High cost of medical examination and treatment

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 (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 have high health insurance costs such as 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 health insurance health insurance costs nationwide.

According to the assessment of Vietnam Social Security, the unusual increase in health insurance 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 appointments being too high at some medical facilities.

Handling warnings about rising 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-level Payment Center (Vietnam Social Insurance), said that this unit has built many tools to support cost control activities at local Social Insurance. The Center also organized training for Social Insurance of 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 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 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 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, clearly agreeing with the health department to implement", 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 health insurance treatment costs aims to limit unnecessary and unreasonable prescriptions, prevent waste in service use, use of drugs to prolong treatment days, etc., contributing to focusing treatment resources for patients, especially those with serious and chronic illnesses.

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 on the appraisal system and promptly send warning information to medical examination and treatment facilities about costs that are higher than the average cost of medical examination and treatment facilities of the same class, same line, same specialty; update and report the results of thematic appraisals in accordance with regulations".

Mr. Hoa also suggested that provincial Social Insurance should closely coordinate with the Department of Health and medical examination and treatment facilities to provide information and support in implementing 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