Delivering the opening speech at the seminar, Deputy General Director of VSS - Pham Luong Son said: Vietnam is drastically changing the payment method of medical expenses covered by health insurance in order to improve the quality of medical and health care for people through the health insurance mechanism. In recent years, the VSS and the MoH have actively coordinated and been responsible for this change. Up to now, the MoH has issued a circular guiding the capitation payment in outpatient care areas, and is expected to issue a circular guiding the DRG payments by the end of 2021. “Thus, the payment method will be fundamentally renewed. It can be said that this is a big "turning point", and a hallmark in the process of organizing the implementation of health insurance policies in Vietnam". Son emphasized and expressed his hope that international experiences drawn and shared by experts will help Vietnam improve and successfully innovate the payment method for medical examination covered by health insurance.

Overview image of the meeting

Appreciating the medical achievements that Vietnam has accomplished in recent years, the World Banks’s Operations Manager in Vietnam, Ms. Stefanie Stallmeister, cited impressive figures that Vietnam has achieved: The average life expectancy of the Vietnamese people is 76 years old - the highest in the region compared to other countries with similar income, the coverage of health insurance in Vietnam has reached over 89% of the population, etc. However, WB's experts also expressed concern about increasing risks that are threatening the financial sustainability of Vietnam's health achievements, such as: aging of the population, burden of disease with an increasing incidence of cancer, chronic and non-communicable diseases, etc.

"Especially, currently, Vietnam is taking the hospital as the center of the health care sector, with 73% of medical expenses being "poured" into hospitals. In East Asia, there is no country with more hospital spending than Vietnam.”, commented Ms. Stefanie Stallmeister. According to her, one of the key factors leading to the "excessive" concentration for hospitals is that Vietnam is charging medical examination fees according to service charges. Currently, the Vietnamese authorities have fully identified this issue, and decided on the transition of the hospital fee payment system to DRG as what has been applied in many developed countries. However, along with the hard preparations in the past time, Vietnam still needs to design some key foundations to perfect the transition. These are also the main contents mentioned in the discussion sessions of this seminar.

At the afternoon discussion session on May 4, the seminar focused on "What should the organizational structure of the DRG system be like?" with some specific contents: What are the main functions of a strong DRG system? To whom should these functions be assigned? Which agencies, organizations or units would have the potential to participate in the DRG system?, etc. Sharing on how some countries have solved these problems, Mr. Christophe Lemiere - an WB's expert, also shared some examples of Thailand, Estonia, Finland, and France in assigning responsibility for each function of the DRG system (disease classification; DRG category; Data and coding rules; cost accounting data; Relative weight; Basic payment rate) for specific agencies and units, etc.

The seminar also shared international experiences in France, Thailand, Australia and Estonia on the total payment control mechanism for hospitals in the DRG system, and suggested some ideas for Vietnam, such as: How should the "ceiling" level of DRG be applied? Staging DRG-based payments, etc.

International experts attended the online seminar

Sharing at the seminar, Duong Tuan Duc, Director of the Center for Medical Review and Tertiary Care Payments (VSS), pointed out one of the current difficulties in Vietnam when applying DRG is to build the adjustment coefficient (amnesty of reasonable expenses to be paid to hospitals). According to Duc, in Vietnam, the system of medical care facilities providing inpatient services range from the grassroots level to the central level; and within the same group of diagnostics, the costs are hugely different as there is a big difference even at the same hospital grade.

Therefore, the trials on how to calculate the coefficients that have been studied by this group of experts on this payment method have not met the requirements of each group of medical facilities. The second problem is that Vietnam has not yet implemented the cost accounting as a basis for building the basic payment rate. Due to the lack of treatment procedures and guidelines, it is difficult to calculate specific costs incurred on each treatment process. These are the issues that Vietnam is in need of support and advice from international experts, as well as experience in solving this problem in countries that have already applied DRG.

The seminar will take place in 2 days, May 4 and 5 with two sessions to discuss the following main contents: International experience in payment management for hospitals and the transition to DRG payment method; Experience in cryptographic quality management in the DRG payment system. At each session, the delegates will be sharing experiences in applying DRG in a number of countries that have implemented this method of payment for medical costs, issues to be noted, and will together discuss the direction for Vietnam.

The issues of encryption verification system will continue to be discussed at session 2 of the seminar on the afternoon of May 5, with a view to giving suitable directions for Vietnam.