the scope of the health insurance fund. Within 12 years, health insurance payments for drugs have increased from 11.5 trillion VND in 2010 to over 40.5 trillion VND in 2022, and payments for medical equipment have increased from about 750 billion VND in 2010 to over 13.5 trillion VND in 2022.

With new forms of bidding such as negotiating drug prices, national centralized bidding (according to No. 43, Decree 63 in the Law on Procurement), good quality drugs but at reduced prices have brought many benefits to patients and reduced the burden on the health insurance fund, providing additional financial resources to ensure the rights of health insurance participants. The drug payment rate decreased from 60-62% in 2010 to 54.5% in 2013 and now it has decreased to about 34% of the total health insurance payment. The payment rate for medical equipment increased from 4% in 2010 to 8% in 2018 and 11.18% in 2022.

VSS’ Deputy Director General, Dao Viet Anh, delivered a speech at the seminar

Challenges of achieving sustainable health insurance goals

To clarify the challenges in implementing the current health insurance policy, Le Van Phuc, Department of Health Insurance Implementation (VSS) analyzed some contradictions between reality and policy implementation objectives. Regarding financial resources, although the coverage rate has reached 92% of the population, the health insurance contribution rate is low, leading to limited health insurance funds. Meanwhile, the demand for medical services is increasing, and people's demand to access new drugs and effective medical equipment for diagnosis and treatment is also increasing.

Illustrative image (VSS)

One of the complex issues at present is the procurement and use of drugs. Currently, drug procurement has been applied in the form of negotiating drug prices, national centralized bidding, and initial results have been achieved, such as reduced drug prices, stable supply, regulated drug distribution, and avoidance of drug shortages. However, this is a new form of implementation, so there are still difficulties in organizing and implementing it. Many BDG drugs have not yet been negotiated for prices or still have a large price gap compared to Generic drugs in Group 1.

Besides, the challenge in purchasing medical equipment is that there is no in-depth guidance on medical equipment procurement bidding, which is still being conducted as ordinary goods. There are no new procurement mechanisms such as negotiating drug prices, national centralized bidding, and no clear regulations on local-level centralized bidding. Purchasing medical equipment at healthcare facilities and localities still faces many challenges. Some medical equipment has high costs, a wide price range, and no maximum payment or payment conditions defined. Health Technology Assessment (HTA) has not yet been applied to determine the list of medical equipment and the payment level for health insurance.

Representatives from the VSS recommended that to ensure a balanced health insurance fund as well as sustainable development of health insurance participants, it is very important to build an effective, safe and cost-effective list of drugs and medical equipment that is suitable for the health insurance fund's payment capabilities. In addition, controlling drug and medical equipment prices through different procurement mechanisms from national to local levels and controlling the use, prices, and quality of drugs and medical equipment from the health insurance fund play an important role in ensuring the reasonable and effective use of the health insurance fund.

Building an effective list of health insurance drugs: How?

In the discussion topic "Applying Health Technology Assessment (HTA) to increase access to innovative drugs," Dr. Nguyen Khanh Phuong, Deputy Director of the Institute for Health Strategy and Policies, emphasized that ensuring access to drugs, including new drugs, is an essential content to implement universal health coverage. This expert recommends the need to apply a comprehensive and coherent approach to enhance access to new drugs, including three pillars: promoting drug innovation, accelerating approval speed, and innovating financial mechanisms.

In addition, reviewing price management policies, procurement, and payment related to the supply of generic drugs to identify necessary adjustments to enhance the access and effective use of this drug group. Studying and learning from international experiences in implementing some policy tools to strengthen the management of generic drugs, such as price negotiation, referencing international prices, applying health technology assessment, and sharing risk agreement. The application of new mechanisms needs to be based on international experiences combined with full analysis and evaluation of the actual situation in Vietnam as well as determining appropriate implementation conditions./.