Hanoi strengthens control of medical examination and treatment costs under health insurance

Accordingly, in order to effectively implement the health insurance policy, ensure the legitimate rights of health insurance participants, effectively manage and use the health insurance fund and estimate the cost of health insurance examination and treatment in 2024 assigned by the Prime Minister; The City People's Committee requests the Department of Health to provide professional guidance and supervise the Medical Centers of districts, towns and cities to comply with the provisions of the law on medical examination and treatment, professional instructions of the Ministry of Health, and legal provisions related to the provision of technical services to ensure quality, efficiency and savings; develop diagnostic and treatment guidelines, in accordance with the professional requirements, facilities and human resources of the Medical Center.

People go through medical examination and treatment procedures at Van Dinh General Hospital, Ung Hoa District, Hanoi

Along with that, develop a plan and direct the implementation of connecting primary health care with upper-level hospitals to enhance effective interaction and professional support between the primary level and the basic and specialized levels to improve the quality of medical examination and treatment at the primary health care level, meeting the medical examination and treatment and health care requirements of health insurance participants at the primary health care level.

Coordinate with the People's Committees of districts, towns and cities to invest in facilities, build organizational structures, and train and improve professional capacity for staff of the Medical Center to better serve the work of medical examination and treatment and health care for people at the grassroots health level.

The City Social Insurance Agency analyzes the situation of health insurance payment by medical centers on the Appraisal Information System to promptly notify medical centers of increased costs compared to the previous period and medical facilities of the same level and class. Coordinate with the Department of Health to organize working sessions with medical facilities to request review and adjustment of unreasonably increased costs.

Coordinate with the Department of Health to conduct interdisciplinary inspections as planned, conduct surprise inspections of medical centers with unusually high prices, strictly handle violations and waste in health insurance payment (if any); transfer files to the investigation agency for medical facilities with violations for handling according to the provisions of law.

People's Committees of districts, towns and cities shall review and invest in medical facilities and equipment, and supplement human resources for general clinics and commune health stations under the Health Center to improve the quality of grassroots health activities, meet the needs of primary health care, manage people's health, implement family medicine principles, and effectively manage and treat chronic diseases at grassroots health facilities to limit the transfer of patients to higher-level health care facilities for examination and treatment.

Strengthen inspection and supervision of medical examination and treatment and payment of health insurance examination and treatment costs at medical centers; strictly handle violations and responsibilities of directors of medical centers for violations, abuse and profiteering of health insurance.

In addition, the City People's Committee also requested the Medical Centers of districts, towns and cities to review the work of medical examination and treatment and payment of health insurance examination and treatment costs; develop plans and have specific solutions to strictly control health insurance examination and treatment costs at the unit; prevent and combat abuse and profiteering of the health insurance fund.

Source: https://kinhtedothi.vn/ha-noi-tang-cuong-kiem-soat-chi-kham-benh-chua-benh-bao-hiem-y-te.html