Health insurance spending increased abnormally by nearly 4,000 billion, is it beneficial for patients?

Bệnh nhân thanh toán BHYT tại Bệnh viện Thanh Nhàn (Hà Nội) - Ảnh: NAM TRẦN — Patients paying their health insurance premiums at Thanh Nhan Hospital ( Hanoi ) - Photo: NAM TRAN

While increased spending from the fund is necessary, many people are concerned about whether it will benefit patients, whether the spending is justified, and where the funds are actually going.

Expenditure on health insurance medications is increasing.

According to the report on the cost of medical examination and treatment covered by health insurance nationwide in the first three months of the year, conducted by the Health Insurance Policy Implementation Board, the number of visits and expenses increased due to the average cost of inpatient and outpatient treatment in general and in some provinces; the rate of emergency procedures, tests, inpatient treatment, etc., all increased.

According to this report, in the first quarter, the whole country recorded 40.4 million health insurance-covered medical examinations and treatments, an increase of 6.47% compared to the same period in 2023; the health insurance fund paid out 30,974,470 million VND, an increase of 14.9% compared to the same period in 2023.

Estimated utilization rate of budget funds in the first quarter increased by over 26.8% compared to the same period last year, while expenditure increased by 13.9% compared to the same period last year. Some provinces and cities saw very large increases such as Tay Ninh (32.8%), Tien Giang (35.9%), Da Nang (31.5%), Quang Binh (27.8%)...

In particular, some medical facilities have seen their health insurance expenditures increase by more than 5-10 times compared to the same period last year. Some provinces have a much higher proportion of drug expenditures than the national average and a much larger increase than the number of medical examinations and treatments.

Provinces and cities with higher rates of drug expenditure compared to 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, and Tra Vinh (120%). In addition, at many polyclinics, while the number of laboratory tests and diagnostic imaging procedures remains unchanged, drug costs are almost zero.

The Health Insurance Policy Implementation Board assessed that the increase in health insurance costs for medicines in the first three months of the year was due to the fact that in 2023, the results of the national centralized bidding for medicines had been approved by the Ministry of Health; the Ministry of Health had also approved the results of price negotiations for 64 medicines on the price negotiation list. In addition, some provinces that were slow in bidding in 2023 had their contractor selection results approved, leading to increased spending.

While the proportion of spending on medicines increased, the proportion of using generic drugs did not increase, remaining at around 25%; the proportion of using medical supplies decreased slightly.

Bid price chaos

According to the report from the Health Insurance Policy Implementation Board, a review of the bidding results revealed that the winning bid prices for medicines varied from place to place.

Specifically, the drug containing the active ingredient Ceftriaxon 2g, group 1, had a winning bid price of 56,000 VND/bottle, while the winning bid price for the same drug with a concentration of 1g, group 1, in 2023 ranged from 14,000 to 17,000 VND/bottle nationwide.

The drug containing the active ingredient Ceftazidim 3g, injectable, group 4, had a winning bid price of 88,000 VND/vial, while a 1g vial in the same group had a winning bid price of 9,400 VND/vial (3 times higher concentration, 9 times higher price).

In particular, there is still a significant difference in the winning bid prices for the same type of medical supplies between hospitals and localities. For example, a complete knee joint from the American brand M. costs 65 million VND at Thong Nhat Hospital and Nguyen Tri Phuong Hospital (Ho Chi Minh City); 62 million VND at 30-4 Hospital (Ho Chi Minh City); 56.5 million VND at Cho Ray Hospital; 55 million VND at the Ho Chi Minh City Orthopedic and Trauma Hospital; and 51.3 million VND at Nghe An Provincial Friendship General Hospital.

For example, a single-chamber permanent pacemaker (SPHERA SR) with responsiveness, SureScan MRI, and standard accessories from Medtronic/Singapore costs 52.5 million VND at Hospital 103 (Hanoi); 52.4 million VND at Hospital 354 (Hanoi); 50 million VND at Thai Binh, Ha Giang, Tien Giang, Nghe An Provincial General Hospitals and Viet Tiep Friendship Hospital in Hai Phong; and 45 million VND at Hue Central General Hospital.

The Health Insurance Policy Implementation Board requests that provincial and city social insurance agencies strengthen the review, analysis, and comparison of medical supply prices as soon as bidding results are available, in order to take timely intervention measures and contribute to reducing medical supply expenditures from the health insurance fund as well as out-of-pocket payments by patients.

At a recent meeting on the assessment of health insurance medical examination and treatment costs, Deputy General Director of Vietnam Social Security Nguyen Duc Hoa stated that the unusual increase in health insurance medical examination and treatment costs in the provinces has many causes. Some local social security leaders have not paid sufficient attention to this issue; they have not coordinated well with the provincial health departments; and their methods remain outdated and lack innovation. In addition, there is a situation of excessively high emergency and inpatient prescriptions at some medical facilities...

Speaking to Tuoi Tre newspaper, Mr. Hoa said that the increase in health insurance costs for medical examinations and treatment has been significant in some provinces, but in other provinces the increase is insignificant and not yet a cause for concern.

Risk of exceeding health insurance budget estimates.

As one of the top 10 localities with the highest increase in health insurance-covered medical examinations and treatments in the first three months of the year, Ho Chi Minh City's total health insurance-covered medical examination and treatment costs at healthcare facilities that were requested for payment amounted to 6,818 billion VND, an increase of 14.66% compared to the same period last year. The projected expenditure for 2024 is over 24,000 billion VND.

According to Ms. Nguyen Thi Thu Hang, Deputy Director of the Ho Chi Minh City Social Insurance Department, in 2023, the amount paid to patients at 187 medical facilities in Ho Chi Minh City was 22,723 billion VND, an increase of 14.15% compared to the same period last year, reaching 103.94% of the projected amount (approximately 700 billion VND). In 2023, there were 20.59 million health insurance-covered medical examinations and treatments, an increase of 18.76% compared to the same period last year.

Ms. Hang also stated that the cost of medical examinations and treatments covered by health insurance at healthcare facilities in Ho Chi Minh City has increased rapidly in the first three 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 Ho Chi Minh City Social Insurance agency discovered cases of non-compliance with regulations on medical examination and treatment for cardholders; and refusal of payment during regular audits. Most errors occurred due to administrative mistakes or medical staff misunderstanding regulations on medical examination and treatment.

Thanks to the coordinated management by the Ho Chi Minh City Social Insurance agency and healthcare facilities, and through the auditing system, no cases of organized health insurance fraud occurred in 2023.

Currently, the Ho Chi Minh City Social Insurance agency proactively analyzes medical examination and treatment cost data on the inspection system, adjusting any inconsistencies in inpatient treatment prescriptions, drug prescriptions, medical supplies, and technical services... in accordance with regulations.

Healthcare facilities need to proactively detect, review, and verify any high increases in health insurance-covered medical expenses based on recommendations and warnings, and conduct bidding for the procurement of medicines, chemicals, and medical supplies in a timely and sufficient manner to meet treatment needs, preventing insured patients from having to purchase medicines and medical supplies themselves that are covered by the health insurance fund.

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