During a meeting with the Social Insurance agencies of 12 provinces/cities to assess the work of controlling health insurance medical examination and treatment costs, the Director General of Vietnam Social Insurance, Nguyen The Manh, emphasized that localities need to clearly understand the importance and their responsibility in managing the health insurance fund.
Provinces and cities that utilize large funds bear even greater responsibility, constantly improving management efficiency and fulfilling their obligations to the people in health insurance medical examination and treatment. Specifically, units controlling health insurance medical examination and treatment costs aim to optimize the use of health insurance funds, prevent and minimize unreasonable and wasteful expenses.
The Director General requested that the Social Insurance agencies of provinces and cities evaluate the results of controlling health insurance medical examination and treatment costs from the beginning of the year to date. Head of the Health Insurance Policy Implementation Board, Le Van Phuc, added that the total health insurance medical examination and treatment costs of 12 provinces/cities account for more than 50% of the national total. By the end of May 2024, some provinces in this group had a high rate of increase in health insurance medical examination and treatment costs, potentially exceeding the budget allocated by the Government .
Many localities have significantly higher numbers of health insurance-covered medical examinations and treatments than the national average, both for inpatient and outpatient care, and similarly, higher average treatment days…
Director General Nguyen The Manh requested that the specialized units of Vietnam Social Security adhere closely to the regulations in Government Decree 75/2023/ND-CP to develop control mechanisms and establish criteria for each level of leadership and relevant officials to understand and use as a reference when implementing the regulations.
Based on the legal framework of the Health Insurance Law and Decree 75/2023/ND-CP, local social insurance agencies regularly send warnings to health insurance medical examination and treatment facilities about inappropriate and unreasonable additional costs and factors, evidenced by figures and charts, so that medical facilities are aware and can make adjustments accordingly.
In controlling health insurance medical examination and treatment costs, local social insurance agencies need to move from a general to a detailed approach. Based on statistical systems, local social insurance agencies should issue warnings, combine inspections and audits, and request explanations to identify and prove irregularities, thereby refusing payment according to regulations. Extreme approaches should be avoided; all information must be public and transparent to ensure the rights of patients.
Source: https://kinhtedothi.vn/kiem-soat-chat-chi-phi-kham-chua-benh-bhyt-774478.html
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