Ensuring medical examination and treatment benefits for health insurance participants

By the end of May 2023, there were 3,200,536 people participating in health insurance in the province, with the health insurance coverage rate reaching 85.65% of the population (excluding groups participating in health insurance outside the province, abroad and in the armed forces). In order to ensure the rights of health insurance participants, in recent times, Party committees, authorities and professional agencies in the province have made efforts to implement many solutions to improve the quality of medical examination and treatment, creating favorable conditions for health insurance participants, thereby creating trust and consensus among the people.

Ensuring medical examination and treatment benefits for health insurance participants A surgery at Thanh Hoa Provincial General Hospital.

Mr. HVC, Cam Binh commune (Cam Thuy) said: He has had degenerative disc herniation for several years now, often having to go to the hospital, sometimes twice a month, each time staying in the hospital for 1 week to more than 10 days. Without a health insurance card, it would be very difficult for him and his family because he could not do heavy work due to the disease, while the cost of inpatient treatment if not covered by health insurance, would make it difficult to treat the disease long-term. Currently, each month for medical examination and treatment, after paying for health insurance, Mr. C. only has to pay less than a few hundred thousand dong.

Every day, at Thanh Hoa Provincial General Hospital, there are more than 1,000 people coming for medical examination and treatment, about 1,000 inpatients, of which over 95% have health insurance cards. To improve the quality of health insurance treatment, the hospital has implemented many synchronous solutions, including increasing investment in facilities, equipment, human resources; effectively applying information technology in management, connecting, and communicating health insurance treatment data with insurance agencies. In 2022, Thanh Hoa Provincial General Hospital examined and treated 160,564 patients with health insurance cards, with a total cost of health insurance treatment of more than 697 billion VND.

People's Physician, BSCKII Le Van Sy, Director of Thanh Hoa Provincial General Hospital said: In the past time, the hospital has focused on leading and directing departments, rooms, and centers to implement many solutions to improve the efficiency and quality of information technology application, digital transformation of healthcare in medical examination and treatment to reform administrative procedures, shorten waiting time for patients. Since April 2022, the hospital has deployed a smart testing system to save time transporting samples, managing samples by barcode; reduce manual operations, synchronize with HIS software, ensure the quality of input samples, accurate test results, 90% of test results are returned in less than 60 minutes and is one of the few hospitals nationwide to fully implement the "one-touch" testing solution.

Deputy Director of the Provincial Social Insurance (VSS) Nguyen The Soi said: In 2023, the provincial Social Insurance signed health insurance treatment contracts with 119 medical facilities; deployed and operated the health insurance appraisal information system, monitored social insurance, and connected health insurance treatment cost data with 100% of health insurance treatment facilities. Thereby, supporting and detecting abnormalities in the level of technical service designation of facilities and the frequency of health insurance cardholders. The social insurance sector has also invested in upgrading the modern information technology system, ensuring that all patient data when going to health insurance is quickly connected to the information system of the social insurance agency. All data of patients going to health insurance at health insurance facilities has been connected to the social insurance agency as soon as the patient enters and leaves the hospital, avoiding duplication, and checking patients going to many places for health insurance treatment at the same time, for the same disease. From there, it helps the health insurance payment process to be quick and accurate, reducing waiting time for patients.

Health insurance is a superior social security policy implemented by the State not for profit purposes to mobilize contributions from the community, share disease risks and reduce the financial burden of each citizen when they are sick, ill, or have an accident... The health insurance benefits of participants are increasingly expanded in both scope and level. Accordingly, the list of drugs paid by the Health Insurance Fund meets the medical examination and treatment needs of health insurance card holders with more than 1,000 active pharmaceutical and biological ingredients and hundreds of oriental medicines and herbal medicines. In addition to drug costs, health insurance participants are also paid by the Health Insurance Fund for technical service costs (with more than 9,000 services) and medical supplies. These include high-cost surgeries and procedures such as robotic surgery, joint replacement surgery, spinal disc replacement, pacemaker placement... Notably, some types of medical supplies paid by the Health Insurance Fund are worth hundreds of millions of VND. As for the cost of inpatient bed days, the Health Insurance Fund will pay based on the hospital class and type of treatment bed used.

In recent years, along with the investment and upgrading of medical facilities in the province, the quality of medical examination and treatment services for the people has been increasingly improved, people have access to many modern medical services, new and highly effective medicines, helping many people overcome illness and disease. In particular, the expansion of initial health insurance examination and treatment activities to district health care and communes, wards and towns has created favorable conditions for the people; especially in remote areas, contributing to saving time and reducing travel costs for people when they are unfortunately sick or have a minor illness... Therefore, more than ever, people need to be clearly aware of the benefits of participating in health insurance, helping to limit financial risks for themselves and their families, while sharing some of the difficulties for the community if someone is unfortunately sick.

Article and photos: To Ha

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