Health insurance medical examination and treatment costs increased abnormally

This information was provided by the Vietnam Social Security (VSS) at an online conference on controlling health insurance medical examination and treatment costs this afternoon, May 10th.

In the first four months of the year, health insurance medical expenses increased by nearly 5,600 billion VND compared to the same period in 2023.

According to the Center for Health Insurance Assessment and Multi-Route Payment (Vietnam Social Security), in the first four months of 2024, nationwide, health insurance medical examination and treatment costs increased by nearly 5,600 billion VND compared to the same period in 2023.

Some provinces and cities experienced a significant increase, such as: Ho Chi Minh City, Hanoi, Thanh Hoa, Nghe An, Da Nang, Can Tho, Phu Tho, Hai Phong, Dong Nai, Dak Lak, Thai Binh , Bac Giang, Quang Ninh…

This situation is due to factors such as the increase in the number of health insurance-covered medical examinations and treatments, the average cost of inpatient and outpatient treatment in general and in some provinces; and the rate of emergency room visits, laboratory tests, inpatient treatment, and diagnostic imaging…

According to Deputy General Director of Vietnam Social Security Nguyen Duc Hoa, the conference aims to promptly resolve and overcome difficulties and obstacles in coordinating the implementation of health insurance medical examination and treatment, ensuring the rights of health insurance participants, and effectively controlling costs according to regulations.

Effectively control costs, prevent waste and abuse.

Given the unusually high increase in the use of health insurance funds for medical examinations and treatments nationwide in the first four months of 2024 compared to the same period in 2023, the Deputy General Director of Vietnam Social Security requested relevant affiliated units and local Social Security offices to report and assess the causes, and propose solutions to effectively control costs and prevent waste and abuse.

To support local social insurance agencies, the leaders of Vietnam Social Insurance said that the agency has built and supplemented a comprehensive reporting system for indicators and requirements in accordance with Decree No. 75/2023/ND-CP guiding measures for implementing some articles of the Health Insurance Law.

Accordingly, the situation regarding the use of health insurance funds for medical examinations and treatment in each province will be statistically detailed, covering inpatient treatment, laboratory tests, and diagnostic imaging; with assessments and comparisons with the national and regional levels; and identifying issues requiring focused inspection and review.

"This is an effective and important tool; local social insurance directors need to increase their access to and use of it to serve management work; at the same time, enhance the responsibility of provincial and city social insurance directors in resolving issues within their authority and clearly coordinating with the health department for implementation," Mr. Hoa requested.

Regarding the management of health insurance medical examination and treatment costs, Deputy General Director Nguyen Duc Hoa stated that, currently, according to Government Decree 75/2023/ND-CP, the Social Insurance agency is allowed to regularly notify medical facilities of health insurance medical examination and treatment costs, enabling them to review and make appropriate adjustments.

Local social insurance agencies need to seriously and effectively implement this tool; at the same time, they should strengthen research and develop initiatives and solutions in controlling health insurance medical examination and treatment costs according to regulations, ensuring the rights of participants.

In controlling the costs of medical examination and treatment under health insurance, Vietnam Social Security requires localities to review and reorganize the inspection department appropriately, improve the efficiency and capacity of the health insurance inspection department; and to study the establishment of a team to handle warnings about high average costs at medical facilities in the area.

With the warning system provided by Vietnam Social Security, provincial social security agencies need to focus on thoroughly analyzing and identifying high costs, clarifying each factor, and then applying the guidelines of Vietnam Social Security for management; at the same time, strengthening communication and working with medical facilities to create consensus and a common voice; strictly implementing the initial registration for medical examination and treatment as directed by Vietnam Social Security; and strengthening discipline in health insurance assessment work…

Source: https://thanhnien.vn/chi-phi-kham-chua-benh-bhyt-tang-cao-bat-thuong-185240510174221923.htm