Thứ Năm, 5 tháng 12, 2019

Money and health

  Hoa Tran       Thứ Năm, 5 tháng 12, 2019
We had a complicated brain operation that cost about a million dollars. They are homeless patients, the US government pays for the hospital.

The incident occurred during my visit to the University of Michigan, USA about 10 years ago. Professor La Marca took me to visit the hospital. The first reaction of me at that time, was to think of the huge amount of hospital fees; and the second is a ton of paperwork will have to do, "how much is reporting for that huge amount of money?".

It was not until evening, in the atmosphere of a calming bar at Ann Abor, that I asked La Marca about the procedures that the doctors where he had to make the case. "Doctors don't have to do anything. The secretariat will take care of that," I was surprised when he said.

And as far as he knows, it is not too complicated. In particular, he was equally surprised, when I, a doctor, asked that. According to the American professor, a doctor with a few hundred dollars an hour should not do three paperwork. And even a secretary with a salary of $ 20 an hour needs to simplify the procedure, so that the hospital does not have to spend too much on salary.

And I have also found the answer to the second question. In any country, especially countries that precede Vietnam, the state must always find ways to ensure that the poor can be treated. The proportion of state budget for health spending is very high, their GDP is much larger than ours, so the budget for health care is much larger. They are always looking for ways to increase the budget for the poor.

And in us, every once in a while, when the Ministry of Health adjusts prices of medical services, newspapers, social networks are noisy. What is the quality does not increase that price increases, what is the price increase so the poor die. Netizens have the opportunity to swear at the emotionless doctor, no money for cure, conscience is not equal to the monthly salary. The doctors competed in writing and quarreling again. What is the cheap, starving wages, which is overloaded. Another crowd protested, that they had to follow their careers, and if they wanted to have money, they would go to do other jobs ... The Internet "market" was filled with wails, plaintive, loudly about arguments, sometimes. is swearing.

Everyone thinks they are right. Everyone sees the problem from others, but for their part, it is just passive, forced into that position. The whole society kept on tumbling. The payer complained, "What you get is too expensive to pay, you will die". The person who received the money was also unhappy, "Why is the salary so low?" ...

Since the days of the French colonial war zone, medical personnel were extremely rare. The government has made urgent decisions, such as medical students will have to go to the localities to directly examine and then return to study. After graduating from the university, he did not study specialties but went to see a doctor for a medical examination.

Peace, then war again. And when the country was reunited, no one dared to correct the distortions in medical training, as well as the medical management mindset that was completely patched and arrogant to match wartime.

In order to valuate health services, the health sector must first set a minimum health service standard. At the same time, social managers must also set a minimum standard of living, and in turn, the minimum standard of living for health workers. The price of health services must be sufficient to cover the price constituents, including the cost of medical staff salaries. When there is a minimum price for health, people will set a budget spending for health and a receivable amount for health insurance.

However, we are doing the opposite. We see how much the budget has, and how much we can spend on health. From that money, people calculate what to invest in health.

Similarly, a percentage of the employee's salary is set, and the decision to collect Health Insurance is proportional to that. No one has been able to accurately answer the scientific basis for paying 4.5% (or 2%) of salary for Health Insurance. That rate is built completely emotional. I know there will be critics, that 4.5% or 2% of the other is not emotional, because the salary is much, other needs are now, so only how much is left for health. Then worse, health has been ranked below. Turns out, there are many other things that take precedence over health.

If health is the most precious thing, then the cost of health must be the biggest, and must be of primary concern. And so, the share of health spending must be first, how much is left to be divided by other needs. In advanced countries, the percentage of income for health is much more than that 4.5%. In Vietnam, a lower level of income should, in fact, have a higher proportion of income for health.

Because health is not considered as valuable as it is often said, it is only about health insurance that decides how the doctor should see the doctor, what to do, how to give the medicine, and decide always what to use and what not to use. Because only that much money only.

Meanwhile, many public health facilities use part of the budget to work together with some private health businesses - in the form of socialization - to make a profit. That is, part of the budget should have been focused on the poor, again invested in the rich, who could afford to pay for the one-night bed cost equal to the poor's monthly salary.

Only when we appreciate the importance of health, only when we have a proper and scientific policy on health; And only when we know how to allocate a reasonable budget to the poor will no longer have to deal with public opinion when raising prices for health services.

And I want to remind you, health workers learn to make a living. They do not learn vocational to charity. It is the responsibility of the state to ensure that health workers are well cared for in life, and have a working environment sufficient to perform their functions and duties.

In my place, I always try not to let doctors, nurses, technicians, pharmacists handle money with patients. Everything about money is transparent. Anyone can know how much it costs to do such things, from a small pill, to a major operation. But when the money comes, the accounting department, the cashier will work.

I don't know if anyone thinks that I don't trust doctors, pharmacists, nurses, technicians. But honestly, I consider it a respect for them, so that they do not dispense their devotion for money. I wonder if I'm too old-fashioned?

Vo Xuan Son
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