Thanks to the application of digital technology, the patient's health insurance card information is looked up online and updated directly into the medical facility's management software. Receiving and verifying information is done quickly and transparently, helping patients enjoy full benefits during the treatment process, while reducing administrative procedures for medical staff.
Instead of using paper health insurance cards as before, people can now use their ID cards or the digital social insurance application (VssID) on their smartphones when examining and treating patients. This is an important step forward in synchronizing data and digitizing the entire health insurance examination and treatment process.
After completing the examination and treatment process, the medical facility is responsible for sending all relevant data (including treatment instructions, use of drugs, medical supplies, etc.) to the Social Insurance agency through the Health Insurance Appraisal Data Receiving Portal. This system allows the Social Insurance agency to check and evaluate all medical examination and treatment costs paid by the Health Insurance Fund, based on electronic data provided by departments, faculties, and doctors.
At the Social Insurance Agency Region VIII, the Health Insurance Assessment Department analyzes each electronic medical record, evaluates the treatment regimen, procedures, medical supplies and prescribed drugs. Cases with signs of inappropriateness or unreasonableness will be warned by the system to request the medical examination and treatment facility to review. In case the facility cannot provide a reasonable explanation, the treatment costs will not be paid from the Health Insurance Fund.
Currently, in the province, there are more than 20 medical examination and treatment facilities that have deployed electronic medical records, helping to transfer data to the appraisal system of the Social Insurance sector more quickly and accurately. After the patient finishes treatment, the Social Insurance agency can directly access the electronic records sent by the medical examination and treatment facility to conduct appraisal and cost assessment.
According to Mr. Phan Dang Hung, Deputy Head of the Health Insurance Appraisal Department (Social Insurance Region VIII), the implementation of electronic medical records helps shorten the time for checking and comparing compared to the previous paper record method, when appraisers had to regularly go directly to medical facilities to manually check each item. This not only helps reduce official costs, but also increases transparency and efficiency in the appraisal process.
The Health Insurance Appraisal System has been deployed nationwide by the Social Insurance sector for nearly 10 years and is being increasingly improved. All appraisers can access, exploit, and analyze common data on the sector system.
According to data from Social Insurance Region VIII, in the first 6 months of 2025, the whole province handled over 1.4 million people's health examinations and treatments under health insurance, an increase of more than 93,000 cases compared to the same period in 2024. The total cost of health examinations and treatments under health insurance in the whole province was 1,325 billion VND, an increase of 236 billion VND compared to the same period. It can be affirmed that the health insurance appraisal process through digital transformation has helped strengthen the connection between the health sector and the social insurance sector, ensuring timely information sharing and handling of problems as soon as they arise during the health insurance examination and treatment process.
As the “backbone” in medical cost management, health insurance appraisal not only contributes to effectively controlling health insurance fund expenditures, but is also a key factor in implementing health insurance policies in a sustainable, fair and transparent manner.
Source: https://baoquangninh.vn/chuyen-doi-so-trong-quy-trinh-giam-dinh-bhyt-3366624.html
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