Health insurance medical examination and treatment costs increased abnormally

The above information was announced by Vietnam Social Security (VSS) at the online conference on controlling health insurance medical examination and treatment costs this afternoon, May 10.

In the first 4 months of the year, health insurance medical examination and treatment costs increased by nearly 5,600 billion VND compared to the same period in 2023.

According to the Center for Health Insurance Assessment and Multi-level Payment (Vietnam Social Security), in the first 4 months of 2024, nationwide, health insurance medical examination and treatment costs increased by nearly 5,600 billion VND compared to the same period in 2023.

Some provinces and cities have a huge increase such as: Ho Chi Minh City, Hanoi, Thanh Hoa, Nghe An, Da Nang, Can Tho, Phu Tho, Hai Phong, Dong Nai, Dak Lak, Thai Binh , Bac Giang, Quang Ninh...

The above situation is due to factors such as the increase in the number of health insurance examinations and treatments, the average cost of inpatient and outpatient treatment in general and in some provinces; the rate of emergency appointments, testing, inpatient treatment, diagnostic imaging, etc.

According to Deputy General Director of Vietnam Social Security Nguyen Duc Hoa, the conference aims to promptly resolve and remove difficulties and obstacles in the coordination of health insurance examination and treatment, ensure the rights of health insurance participants, and control costs well according to regulations.

Good cost control, prevent waste and abuse

Faced with the situation of using health insurance medical examination and treatment costs nationwide in the first 4 months of 2024 with an unusually high increase compared to the same period in 2023, the Deputy General Director of Vietnam Social Security requested relevant affiliated units and local Social Security to report, assess the causes, and propose solutions to control costs well, prevent waste and abuse.

To support local social insurance agencies, the leader of Vietnam Social Insurance said that this agency has built and supplemented a system to synthesize and report indicators and requirements according to Decree No. 75/2023/ND-CP on guiding measures to implement a number of articles of the Law on Health Insurance.

Accordingly, the situation of using health insurance examination and treatment costs of each province will be detailed in terms of inpatient treatment, testing, and diagnostic imaging; evaluated and compared 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 at localities need to increase access and use to serve management work; at the same time, enhance the responsibility of Social Insurance directors of provinces and cities in thoroughly resolving issues within their authority, and clearly agree with the Department of Health to implement," Mr. Hoa requested.

Regarding the management of health insurance examination and treatment costs, Deputy General Director Nguyen Duc Hoa said that currently, according to Decree 75/2023/ND-CP of the Government, the Social Insurance agency is allowed to regularly notify the health insurance examination and treatment costs to medical facilities, for self-review and reasonable adjustment.

Social insurance agencies in localities need to seriously and effectively implement this tool; at the same time, strengthen research, have initiatives and solutions in controlling health insurance examination and treatment costs according to regulations, ensuring the rights of participants.

In the work of controlling health insurance examination and treatment costs, Vietnam Social Security requires localities to review and arrange appropriate appraisal departments, improve the efficiency and capacity of health insurance appraisal departments; and study the establishment of a team to handle warnings about increased average costs at medical facilities in the area.

With the warning system provided by Vietnam Social Security, provincial Social Security agencies need to focus on exploiting and carefully analyzing increased costs, clarifying each factor and then applying the instructions of Vietnam Social Security for management; at the same time, increase information, work with medical examination and treatment facilities, create consensus and a common voice; strictly implement initial medical examination and treatment registration according to the direction of Vietnam Social Security; strengthen discipline in health insurance appraisal work...

Source: https://thanhnien.vn/chi-phi-kham-chua-benh-bhyt-tang-cao-bat-thuong-185240510174221923.htm