Satisfaction with Patient Care Policy After Medical Examination and Treatment

90.75%). Only 9.25% of patients were dissatisfied with this issue (6.75% had no opinion). This result is higher than the study by Ha Thi Thuy (2012) which only had 77.1% of patients satisfied. The hospital is gradually developing and improving, the departments are increasingly expanded and more spacious to better meet the needs of patients.

The level of satisfaction and very satisfied with the clinic being equipped with modern and advanced equipment and machinery accounted for 73.25%, 19.5% of patients had no opinion because they did not use the equipment and machinery during medical examination and treatment so they could not evaluate, 7% of patients were dissatisfied and very dissatisfied because they found the hospital's machinery was not adequate to serve them or some opinions also said that the maintenance and repair work was not good, reducing the life of the equipment... limiting the quality of medical examination and treatment, some complained that the hospital had not fully utilized the modern equipment because the staff were not qualified enough to operate the equipment. Compared to the study by Ngo Thi Thuy Nhi (2015), the modernity of the clinic only accounted for 50.6% of satisfied and very satisfied patients. The modernity of machinery and equipment greatly affects the quality of medical examination and treatment, so hospitals need to invest in upgrading the quality and quantity of these machines to further serve the people.

Overall satisfaction with hospital facilities and equipment accounted for 76.35%, dissatisfaction was 23.65%. This result is also similar to the study by Ngo Thi Thuy Nhi (2015) with satisfaction rate of 77.8% and dissatisfaction rate of 22.2%.

5.2.4 Satisfaction with patient care policy after medical examination and treatment

The satisfaction level with the hospital calling to inquire about the patient's health after the time of examination and treatment at the hospital and the satisfaction level with the hospital calling to advise the patient about the health status after the examination and treatment at the hospital was 100% answered that the hospital has not done this. Usually, the policy of caring for patients after examination and treatment is only implemented in private hospitals, while public hospitals are hardly concerned. In the future, hospitals should implement a policy of caring for patients after examination and treatment to better monitor the patient's health condition, at the same time creating sympathy from patients towards the hospital, patients will feel more cared for and cared for.

The rate of satisfaction and very satisfaction with the quality of the medicine provided is 63.2% (59.8% satisfied), no opinion is 6%, unsatisfied and very unsatisfied is 30.8% (30.6% dissatisfied). This result is similar to the study of Ha Thi Thuy (2012) with the rate of satisfaction and very satisfaction with the quality of medicine accounting for 63.5%. The reason for this low satisfaction rate is because the quality of health insurance medicine is not really good. In terms of types, health insurance medicine and medicine for regular examination are not different, but only different in function.

quantity, concentration; in addition, 50-60% of the drugs used in health insurance are domestic drugs (produced by domestic pharmaceutical companies and factories), so the quality of drugs is still limited, leading to a decrease in the quality of treatment for people, patients take a lot of medicine but still do not recover. This is a matter of great concern, affecting the psychology of people when participating in health insurance. They think that it is better to spend more money on medical examination services, or go to private hospitals where the quality of drugs is better. The list of drugs covered by health insurance is one of the factors that determine the quality of health insurance examination and treatment, and health insurance benefits. It is recommended that Cao Lanh District General Hospital in particular and Vietnam Health Insurance in general should have new policies and new solutions to improve the list of health insurance drugs so that people see that the benefits they enjoy when participating in health insurance are worthy (https://xetnghiemmau.com).

Regarding the reason why patients return to the hospital for medical examination and treatment, 74.5% of patients answered that this is because this is where they initially registered for health insurance; some answered that it is convenient, close to home; or because this is the highest-ranking district hospital in the area, so the quality is better than other hospitals. 12% said that the doctors, nurses, and medical staff provide good service. 9.5% felt that the quality of medicine is good. And only 4% answered that the facilities and equipment are spacious and modern. This shows that there are still many backlogs, the quality of health insurance examination and treatment at Cao Lanh District General Hospital is not really good. Most patients return to the hospital for medical examination and treatment because it is close to home, more convenient, and this is also the highest-class hospital in the area, so there is no other choice, not because the service quality is really good. Therefore, improving the quality of health insurance examination and treatment services at Cao Lanh District General Hospital is not only to encourage people to voluntarily and actively participate in health insurance, but also a condition to promote the effectiveness of health insurance examination and treatment for patients, and improve the satisfaction of health insurance subjects with the medical care of the district.

