Patients pay health insurance at Thanh Nhan Hospital ( Hanoi ) - Photo: NAM TRAN
Increasing spending from the fund, but whether patients benefit, whether the spending is correct or where the costs go are things that many people are concerned about.
Health insurance drug spending increases
According to the report on the cost of medical examination and treatment under health insurance nationwide in the first 3 months of the year conducted by the Health Insurance Policy Implementation Board, the number of visits and expenditures increased due to the average cost of inpatient and outpatient treatment in general and in some provinces; the rate of emergency appointments, testing, inpatient treatment... all increased.
According to this report, in the first quarter, there were 40.4 million health examinations and treatments nationwide under health insurance, an increase of 6.47% over the same period in 2023; the health insurance fund paid VND 30,974,470 million, an increase of 14.9% over the same period in 2023.
Estimated rate of using budget fund in the first quarter increased by over 26.8% compared to the same period, expenditure rate increased by 13.9% compared to the same period. Some provinces and cities had very large increases such as Tay Ninh (32.8%), Tien Giang (35.9%), Da Nang (31.5%), Quang Binh (27.8%)...
In particular, there are medical facilities where the number of health insurance-covered medical examination and treatment expenses increased by 5-10 times compared to the same period last year. Some provinces have a much higher drug expenditure rate than the national average and increased much more than the number of medical examinations and treatments.
Provinces and cities with higher drug spending rates than the national average include Son La (129%), Quang Binh (128%), Khanh Hoa (124%), Quang Ninh (123%), Thai Binh, Ha Tinh (122%), Dak Lak, Phu Tho, Hai Phong, Tra Vinh (120%). In addition, at many general clinics, while the indications for testing and diagnostic imaging have not decreased, drug costs are almost 0%.
The Health Insurance Policy Implementation Board assessed that the health insurance costs for drugs increased in the first 3 months of the year because in 2023, the Ministry of Health approved the results of contractor selection for drugs with centralized bidding at the national level; the Ministry of Health approved the price negotiation results for 64 drugs on the price negotiation list. In addition, some provinces that were slow to bid in 2023 had their contractor selection results approved, leading to increased costs.
While the rate of spending on drugs increased, the rate of using generic drugs did not increase, both at 25%; the rate of using medical supplies decreased slightly.
Bid price chaos
Also according to the report of the Health Insurance Policy Implementation Board, through reviewing the results of contractor selection, it shows that the winning bid price of drugs varies from place to place.
Specifically, the drug with the active ingredient Ceftriaxone 2g, group 1 has a winning bid price of 56,000 VND/bottle, while the content of this drug type 1g, group 1 has a winning bid price range nationwide in 2023 from 14,000 - 17,000 VND/bottle.
The drug contains the active ingredient Ceftazidim 3g, injection, group 4, the winning bid price is 88,000 VND/bottle, while the content of 1g in the same group has a winning bid price of 9,400 VND/bottle (content 3 times higher, price 9 times higher).
In particular, there is still a large difference in the winning bid price for the same type of medical supplies between hospitals and localities, for example, the total knee joint of the American brand M. at Thong Nhat Hospital, Nguyen Tri Phuong Hospital (HCMC) is 65 million VND; 30-4 Hospital, HCMC is 62 million VND; Cho Ray Hospital is 56.5 million VND; Ho Chi Minh City Orthopedic and Trauma Hospital is 55 million VND; Nghe An Provincial General Hospital is 51.3 million VND.
Or the SPHERA SR 1-chamber permanent pacemaker, with response, SureScan MRI and standard accessories from Medtronic/Singapore at Hospital 103 (Hanoi) is 52.5 million VND; Hospital 354 Hanoi is 52.4 million VND; General Hospitals of Thai Binh, Ha Giang, Tien Giang, Nghe An, Viet Tiep Friendship Hospital Hai Phong is 50 million VND; at Hue Central General Hospital is 45 million VND.
The Health Insurance Policy Implementation Board requested that social insurance agencies of provinces and cities strengthen the work of reviewing and comparing medical supplies prices as soon as the bidding results are available in order to have timely intervention measures, contributing to reducing the cost of medical supplies of the Health Insurance Fund as well as the out-of-pocket payments of patients.
At a recent meeting on assessing the cost of health insurance examination and treatment, Deputy General Director of Vietnam Social Security Nguyen Duc Hoa said that the unusual increase in health insurance examination and treatment costs in the provinces has many 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-fashioned and lacks creativity. In addition, there is a situation of emergency and inpatient appointments being too high at some medical facilities...
Talking to Tuoi Tre, Mr. Hoa said that the increase in health insurance costs in some provinces is high, while in other provinces the increase is insignificant, so there is not much to worry about.
Risk of exceeding health insurance budget
As one of the 10 localities that increased the number of health insurance examinations and treatments in the first 3 months of the year, Ho Chi Minh City has a total cost of health insurance examinations and treatments at medical facilities proposed for payment of 6,818 billion, an increase of 14.66% over the same period. The estimated expenditure in 2024 is over 24,000 billion VND.
Ms. Nguyen Thi Thu Hang, Deputy Director of Ho Chi Minh City Social Insurance, said that in 2023, the amount paid to patients at 187 medical examination and treatment facilities in Ho Chi Minh City was VND22,723 billion, an increase of 14.15% over the same period last year, equal to 103.94% of the estimate (about VND700 billion). In 2023, there were 20.59 million health examination and treatment visits covered by health insurance, an increase of 18.76% over the same period last year.
Ms. Hang also said that the cost of health insurance examination and treatment at medical facilities in Ho Chi Minh City has increased rapidly in the first 3 months of 2024.
Recently, the Ho Chi Minh City People's Committee issued a document on strengthening the management and control of health insurance medical examination and treatment costs in 2024. In 2023, the City Social Insurance discovered cases of improper implementation of regulations on medical examination and treatment for cardholders; refusing to pay during regular assessments. Most errors occurred due to administrative errors or because medical staff did not understand the regulations on medical examination and treatment correctly.
Because the City Social Insurance and medical facilities coordinate management and through the appraisal system, there have been no cases of organized health insurance fraud in 2023.
Currently, Ho Chi Minh City Social Insurance proactively analyzes medical examination and treatment cost data on the appraisal system, adjusting unreasonable indications for inpatient treatment, drug indications, medical supplies, technical services... in accordance with regulations.
Medical examination and treatment facilities need to proactively detect, review, and verify the increased costs of health insurance examination and treatment at the facility according to recommendations and warnings, and bid for the procurement of drugs, chemicals, and medical supplies in a timely and adequate manner to meet treatment needs, and not let insured patients have to buy drugs and medical supplies within the scope of payment of the health insurance fund.
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