Hospital owes health insurance more than 7,000 billion VND

Vietnam Social Security has not yet paid more than 7,000 billion VND to medical facilities, causing hospitals to lack money to purchase supplies, affecting medical examination and treatment.

The information was presented by hospital leaders at the Conference on the implementation of Decree 75 on detailed regulations and guidance on measures to implement a number of articles of the Law on Health Insurance (HI) , on November 16. The conference took place in the context of the Government having just issued Decree 75 amending and supplementing a number of articles of Decree 146/2018 of the Law on Health Insurance.

Many hospital and health department leaders said that the lack of health insurance settlement has caused difficulties in medical examination and treatment. A representative of the Binh Dinh Health Department said that the amount of health insurance examination and treatment that has exceeded the total amount that has not been settled locally is 42 billion VND. This figure in Can Tho is 10 billion VND, and in Hue Central Hospital is 57 billion VND.

Some hospitals in Ho Chi Minh City were refused payment of VND1,400 billion by the Health Insurance Fund because it exceeded the total payment amount. Minister of Health Dao Hong Lan emphasized in October 2022 that "many hospitals have become debtors because the medical examination and treatment costs have not been paid by the Health Insurance Fund".

According to preliminary statistics from the social insurance agencies of 63 provinces and cities, the total amount of money that Vietnam Social Insurance (VSI) has not yet paid to medical examination and treatment facilities is more than 7,000 billion VND. This situation causes hospitals to delay in paying for medical supplies and medicine packages, leading to contractors providing small and slow supplies, affecting the examination and treatment work.

The hospital becoming a "debtor" has been going on since 2019, when the Social Insurance paid and settled the cost of health insurance examination and treatment for hospitals according to the total payment method. This calculation method is based on the guiding formula in Decree 146, issued in 2018 by the Government. Specifically, every quarter, the Social Insurance conducts an appraisal and temporary settlement for hospitals determined by the quantity and price of medical services; the costs of drugs, chemicals, medical supplies, blood, and blood products have not been included in the price of services used for patients.

However, when making annual settlements, the Social Insurance agency bases its total payment on the total payment (determined based on the total payment of the previous year). This is the biggest obstacle for all hospitals, because in reality, the total cost of medical examination and treatment in the following year is always higher than the previous year. The total payment for medical examination and treatment under health insurance is much lower than the actual cost that the facilities have used for patients. This leads to the consequence that the costs arising from the medical examination and treatment activities under health insurance of hospitals are not paid by the health insurance fund due to exceeding the total payment.

Ms. Tran Thi Trang, Director of the Health Insurance Department (Ministry of Health), said that this problem was resolved when the Government issued Decree No. 75. In which, the regulation on the total payment for health insurance examination and treatment costs was abolished, and payment was made according to actual costs. Hospitals were informed of the estimated amount of health insurance examination and treatment costs as a basis for planning the use of funds during the year.

"This is an important content in the regulations on payment of health insurance examination and treatment costs, removing payment difficulties for medical examination and treatment facilities in the past time," said Ms. Trang.

People come to see a doctor and buy medicine at the Ho Chi Minh City Orthopedic Hospital. Photo: Quynh Tran — People come to see a doctor and buy medicine at the Ho Chi Minh City Orthopedic Hospital. Photo: *Quynh Tran*

According to the new regulations, health insurance will pay for the actual technical services, medicines, medical supplies... used for patients and the prices according to current regulations. Thus, these regulations will remove difficulties and obstacles in payment of health insurance medical examination and treatment costs between medical examination and treatment facilities and social insurance agencies, creating conditions for medical examination and treatment facilities to improve operational efficiency and ensure the rights of patients.

Mr. Le Van Phuc, Deputy Head of the Health Insurance Policy Implementation Department, Vietnam Social Security, said that based on Decree 75, costs exceeding the total payment level determined according to Decree 146 from 2019 to 2020 and 2022 will be reviewed for re-payment. In 2021, implementing Resolution 144, Vietnam Social Security has made payments for costs exceeding the total level.

"Vietnam Social Security is asking provincial social security agencies to review, synthesize, evaluate, and appraise to make payments to medical facilities," said Mr. Phuc, adding that in 2023, payments will be made in accordance with the provisions of Decree 75.

Le Nga

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