5.2.5 Recommendations for further improvement of Vietnam's health insurance

Nine out of 34 respondents agreed that the quality of health insurance drugs should be improved. This is the most pressing issue for people, as the amount of money they spend on health insurance is not small but the quality of the drugs they receive is not worth it. The Ministry of Health should review this issue and find a solution to ensure that the health insurance fund does not overspend and to ensure the quality of health insurance drugs for people.

Creating fairness in the quality of medicine, services, as well as the service attitude of medical staff for patients with health insurance and services is the opinion of 7 patients coming for examination. These are mainly subjects participating in compulsory health insurance. They feel it is unfair that they are forced to participate in health insurance, have to pay a lot of money but in return the quality of examination, treatment and illness is not good. This injustice also creates hesitation for people when

participate in health insurance, and the goal of our country's health insurance is to move towards universal health insurance. Therefore, overcoming this problem is very urgent, the Ministry of Health should pay attention.

There are 7 subjects who have opinions that there should be an additional Saturday or Sunday for health insurance examination, mainly serving the subjects of workers, civil servants, students. Because these subjects all go to school or work on weekdays from Monday to Friday, they do not have time to go to the clinic. If they go to the clinic on these days, they have to take a day off, losing a day of work or a day of study, affecting competition, as well as work and study performance.

Five patients proposed to open the provincial health insurance system for outpatients. They said that this would help patients access better quality medical examination and treatment services if the health insurance services at the commune or district level do not meet their medical examination and treatment needs. This has both positive and negative aspects; patients participating in health insurance will enjoy better quality medical examination and treatment, but at the same time, it will also lead to overloading of provincial hospitals due to the increasing number of patients.

Improving the professional qualifications of doctors at the grassroots level to solve the problem of requesting to go to a higher level as well as improving the quality of treatment is the opinion of 3 patients interviewed. This is also an issue that many people are concerned about. We request the Ministry of Health to pay attention and have a solution to solve this problem.

Two patients suggested that the quality and quantity of machinery and equipment at grassroots hospitals should be improved to improve the quality of medical examination and treatment.

For students, health insurance premiums should be reduced or completely free, this is the opinion of 2 patients who came to see the doctor, because this is a group of people who do not have economic capacity, so they should receive more attention from the community.

Two patients suggested that health insurance cards should have a photo and a stamp on the back so that people do not need to bring their ID cards when going to the hospital. This is also a good idea to simplify administrative procedures and avoid complicated paperwork.

One patient said that there should be a policy for patients who have participated in long-term health insurance (over 5 years): such as calling for consultation for a general examination. This is a good thing to do to show care for patients, improving the quality of medical examination and treatment.

Health insurance for students should be purchased by household to reduce costs. There is one comment. Because according to the current Health Insurance Law, the monthly contribution of voluntary health insurance participants in households is gradually reduced from the second member onwards, specifically as follows: the first person pays a maximum of 6% of the basic salary; the second, third, and fourth people pay 70%, 60%, and 50% of the contribution of the first person, respectively.

First; from the fifth person onwards, the contribution is 40% of the first person's contribution (National Assembly, 2014).

There must be a separate examination area and separate medicine distribution for civil servants to shorten the examination time because these people have to work in agencies and companies. On the other hand, they pay higher health insurance premiums than ordinary people but have to wait a long time, leading to dissatisfaction. There is one comment.

5.2.6 Overall satisfaction with health insurance treatment

The rate of patients generally satisfied with health insurance examination and treatment is 81%, and 19% are dissatisfied. This result is higher than the study by Ha Thi Thuy (2012) with the patient satisfaction rate of 57.4%. The reason for this difference may be that Ha Thi Thuy's study was conducted at Can Tho Central General Hospital, where the educational level of the people is higher than that of the people in Cao Lanh district, mainly manual laborers. Therefore, their satisfaction requirements are also higher than those of the people living in the district.

5.3 Advantages and difficulties of hospitals in implementing regulations and policies on health insurance

5.3.1 About facilities

In general, the hospital's facilities are quite well-invested, with a total area of 21,836 m2 divided into 9 areas directly serving patient examination and treatment and 8 auxiliary areas. The hospital includes 19 examination departments, 150 beds, 7 clinical departments, 4 paraclinical departments, 4 functional rooms. Compared to Cu Lao Minh Regional General Hospital, Ben Tre in the study of Le Quang Trung (2013), which is also a grade III hospital at the district level but has an area twice as large with 41,000 m2 , 360 beds, 12 clinical departments, 4 paraclinical departments and 4 functional rooms. The explanation for this difference is because Cu Lao Minh area is part of Ben Tre province, with 4 districts: Cho Lach, Mo Cay, Mo Cay Bac, Thanh Phu. Therefore, Cu Lao Minh Regional General Hospital is a general hospital for all 4 districts in the region, so it must be much larger in scale.

