Surprise inspection of medical centers with unusually high health insurance premiums

The Hanoi People's Committee issued Official Document No. 4193/UBND-KGVX, requesting strengthened control over medical examination and treatment expenses covered by health insurance at medical centers in the city.

Unannounced inspections of medical centers with unusually high health insurance premiums.

The Hanoi People's Committee issued Official Document No. 4193/UBND-KGVX, requesting strengthened control over medical examination and treatment expenses covered by health insurance at medical centers in the city.

According to a report by the Hanoi Social Insurance Agency, in the first 10 months of 2024, the total expenditure on medical examination and treatment covered by health insurance at district and town health centers reached VND 281.9 billion, an increase of 12% compared to the same period in 2023.

However, this expenditure is not commensurate with the number of medical examinations and treatments (an increase of only 5%), leading to the risk of exceeding the budget allocated by the Prime Minister for 2024.

Illustrative image.

To effectively manage and utilize the Health Insurance Fund, the City People's Committee requests the Department of Health to direct district, county, and town health centers to fully comply with legal regulations on medical examination and treatment, professional guidelines from the Ministry of Health, and regulations related to the provision of technical services. This aims to ensure quality, efficiency, and cost-effectiveness in the use of the health insurance fund.

The Department of Health also needs to develop and implement guidelines on diagnosis and treatment, tailored to the facilities and human resources of the health centers.

At the same time, the Department of Health must develop a plan to connect primary healthcare facilities with higher-level hospitals to enhance professional support, thereby improving the quality of medical examination and treatment at the primary healthcare level.

The City People's Committee also requested the Department of Health to coordinate with the People's Committees of districts, counties, and towns to invest in facilities, organize the organizational structure, and improve the professional capacity of staff at the Health Centers to meet the healthcare needs of the people at the grassroots level.

Regarding the city's social insurance agency, the People's Committee of Ho Chi Minh City requested that it analyze the situation of medical examination and treatment expenses covered by health insurance and promptly notify medical centers with unusually high costs compared to the previous period.

Social insurance agencies must also coordinate with the Department of Health to conduct surprise inspections of medical centers with unusually high medical examination and treatment costs, strictly handle violations, and transfer files to investigative agencies if they discover acts of health insurance fraud.

The Hanoi People's Committee also requested districts, counties, and towns to review and invest in medical facilities and equipment, and supplement personnel for polyclinics and commune health stations under the Health Center. The goal is to improve the quality of medical examination and treatment and health management for people at the grassroots level, limiting the transfer of patients to higher-level facilities.

Furthermore, the People's Committees of districts, counties, and towns need to strengthen inspection and supervision of medical examination and treatment and payment of health insurance expenses at medical centers, strictly handle violations (if any), and require the directors of medical centers to be held responsible if violations or abuse of health insurance occur.

Medical centers also need specific solutions to control the costs of medical examinations and treatments covered by health insurance, and to prevent abuse and fraudulent exploitation of the health insurance fund. Weekly, these centers must conduct self-checks of medical examination and treatment costs to promptly detect and address violations.

Source: https://baodautu.vn/kiem-tra-dot-xuat-cac-trung-tam-y-te-chi-bao-hiem-y-te-cao-bat-thuong-d232462.html