In the first 6 months of 2025, the whole province has 60 health insurance facilities with an increase in the number of medical examinations and treatment visits compared to the same period in 2024.
According to the report of the Thanh Hoa Provincial Social Insurance Agency, in the first 6 months of 2025, the number of patients going for medical examination and treatment was 2,697,525, an increase of 3.4%, equivalent to an increase of 88,608 compared to the same period in 2024. The cost of health insurance for 6 months was 3,083,430 million VND, an increase of 18.6%, equivalent to an increase of 483,010 million VND compared to the same period in 2024. The implementation of the estimated expenditure for health insurance for the whole province in the first 6 months of 2025 was equal to 58% of the estimate assigned by the Vietnam Social Insurance in 2025. It is expected that in 2025, the cost of health insurance for medical examination and treatment of medical examination and treatment facilities proposed to pay the amount of 6,200,000 million VND, the whole province exceeded the assigned estimate by about 15.8%.
The reason for the increase in health insurance medical examination and treatment costs is due to the application of technical service prices approved under Resolution No. 596/NQ-HDND of the Provincial People's Council from January 1, 2025, leading to an increase in medical examination and treatment costs compared to the same period in 2024 of VND 189.5 billion. Of which, public hospitals increased by VND 160.5 billion and the costs of technical services such as testing, diagnostic imaging, procedures, and surgery at non-public health insurance medical examination and treatment facilities were applied the new prices of public health examination and treatment facilities according to Resolution No. 596/NQ-HDND. Increased costs due to the application of Decree No. 02/2025/ND-CP dated January 1, 2025 of the Government amending and supplementing a number of articles of Decree No. 146/2018/ND-CP dated October 17, 2018 detailing and guiding measures to implement the Law on Health Insurance, which has been amended and supplemented by a number of articles in Decree No. 75/2023/ND-CP dated October 19, 2023 of the Government, non-public health insurance facilities are allowed to apply the prices of medical services of public health facilities at the same level in the area, the cost of medical examination and bed fees increased by VND 74.64 billion. Increased costs due to an increase in the number of medical facilities signing new contracts (3 facilities): 4.9 billion VND for the first 6 months of 2025. In addition, many indicators increased compared to the same period and the national average such as: Rate of patients being assigned to inpatient treatment; average treatment days; rate of bed expenses...
Specifically, there are 60 health insurance facilities with a high increase in the number of health insurance visits compared to the same period in 2024, 90 health insurance facilities with a high increase in health insurance costs, 92 health insurance facilities with an increase in the average cost of outpatient treatment, and 53 health insurance facilities with an increase in the average cost of inpatient treatment.
Another reason for the current increase in health insurance costs is that some hospitals only admit patients for inpatient treatment when their condition is not severe enough to require hospitalization, the rate of bed fees and the number of inpatient treatment days are longer than the average of the whole province and the whole country..., and there is also a situation of prescribing medical services, drugs, and medical supplies that are not appropriate to the condition of the disease, causing waste of the health insurance fund.
Deputy Director in charge of the Department of Health Le Van Cuong said: The Department of Health will continue to accompany the Social Insurance in implementing the health insurance policy in the area to prevent abuse and profiteering of the health insurance fund. Accordingly, it will propose solutions to control health insurance medical examination and treatment costs, contributing to optimizing the effective use of the health insurance fund, in accordance with regulations, ensuring the rights of health insurance participants when going for medical examination and treatment; improving the effectiveness of state management in the health sector, ensuring social security in the province.
According to Director of the Provincial Social Insurance Nguyen Khac Tuan: In the face of increasing costs of health insurance, the Provincial Social Insurance continues to strengthen the work of surprise inspections of human resources performing health insurance to ensure the rights of patients receiving health insurance who are being treated at health care facilities according to the list posted on the Department of Health's information portal. Coordinate with the Department of Health to share information and data, organize inspections at health care facilities with unusually high costs that have been warned by the Social Insurance agency many times but have not been adjusted. Assign the local Social Insurance to check and compare payment request documents, resolutely not pay for contents that are against regulations, do not meet legal conditions or the scope of expertise of medical staff is not suitable for the implementation of health services...
Article and photos: Ha Thu
Source: https://baothanhhoa.vn/kiem-soat-hieu-qua-chi-phi-nbsp-kham-chua-benh-bhyt-257186.htm
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