5.3.2 About hospital equipment and machinery

The hospital currently has almost all the necessary machinery and equipment as prescribed by the Ministry of Health for district-level hospitals (Ministry of Health, 2004) to serve patients coming for medical examination and treatment. However, the hospital still lacks a CT scanner (CT

– Scanner), so it still cannot meet all the needs of patients for medical examination and treatment. On the other hand, the quality of the machines has degraded and no longer works well due to poor maintenance, some machines are still "covered" and not put into use due to lack of qualified staff to operate the equipment, which also reduces the quality of treatment. A clear proof is the level of satisfaction and very satisfied with the room.

Medical examinations equipped with modern and advanced equipment and machinery only account for 73.25%.

Compared to Vu Khac Luong's study (2012) on the current status of medical examination and treatment for people with health insurance cards at ward health stations in Rach Gia city, Kien Giang, the number of equipment at 3 ward health stations only had 65.9% of the total 176 types of equipment as prescribed. This can be explained because Vu Khac Luong's study was conducted at a health station, so it did not receive much investment, so there was still a lack of equipment; Cao Lanh District General Hospital is a class III hospital, a regional medical examination and treatment center, so it has received more careful investment in equipment.

5.3.3 On the quality and quantity of medical staff

Currently, the hospital has 175 staff, including: 1 Specialist II level and 2 masters on the hospital board of directors, 16 Specialist I doctors, 9 doctors, 4 university pharmacists, 12 secondary pharmacists, 12 nursing bachelors, 16 physicians, 79 secondary nurses, 24 other staff. Regarding the quantity, the hospital still lacks some specialties such as anesthesia, resuscitation, diagnostic imaging, obstetrics, ENT... to apply many new techniques to serve the needs of examination and treatment for patients. Regarding the quality of the team of doctors, medical staff, through the assessment of patients coming for examination, it shows that only 55.75% of patients are satisfied with the professional capacity of doctors; because this is a district hospital, the professional qualifications of doctors are limited. Compared with Trinh Thi Hien's study (2016), the level of patient satisfaction with the professional competence of doctors is higher at 67.01%; because this study was conducted at Dong Da Hospital, Hanoi, a hospital in the city, so the professional qualifications of doctors are also higher.

5.3.4 On the collection and expenditure of the hospital's health insurance fund

Every year, the hospital's health insurance fund is balanced reasonably, without any overspending. Specifically, the hospital's health insurance revenue and expenditure in the last 3 years (2014, 2015, 2016) is presented in the following table:

Table 4.35 Revenue and expenditure of health insurance fund of hospitals over the years

Year

Health insurance revenue (VND)	Health insurance premium (VND)
2014	9,232,160,391	8,770,552,371
2015	10,491,301,622	9,442,171,460
2016	15,239,588,550	13,258,442,039

Maybe you are interested!

The hospital's health insurance fund revenue and expenditure situation over the years has always ensured that revenue is higher than expenditure, thus avoiding overspending. This situation is maintained quite well partly because patients who receive health insurance medical examination and treatment are at the right place of registration.

Initial treatment, limiting wrong-line medical examination and treatment, and going beyond the line can lead to increased health insurance expenditure. This result is quite consistent with the study of Nguyen Le Kim Huynh (2014); revenue and expenditure have increased steadily over the years and there is no overspending.

5.3.5 On the quantity and quality of drugs used for health insurance

The supply of drugs for health insurance in hospitals today generally ensures adequate and timely supply to meet treatment needs and ensure the quality of medical examination and treatment. Regarding the quality of drugs, hospitals always ensure the quality of drugs in prescriptions, instructions for drug use in treatment and ensure the quality of drugs in hospitals. The hospital selects and builds a list of hospital drugs based on the list of modern drugs covered by health insurance according to Circular 40/2014/TT-BYT, the results of drug supply bidding, the actual needs of the hospital and hospital regulations. Compared to the study of Vu Khac Luong (2012), the rate of essential drugs is only 58.6

– 62% because this study was conducted at a health station.

5.4 Limitations of the topic

The study on the current status of medical examination and treatment under health insurance at Cao Lanh District General Hospital was only conducted in a short period of time (April 1, 2017 to May 1, 2017), so many research subjects were missed, and all patients' opinions when coming for medical examination and treatment were not surveyed.

