Protect people's health care with health insurance policy

Health Insurance - A card that accompanies many people on their journey of medical examination and treatment

This is the second time Mr. Dinh Van Thu (Gia Hoa commune, Gia Vien) has been admitted to the Provincial General Hospital to have a coronary stent placed. His health is gradually recovering, and on his hospital bed, Mr. Thu shared with us about his serious illness.

3 years ago, Mr. Thu often felt tired, had chest pain and difficulty breathing, so he went to the hospital and was diagnosed with coronary artery intervention by placing a stent. This time he was hospitalized with unstable chest pain, coronary artery scan showed that 2 stents placed from the previous time, 1 stent had re-narrowed.

Although he had a serious illness, he was examined and treated promptly, so his health gradually stabilized. The best thing is that with a health insurance card, all of Mr. Thu's treatment and stent costs are covered by insurance. "If I didn't have health insurance, the cost of each stent placement would have been several tens of millions of dong..." - Mr. Thu said.

Currently being treated at the Department of Trauma and Orthopedics (Provincial General Hospital), Ms. Vu Thi Hoa (Yen Thuy District, Hoa Binh Province) said: I unfortunately had a traffic accident in Ninh Binh, so my family took me to the Provincial General Hospital for emergency treatment. With a diagnosis of a torn knee ligament, Ms. Hoa is being treated to reduce swelling of the wound before surgery.

Ms. Hoa confided: Fortunately, I have participated in voluntary health insurance for my three children since 2023, so now I feel secure when I have a health insurance card. Previously, my family enjoyed benefits from Program 135, so we were given health insurance cards. After the program ended, I decided to continue participating because I realized the meaning of participating in health insurance. When I am healthy, the fund will be for those who are unfortunately sick or have accidents. And when I am unfortunately hospitalized, health insurance will accompany and pay. Moreover, with the health insurance examination and treatment (KCB) connection, even though I am from Hoa Binh province and go to Ninh Binh for treatment, my family and I do not have to worry much about the cost...

According to Dr. Nguyen Hoang Thanh, Deputy Head of the Department of Trauma and Orthopedics, Provincial General Hospital: The Department of Trauma and Orthopedics has a large number of patients, an average of 100-110 patients are treated every day, the bed occupancy rate is always 100%. Patients coming here for treatment are mostly cases of traffic accidents, injuries occurring in daily life, work... The cost of treatment and surgery for these cases is often high, with cases of multiple injuries costing up to 100 million VND. The specificity of the patients coming here is that they are all sudden and unexpected cases, so the cost of treatment is an important issue, especially for those with low incomes and difficult circumstances. Therefore, in the process of receiving and treating patients, the doctors and nurses at the Department always try to propagate and guide patients to understand the meaning and importance of the health insurance card...

Many solutions to ensure benefits for people with health insurance cards

In recent years, to meet the high-quality medical examination and treatment needs of people in and outside the province, the adoption of new techniques in examination and treatment continues to be effectively implemented by medical units in the province.

Techniques such as: DSA-based gastric variceal imaging and treatment, DSA-based biliary drainage, ultrasound-guided transrectal prostate biopsy, total thyroidectomy for thyroid cancer, laparoscopic lobectomy, absolute alcohol injection for breast cyst treatment, automated bacterial culture and identification, automated systemic drug-resistant bacteria, quantitative drug-resistant bacteria, hemoglobin electrophoresis, tympanometry, etc. are effectively implemented by hospitals in the province. Therefore, patients have access to new technical applications in examination and treatment right at the local level, saving treatment costs, without having to go to higher levels.

This result is also an important premise to help medical units make a breakthrough in improving the quality of medical examination and treatment, bringing satisfaction to patients, and meeting people's expectations about health insurance medical examination and treatment at medical units in the province.

Social Insurance officers of Yen Khanh district propagate to people about health insurance policy.

