Accordingly, nationwide, there were 40.4 million health insurance-covered medical examinations, an increase of 6.47% over the same period in 2023; with the amount paid by the health insurance fund being 30,974 billion VND, an increase of 14.9% over the same period in 2023. In particular, there were medical facilities with medical examination and treatment expenditures increasing by 5-10 times over the same period last year.
According to estimates by Vietnam Social Security, by June, the whole country had about 89.552 million people receiving health insurance treatment (an increase of 6.563 million people, equivalent to 7.91% over the same period in 2023); with the amount of appraisal and payment of more than 66,920 billion VND. Some provinces with high medical examination and treatment costs include Hanoi, Ho Chi Minh City, Thanh Hoa, Nghe An, Quang Binh, Da Nang, Dak Lak, Can Tho... These are the units that account for a very large proportion of the national health insurance treatment and treatment costs.
According to the assessment of Vietnam Social Security, the unusual increase in health insurance medical examination and treatment costs in the provinces has the following causes: Social Security leaders in some localities have not really paid attention to this work; have not coordinated well with the health department; the way of doing things is still old, lacking creativity. In addition, there is a situation of emergency and inpatient orders being too high at some medical facilities.
Handling warnings about high average costs
Faced with the situation of high increase in the use of health insurance medical examination and treatment costs nationwide in the first months of the year, Vietnam Social Security has issued many documents directing social security agencies of provinces and cities to strengthen control of health insurance medical examination and treatment costs.
Mr. Duong Tuan Duc, Director of the Health Insurance Assessment Center and Multi-line Payment Center (Vietnam Social Insurance), said that this unit has built many tools to support cost control activities at local social insurance agencies. The center also organized training for social insurance agencies in provinces and cities on methods and skills to assess unreasonable cost increases, management tools, and risk identification. These tools and solutions have been and are bringing about efficiency, supporting the work of controlling health insurance medical examination and treatment costs in accordance with regulations.
The leader of Vietnam Social Security added that this agency has built and supplemented a system to synthesize and report indicators and requirements according to Decree No. 75/2023 on guiding measures to implement a number of articles of the Law on Health Insurance.
Accordingly, the situation of using health insurance medical examination and treatment costs of each province will be detailed in terms of inpatient treatment, testing, and diagnostic imaging; there will be assessments and comparisons with the whole country and by region; and issues that need to be focused on for inspection and review will be pointed out. "This is an effective and important tool. Directors of social insurance in localities need to increase access and use to serve management work; at the same time, enhance the responsibility of directors of social insurance in provinces and cities in thoroughly resolving issues within their authority, and clearly agree with the health department for implementation", said Deputy General Director of Vietnam Social Insurance Nguyen Duc Hoa.
Coordinate with the health sector to resolve unreasonable factors
Sharing with Thanh Nien, Mr. Nguyen Duc Hoa said that controlling the cost of health insurance is to limit unnecessary and unreasonable prescriptions, prevent waste in using services, use of drugs to prolong treatment days, etc., contributing to focusing treatment resources for patients, especially those with serious and chronic diseases.
To ensure payment of health insurance medical examination and treatment costs in accordance with legal regulations, Mr. Hoa noted: "Local social insurance agencies need to proactively review and detect abnormalities warned in the appraisal system and promptly send warning information to medical examination and treatment facilities about costs that are higher than the average costs of medical examination and treatment facilities of the same class, same level, same specialty; update and report the results of thematic appraisals in accordance with regulations".
Mr. Hoa also suggested that the provincial Social Insurance should closely coordinate with the Department of Health and medical examination and treatment facilities to provide information and support in the implementation of health insurance; focus on resolving unreasonable factors in drug bidding, emergency indications, testing, inpatient treatment, referrals, etc.
Source: https://thanhnien.vn/chi-phi-kham-chua-benh-tang-cao-18524070123482227.htm
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