Surprise inspection of medical centers with unusually high health insurance premiums

Hanoi People's Committee issued Official Dispatch No. 4193/UBND-KGVX, requesting to strengthen control of medical examination and treatment expenses covered by health insurance at medical centers in the area.

Hanoi People's Committee issued Official Dispatch No. 4193/UBND-KGVX, requesting to strengthen control of medical examination and treatment expenses covered by health insurance at medical centers in the area.

According to the report of Hanoi Social Insurance, in the first 10 months of 2024, the total expenditure for health insurance examination and treatment at medical centers of districts, towns and cities reached 281.9 billion VND, an increase of 12% over the same period in 2023.

However, this cost is not commensurate with the number of medical examinations and treatments (increased by only 5%), leading to the risk of exceeding the budget assigned by the Prime Minister in 2024.

Illustration photo.

In order to effectively manage and use the Health Insurance Fund, the City People's Committee requests the Department of Health to direct district, county and town health centers to fully comply with the provisions of the law on medical examination and treatment, professional instructions of the Ministry of Health and regulations related to the provision of technical services. This is to ensure quality, efficiency and savings in the use of the health insurance fund.

The Department of Health also needs to develop and implement guidelines on diagnosis and treatment, in accordance with the physical and human resources capabilities of health centers.

At the same time, the Department of Health must develop a plan to connect grassroots health facilities with upper-level hospitals to increase professional support, thereby improving the quality of medical examination and treatment at grassroots health facilities.

The City People's Committee also requested the Department of Health to coordinate with the People's Committees of districts, towns and cities to invest in facilities, organize the apparatus, and improve the professional capacity of staff at the Medical Centers to meet the health care needs of people at the grassroots level.

Regarding the city's social insurance, the City People's Committee requires the organization to analyze the situation of health insurance medical examination and treatment expenses and promptly notify the Medical Centers with unusually high costs compared to the previous period.

Social insurance must also coordinate with the Department of Health to conduct surprise inspections of medical centers with unusual medical examination and treatment costs, strictly handle violations, and transfer files to the investigation agency if health insurance fraud is detected.

The Hanoi People's Committee also requested districts, towns and cities to review and invest in medical facilities and equipment, and add more human resources to general clinics and commune health stations under the Health Center. The goal is to improve the quality of medical examination and treatment and manage people's health right at the grassroots level, limiting the transfer of patients to higher levels.

In addition, the People's Committees of districts, towns and cities need to strengthen inspection and supervision of medical examination and treatment and payment of medical examination and treatment costs under health insurance at medical centers, strictly handle violations (if any), and at the same time require directors of medical centers to take responsibility if violations or abuse of health insurance occur.

Medical centers also need specific solutions to control health insurance medical examination and treatment costs, prevent abuse and profiteering of health insurance funds. Every week, centers must self-check medical examination and treatment costs to promptly detect and handle violations.

Source: https://baodautu.vn/kiem-tra-dot-xuat-cac-trung-tam-y-te-chi-bao-hiem-y-te-cao-bat-thuong-d232462.html