Tightly control health insurance medical examination and treatment costs

Assessing at the working session with the Social Insurance of 12 provinces/cities on the work of controlling health insurance treatment costs, General Director of Vietnam Social Insurance Nguyen The Manh emphasized that localities need to clearly recognize the importance and their responsibilities in managing the health insurance fund.

Provinces and cities that use large funds have even greater responsibility, constantly improving management efficiency, and fulfilling their responsibilities to the people in health insurance treatment work. Specifically, units control health insurance treatment costs to optimize the use of health insurance funds, prevent and minimize unreasonable and wasteful costs.

Doctor examines patient at Hanoi Lung Hospital. Photo: Ha Linh

The General Director requested that the Social Insurance of provinces and cities evaluate the results of controlling health insurance treatment costs since the beginning of the year. Head of the Health Insurance Policy Implementation Board Le Van Phuc added that the total health insurance treatment costs of 12 provinces/cities account for more than 50% of the whole country. By the end of May 2024, some provinces in this group had a high rate of health insurance treatment costs, likely exceeding the estimate assigned by the Government .

Many localities have a number of health insurance-covered medical examinations much higher than the national average for both inpatients and outpatients, and similarly the average number of treatment days...

General Director Nguyen The Manh requested that the specialized units of Vietnam Social Security closely follow the regulations in Decree 75/2023/ND-CP of the Government to build a control mechanism and set out criteria for each level of leaders and related officials to know and review when implementing.

On the legal basis of the Law on Health Insurance and Decree 75/2023/ND-CP, local Social Insurance regularly sends warnings to health insurance medical facilities about inappropriate and unreasonable increased costs and factors proven through numbers and charts so that medical facilities know and make appropriate adjustments.

In controlling the cost of health insurance, local social insurance needs to go from general to detailed. From statistical systems, local social insurance warns, combines inspection, examination, and requests for explanation, to find and prove unreasonable things, and then refuse to make payments according to regulations. Avoid extreme thoughts and methods; all information needs to be public, transparent, and ensure the rights of patients.

Source: https://kinhtedothi.vn/kiem-soat-chat-chi-phi-kham-chua-benh-bhyt-774478.html