The cost far exceeds the number of visits covered by health insurance.
According to statistics from the Vietnam Social Security, in the first nine months of 2024, the number of medical examinations and treatments increased by 5.8% compared to the same period in 2023, but the costs increased by as much as 15.5%. This increase in costs is equivalent to an increase of VND 13,686 billion compared to the same period in 2023, bringing the total health insurance expenditure for medical examinations and treatments to VND 102,057 billion.
Therefore, the effectiveness of controlling health insurance medical examination and treatment costs is primarily reflected in ensuring the rights of health insurance participants, requiring medical facilities to provide accurate and sufficient medical services to health insurance patients. In addition, it involves the efficient use of the health insurance fund and transparent and compliant settlement procedures.
Deputy General Director of Vietnam Social Security Nguyen Duc Hoa emphasized that the fluctuations in health insurance medical examination and treatment costs in 26 localities will have a significant impact on the overall costs nationwide. Evaluating health insurance medical examination and treatment work over the past nine months will help local social security agencies clearly identify the causes of increased costs, as each area has its own unique characteristics.
Based on an analysis of effective solutions, difficulties, and obstacles, the aim is to derive groups of solutions to ensure the optimization of health insurance medical examination and treatment costs, and to minimize unreasonable cost increases in the last months of 2024 and beyond...
It can be seen that one of the positive aspects of the increase in health insurance medical examination and treatment costs is that many localities have ensured the bidding and supply of sufficient medical supplies for surgery, especially for high-cost technical services.
However, there are still instances where healthcare facilities prescribe excessive technical services and tests beyond what is necessary; or prescribe inpatient treatment for patients with mild illnesses that could be treated on an outpatient basis, prolonging the duration of treatment...
Comprehensive solutions for cost control.
Regarding the issue of health insurance coverage, the Head of the Health Insurance Policy Implementation Board of Vietnam Social Security, Le Van Phuc, stated that in the first nine months of 2024, the budget utilization rate of 63 provinces and cities was 84%. Of these, Son La had the highest rate at 91%, followed by Phu Tho at 89%, Bac Giang, Thai Nguyen, Hai Phong , and Thai Binh at 88%; the remaining provinces had budget utilization rates of 87% or lower…
“To ensure effective and optimized spending on health insurance medical examinations and treatments, maximizing benefits for patients, local social insurance agencies need to closely follow the operational guidance documents of Vietnam Social Insurance. In addition, units should improve efficiency in selecting and working with facilities experiencing high cost increases; and simultaneously link cost control with the management and use of the allocated health insurance medical examination and treatment budget for each province…” – Mr. Phuc stated.
Deputy General Director of Vietnam Social Security Nguyen Duc Hoa emphasized that, with the goal of focusing on ensuring the legitimate rights of health insurance participants, the Vietnam Social Security sector is strengthening the assessment of health insurance medical examination and treatment costs and optimizing resources to serve the people.
Identifying the problems arising in each locality and pointing out the causes of increased costs, the leaders of Vietnam Social Security proposed that local Social Security offices develop comprehensive solutions for cost control and strictly implement the guidelines of Vietnam Social Security.
The leaders of Vietnam Social Security also mentioned solutions such as tightening discipline and order, emphasizing the responsibility of each individual and unit; avoiding delays in the implementation of policies and the settlement of benefits; and ensuring effective coordination among relevant units to avoid affecting the rights of health insurance participants.
"We are determined not to pay even a single penny for wasteful or improper expenses. This is also a principle to ensure that the health insurance fund is used effectively in practice," the Deputy General Director of Vietnam Social Security emphasized.
Furthermore, the leaders of Vietnam Social Security requested the Health Insurance Policy Implementation Board and the Health Insurance Assessment and Multi-Route Payment Center to proactively guide and coordinate with local Social Security offices to ensure the effectiveness of health insurance medical examination and treatment cost settlement.
Source: https://kinhtedothi.vn/chi-kham-chua-benh-bhyt-hieu-qua-bao-dam-quyen-loi-nguoi-benh.html