According to comrade Pham Thi Phuong Hanh, Provincial Party Committee member, Director of the Department of Health: In recent times, the health sector has closely coordinated with the provincial Social Insurance agency to effectively manage and use the health insurance fund, ensuring the rights of people when receiving health insurance treatment. The Department has worked with the Social Insurance agency to regularly inspect, urge and remind units to strictly implement the regulations on health insurance policies and professional regulations issued by the Ministry of Health.

The Department has issued many documents requiring units to develop a roadmap to improve the quality of medical examination and treatment for people, including ensuring that medical staff comply with the regulations in their practice licenses, develop diagnostic and treatment guidelines, and ensure adequate supply of drugs and medical supplies for medical examination and treatment. Prescription of drugs and medical services must comply with regulations.

Every month and quarter, the Department of Health coordinates with the provincial Social Insurance to monitor the organization of health insurance-covered medical examination and treatment and resolve problems in the implementation of the health insurance policy. Proactively analyze, identify objective and subjective causes and refuse to pay unreasonable health insurance-covered medical examination and treatment costs, especially evaluate the designation of high-tech services and unusual costs that show signs of abuse of the health insurance fund; coordinate to remove difficulties and obstacles in the process of implementing the health insurance policy in the area to fully ensure the rights of people participating in health insurance-covered medical examination and treatment...

In Ninh Binh, implementing Directive No. 38-CT/TW dated September 7, 2009 of the Secretariat on promoting health insurance (HI) in the new situation, over the past 15 years, the provincial Social Insurance has had many solutions to create favorable conditions for people to actively participate in HI.

By the end of 2023, the whole province had 276,696 people participating in health insurance, of which 193,356 people participated in households working in agriculture, forestry, and fishery with average living standards supported by the state budget and 83,340 people participated in other households. To date, the whole province has over 948,000 people participating in health insurance, reaching a rate of nearly 94%.

Comrade Bui Thi Lan Huong, Director of the Provincial Social Insurance, said: In order to use the health insurance fund and ensure the rights of patients participating in health insurance, the Provincial Social Insurance has had many solutions such as: Regularly coordinating with the Department of Health and health insurance medical facilities in health insurance appraisal, monitoring and supervising medical facilities in the management and use of health insurance funds. At the same time, proactively analyzing health insurance costs, evaluating and controlling periodic costs of each health insurance medical facility. Through health insurance appraisal, detecting subjective causes of increased costs, notifying and requesting health insurance facilities to make timely adjustments, ensuring objectivity and transparency between the Social Insurance agency and health insurance medical facilities.

In addition, the provincial Social Insurance has organized direct working sessions with each medical facility on coordinating the control of health insurance medical costs; developing a plan to inspect health insurance medical facilities to prevent profiteering from health insurance funds. Closely coordinating with the Department of Health to promptly resolve difficulties and problems in health insurance medical services and drug bidding to ensure the rights of health insurance patients.

At the same time, the provincial Social Insurance has closely coordinated with the health sector in health insurance treatment in the direction of reform, simplicity, and time saving for patients such as: using CCCD cards, health insurance cards on the VNeID application to go to health insurance treatment instead of paper cards at health insurance treatment facilities, which has been responded to and highly appreciated by people and health insurance treatment facilities.

With the benefits and convenience of health insurance, people in the province increasingly trust the health insurance policy, the number of patients using health insurance cards to visit health facilities is increasing: In 2009, there were 1,147,371 health insurance visits, by 2023 the whole province had 1,748,006 health insurance visits, an increase of 65.54% compared to 2009. By the end of May 2024, there were 744,202 people with health insurance visits (an increase of 39,299 visits compared to the same period in 2023) with health insurance expenditure of more than 509 billion VND (an increase of 99 billion VND compared to the same period in 2023).

Article and photos: Bui Dieu

Source: https://baoninhbinh.org.vn/bao-ve-cham-soc-suc-khoe-nguoi-dan-bang-chinh-sach-bao-hiem/d20240629222443162.htm