Chapter 7.2 Examination and Treatment

1. Chapter 7.2Examination and Treatment Prepared by Nguyen Trong Khoa

2. UPDATE OF MAJOR NEW POLICIES

3. Eleventh Party Congress Access and equity: • Complete the model of organization of the grassroots health care network. Strengthen capacity of the commune health station; • Ensure that the insured receive examination and treatment services in an advantageous manner; • Implement effectively policies on examination and treatment for policy beneficiaries, the poor, children, ethnic minorities and the elderly • Develop strongly traditional medicine combined with modern medicine; Strengthen capacity for management of curative care; hospital management • Reform the operational mechanism and especially the financial mechanism of public sector health facilities with an orientation towards autonomy, openness and transparency.

4. Eleventh Party Congress Improve quality of examination and treatment services: • Standardize quality of health services, hospital quality, step by step reach regional and international standards. • Improve medical ethics, fight abuses in examination and treatment service provision. • Strengthen capacity and complete or upgrade hospitals at all levels. Modernize certain leading hospitals. Build additional specialist hospitals in large cities, and especially encourage private investments in developing high quality specialist hospitals.

5. Implement tasks assigned in the 5-year health sector plan (2011-2015)

6. Complete the system of legal documents(For implementation of the Law on Examination and Treatment and development of technical guidelines and regulations) Implemented • Draft Decree to implement the Law on Examination and Treatment • Issued: Circular 07/2011/QĐ-BYT Guiding nursing and patient care in hospitals; Circular 08/2011/QĐ-BYT guiding nutrition and diet in hospitals • Currently updating and developing new treatment guidelines and technical guidelines, patient care guidelines Difficulties, impediments • Capacity to develop legal documents in examination and treatment is somewhat limited • Number of legal documents, professional technical guidelines, treatment guidelines and care guidelines is immense. • Resources invested for this purpose remain limited.

7. Implement health technology assessment Implemented • Not yet Difficulties, impediments • A new issue in Vietnam, lack experience for implementation

8. Adjust technical referral system to expand services to lower levels, facilitating access to quality services close to the people Implemented • New Circular guiding the technical referral system was developed, waiting for promulgation. Difficulties, impediments • Patients still don’t trust the technical professional capacity of lower level health facilities

9. Continue to implement the National policy on traditional medicine, strengthen traditional medicine Implemented • Traditional medicine network developed rapidly after the National Policy was passed. • Government passed action plan for development of traditional medicine in Vietnam to 2020 Difficulties, impediments • Awareness and interest in traditional medicine remains low.

10. Improve quality of curative care services: Overcome inappropriate use of drugs, paraclinical and high tech services. Implemented • Developed and issued National action program to strengthen management of laboratories to the year 2020. • Established and put into operation 3 lab testing quality verification centers • Developing guiding circular on hospital quality management and National plan for improving quality of examination and treatment services • Annual hospital survey performed. • Some measures for quality control have been implemented: patient record audit, hotline… Difficulties, impediments • Program to check on quality of lab tests has only begun to be implemented • Quality assurance methods not yet applied widely. • Not yet implemented external quality control measures. Not yet a program to check on use of drugs, or compliance with treatment guidelines • Autonomy policy has increased the risk of abuses of drugs, lab testing and high tech services

11. Continue to promote professional mentoring, implementation of Decision 1816 Implemented • Decision 4026/2010/QĐ-BYT issuing regulations on division of professional mentoring responsibilities in examination and treatment • Annually, more than 400 health workers are seconded to work in lower facilities to facilitate technology transfer Difficulties, impediments • Technology transfer from province to district and district to commune is still limited. • Inadequate human resources in terms of quantity and quality

12. Resolve overcrowded hospitals Implemented • Currently implementing many methods: increase specialist beds, reduce average length of stay, implement technology transfer to lower levels, administrative reforms. Initial reductions in overcrowding are being seen. Difficulties, impediments • Technical competencies at lower levels remain limited • Investments in specialist hospitals in lower levels remains slow, not yet meeting demand. • Autonomy mechanism is tending to break down the referral system, with higher level facilities treating common diseases.. • Morbidity patterns are changing, the health care system is not responding quickly enough. • Number of people covered by insurance has increased, a factor leading to increase in demand for services due to increased access.

13. SUPPLEMENTARY SOLUTIONS (1) Implementation of solutions as proposed in the 5-year plan include: • Continue to strengthen and refine the curative care network at all levels • Adjust technical referral system in order to expand services and medical technologies, especially to lower levels to facilitate the people accessing quality services close to home. • Improve quality of health services • Control overcrowding at hospitals • Hospital financial management • Improve hospital management capacity • Develop traditional medicine system

14. SUPPLEMENTARY SOLUTIONS (2) • Continue to assess implementation of Circular 03 to ensure a uniform model at the district level, refine the grassroots curative care network. • Issue and implement Decree on penalties for administrative violations in health insurance; Develop legal documents guiding payment for disease screening services through health insurance, essential drug list and medical consumables, list of high tech expensive services and resolve problems in paying for health care for traffic accident victims • IEC to people to expand health insurance coverage; Continue to research rolling out capitation payments, case mix payments. Strengthen capacity of provincial health bureau staff in charge of health insurance..

15. SUPPLEMENTARY SOLUTIONS (3) • Adjust user fees appropriately. • Set up a quality management system in curative care. Develop curative care quality indicator set. Promote the setting up of organizations to accredit quality, methods for assessing and piloting assessment and certifying quality. • Strengthen mobilization, awareness raising of leaders and managers about quality. Strengthen training on quality management. Implement quality control methods in medical facilities. • Implement pilot on clinical quality accreditation in order to strengthen compliance with professional guidelines, and control treatment costs.

16. Thank you!