Tighten management of health insurance funds to protect patients' rights.

With medical examination and treatment costs covered by health insurance rising sharply, and many localities exceeding their budgets, the social insurance sector is being forced to tighten auditing and fund management to ensure patients' rights are protected.

According to a report by the Center for Social Insurance and Electronic Health Insurance Payment Control, as of the end of November, the whole country recorded more than 177.8 million medical examinations and treatments covered by health insurance, an increase of more than 10.2 million compared to the same period last year. Payments increased by approximately 16.2%, bringing the utilization rate of the health insurance fund for medical examinations and treatments to 100.1%.

Deputy Director of Vietnam Social Security Nguyen Duc Hoa requested that social security agencies in provinces and cities urgently investigate the prominent issues that have been identified.

Among the localities, Thanh Hoa, Dong Nai, Quang Tri, Nghe An, Son La, Ninh Binh, An Giang , Ha Tinh, Da Nang, and Quang Ninh are the provinces with the highest budget utilization rates. Meanwhile, Tuyen Quang, Gia Lai, Quang Ngai, Hai Phong, Lai Chau, Thai Nguyen, Cao Bang, Ho Chi Minh City, and Dien Bien belong to the group of provinces with low budget utilization rates.

Analysis of payment data reveals significant increases across several healthcare expense categories. Bed fees rose 26.3%, medical supplies 21.5%, medications 10.1%, consultation fees 31.6%, and laboratory and diagnostic imaging fees 22.2%.

The Payment Control Center has identified 10 localities with the highest spending levels, and has also pointed out specific service groups and healthcare facilities showing unusual practices such as prolonged hospital stays, excessively high proportion of bed charges, use of expensive branded drugs, or a significant increase in the prescription of expensive diagnostic procedures.

In Ho Chi Minh City, the number of medical examinations and treatments ranks fourth among 34 provinces and cities, but the amount paid is second nationwide, mainly concentrated in specialized hospitals, accounting for over 59% of total health insurance expenditure. Some facilities have seen a sharp increase in the frequency of MRI scans, surgeries, procedures, and the use of high-priced medications.

In Thanh Hoa , the province with the highest budget allocation nationwide, drug costs, especially for traditional medicine products, have increased sharply. The percentage of patients admitted for inpatient treatment at traditional medicine and rehabilitation facilities has reached over 99%, along with many technical services accounting for the highest proportion of costs nationwide.

Deputy Director of Vietnam Social Security Nguyen Duc Hoa requested that social security agencies in provinces and cities urgently inspect the prominent issues that have been identified, focusing on medical facilities that have significantly increased health insurance payment costs, in order to proactively detect and promptly handle any unusual signs.

He emphasized strict adherence to the health insurance assessment and payment procedures, resolutely refusing to pay for unreasonable or unlawful expenses.

Forecasting that health insurance medical examination and treatment costs will continue to increase in the last month of the year, the leaders of Vietnam Social Security have requested localities to improve the quality of assessment activities, strengthen inspections, and require medical facilities to strictly implement the commitments in health insurance medical examination and treatment contracts, ensuring full compliance with regulations.

Source: https://baodautu.vn/siet-quan-ly-quy-bao-hiem-y-te-de-bao-ve-quyen-loi-nguoi-benh-d457560.html