Health insurance patients pay out of pocket to buy medicine outside, what does the hospital say?

Bệnh nhân bảo hiểm y tế chi tiền túi mua thuốc ngoài, bệnh viện nói gì? - Ảnh 1. — Recently, some hospitals in Ho Chi Minh City have experienced a shortage of health insurance drugs provided to patients - Photo: BUI NHI

People have recently reported that some hospitals in Ho Chi Minh City are running out of medicines covered by health insurance, forcing people to spend more money to buy medicines from outside. The treatment process is also prolonged, causing the cost of buying medicine to be quite high.

According to Tuoi Tre Online on August 8, at the Ho Chi Minh City Post Office General Hospital, there were quite a few patients coming for a follow-up examination. Ms. LA (71 years old) has high blood pressure, diabetes and cardiovascular disease. Ms. A. came for a follow-up examination and was prescribed a “hospital pharmacy prescription” of Clopidogrel (Dogrel SaVi 75mg) by the doctor. Although this medicine is covered by health insurance, Ms. A. had to buy it for 32,000 VND.

Ms. A. said that when she went for a follow-up visit, the doctor informed her that the hospital was currently out of the above medicine, so she asked for her understanding and to buy this medicine at the hospital pharmacy. According to Ms. A., the situation only happened this month. In the months before her health insurance follow-up visit, she did not spend money on medicine.

At District 10 Hospital, some patients said that drug shortages often occur.

The case of Ms. NTML (67 years old) has essential hypertension (primary) and mixed hyperlipidemia. Ms. L. has to have a health insurance check-up once a month here. However, both of the most recent check-ups on August 8 and July 11 were missing drugs on the health insurance list. Specifically, the two prescriptions above lacked lipid-lowering drugs including Simvastatin 10mg and Atorvastatin 10mg.

The doctor will handwrite the medicine that the hospital lacks and ask the patient to buy more at an outside pharmacy.

thiếu thuốc - Ảnh 3. — The patient said that at District 10 Hospital, the health insurance medicine was additionally written in blue ink and was prescribed to be purchased outside - Photo: BUI NHI

“Sometimes the hospital runs out of medicine, so I have to go to another hospital to get examined and get medicine. I just hope the hospital will provide enough medicine to ensure health insurance benefits for patients. Patients also don’t have to waste time buying more elsewhere,” said Ms. L.

Speaking with Tuoi Tre , head of the pharmacy department of the Post Office General Hospital, Tran Quoc Thang, said that for the past two weeks, the hospital has been experiencing a shortage of the health insurance drug Clopidogrel.

The reason is that the number of patients needing medication suddenly increased, and some patients also received medication for 3 months under the new Health Insurance Law, causing the medication to run out faster than planned.

Faced with this situation, the hospital has also developed a plan to handle it and prepare an additional bidding package. It is expected that this weekend, after the plan is approved, the hospital will quickly proceed with ordering medicine to ensure the rights of the people.

When will health insurance cover the cost of self-purchased medicine and supplies?

According to current regulations, patients are paid directly when the hospital does not have available drugs or medical equipment covered by health insurance when the following conditions are met:

First of all, the medicine or medical equipment that the patient is forced to buy outside must be on the list of payments of the health insurance fund.

At the time the doctor prescribes or orders the use, the medical examination and treatment facility must be in the process of selecting a contractor to supply drugs and materials without results or unable to select a contractor despite having followed the correct procedures according to the Law on Bidding.

At the same time, the hospital does not have the same active ingredient available (or has it but in different concentrations, dosage forms and cannot be replaced), or does not have equivalent medical equipment for use.

In addition, patients cannot be transferred to other medical facilities in some special cases such as health conditions not allowing, hospitals in medical isolation or final, specialized hospitals.

In case it is not possible to transfer drugs and medical equipment from another hospital and the drugs and equipment are suitable for the expertise of the medical examination and treatment facility and have been paid for by health insurance at other medical facilities, the patient will also be reimbursed if within the scope of health insurance benefits.

BUI NHI

Source: https://tuoitre.vn/benh-nhan-bao-hiem-y-te-chi-tien-tui-mua-thuoc-ngoai-benh-vien-noi-gi-20250819095349185.htm