The sample size of the study is still limited, 400 subjects surveyed in 1 month compared to the number of 700 medical examinations/day of the hospital is too different. Therefore, the results do not represent the general satisfaction of all patients coming to see a doctor with health insurance.

The research was conducted on patients aged 16 and over, so children were not surveyed, so the results and conclusions may not fully reflect the current situation of health insurance examination and treatment at the hospital.

CHAPTER 6. CONCLUSION AND RECOMMENDATIONS

6.1 Conclusion

Through the study "Current status of medical examination and treatment under health insurance at Cao Lanh District General Hospital, Dong Thap province in 2017" on 400 outpatients, the following conclusions were drawn:

6.1.1 Satisfaction rate of outpatients receiving health insurance treatment at Cao Lanh District General Hospital, Dong Thap Province

 Overall satisfaction with health insurance examination and treatment accounts for 81%, of which:

 Satisfaction with administrative procedures is 84.85%, with:

 Satisfaction with waiting time is 77.75%

 Satisfaction with waiting time for hospital payment procedures is 96%

 Satisfaction with waiting time for medication is 74%

 Satisfaction with the way administrative procedures are organized is 87%.

 Satisfaction with the seriousness and orderliness of administrative procedures is 88%.

 Satisfaction with the spirit, service attitude and expertise of medical staff is 82.4%, with:

 Satisfaction with staff when receiving patients is 85.25%

 Satisfaction with staff attitude when patients ask for instructions is 87%

 Satisfaction with the service attitude of the clinic nurses is 86.75%

 Satisfaction with doctor's attitude during treatment is 91.25%

 Satisfaction with the attitude of the library fee collectors is 92.25%

 Satisfaction with the service attitude of drug dispensing staff is 83%

 Satisfaction with hospital facilities and equipment accounts for 76%

 Satisfaction with spacious, clean, airy waiting rooms and lobbies with enough seats for patients is 68%.

 Satisfaction with the room, waiting room with numbering area, staff to guide to ensure fairness for patients according to the order of patient arrival is 86%

 Satisfaction with spacious and clean clinic is 90.75%

 Satisfaction with the clinic equipped with modern and advanced equipment and machinery is 72.75%

 Satisfaction with patient care policy after medical examination and treatment (for patients who have been examined and treated ≥ 2 times): 346 patients who have been examined and treated ≥ 2 times

 Reasons for patients returning to the hospital for medical examination and treatment: 74.5% of patients answered that they had other reasons for returning to the hospital for medical examination and treatment (this is where they initially registered for health insurance; some answered because it was convenient, close to home; or because this is a district-level hospital of the highest rank in the area, so it has better quality than other hospitals).

Only 12% said that doctors, nurses and medical staff provided good service. 9.5% felt that the quality of medicine was good.

Only 4% responded that the facilities and equipment were spacious and modern.

 General dissatisfaction with health insurance examination and treatment accounts for 19%, of which:

 Satisfaction with the professional qualifications of the treating physician is 55.75%

 Satisfaction with the department's walkways, flat, spacious, easy-to-walk corridors is 64.25%

 Satisfaction with the hospital calling to inquire about the patient's health after the time of examination and treatment at the hospital: 346 respondents all had different opinions that the hospital did not call to inquire about the patient's health after the time of examination and treatment at the hospital.

 Satisfaction with the hospital's phone calls to provide further consultation to patients about their health status after being examined and treated at the hospital: 100% of patients who were examined more than twice (346 patients) responded that the hospital did not call to provide further consultation to patients about their health status after being examined and treated at the hospital.

 Satisfaction with the quality of drugs provided is 63.2%

6.1.2 Advantages and difficulties of hospitals in implementing regulations and policies on health insurance

Regarding facilities: the hospital has a total area of 21,836 m2 , a scale of 150 beds, 7 clinical departments, 4 paraclinical departments, 4 functional rooms . Currently, the hospital consists of 9 areas directly serving the examination and treatment of patients and 8 auxiliary areas . The clinics are invested in construction very spacious and airy, including 19 departments, arranged on 2 floors. However, the corridors and waiting rooms of the hospital are not spacious, during rush hour are very narrow, making it difficult to move around.

Regarding equipment and machinery: the hospital currently has almost all the necessary machinery and equipment according to the regulations of the Ministry of Health for district-level hospitals to serve patients coming for medical examination and treatment. However, the hospital still lacks a CT scanner, on the other hand, the quality of the machinery has degraded and no longer works well due to poor maintenance, some machinery is still not put into use due to lack of qualified staff to operate the equipment.

Comment