Strengthening control of health insurance examination and treatment costs in 2025

Accordingly, the Provincial People's Committee requests Heads of departments, branches, sectors and relevant agencies and units to seriously implement the direction of the Provincial People's Committee on the allocation of revenue and expenditure estimates for social insurance (SI), unemployment insurance (UI), health insurance (HI) and expenses for organization and operation of SI, UI, and HI in 2025.

People receiving medical treatment at Ea H'leo Health Center. (Illustrative image)

The provincial Social Insurance agency proactively reviews, detects, and sends timely warning information to health insurance medical examination and treatment facilities on a monthly and quarterly basis regarding health insurance medical examination and treatment costs that are significantly higher than the average costs of medical examination and treatment facilities of the same technical expertise level and type (general or specialized medical facilities); sudden or unusual increases in costs; errors; and inadequacies… so that medical examination and treatment facilities can check and review in accordance with the law to ensure the rational and effective use of the health insurance fund.

Strengthen the dissemination of information and policies on health insurance to all segments of the population in the province. Implement various communication methods and approaches tailored to different groups of participants, aiming for universal health insurance coverage. Intensify planned and unannounced inspections at health insurance medical facilities to promptly detect, correct, and address any violations according to regulations (if any).

The Department of Health, in coordination with the Provincial Social Insurance Agency and relevant agencies, will organize inspections and audits of health insurance medical examination and treatment facilities that have not adjusted health insurance medical examination and treatment costs to unreasonably high levels as recommended and warned by the Social Insurance Agency. It will also take the lead in coordinating with the Provincial Social Insurance Agency and relevant agencies to submit to competent authorities proposals for amending regulations on the method of payment for health insurance medical examination and treatment costs in accordance with the law on health insurance medical examination and treatment to effectively control costs, ensure they are linked to the quality of medical services, convenient for patients and medical facilities; and ensure the effective implementation of the budget allocated by the Prime Minister .

Directing healthcare facilities to ensure a sufficient supply of medicines, chemicals, medical supplies, and technical services within the scope of coverage for health insurance participants; promoting a spirit of saving and preventing waste in prescribing tests, inpatient treatment, and using services, especially expensive technical services and medicines; selecting and using medicines rationally, prioritizing the use of quality medicines at appropriate prices, and ensuring a rational and effective drug group structure. At the same time, directing healthcare facilities to strictly adjust average health insurance medical examination and treatment costs that are significantly higher than those of similar facilities, levels, and specialties upon receiving recommendations or warnings from the Social Insurance agency regarding costs exceeding the average costs of similar facilities, levels, and specialties...

Healthcare facilities covered by health insurance must use the health insurance fund economically and efficiently in accordance with regulations, ensuring that health insurance expenditures do not exceed the projected amount. They will be fully responsible if any abuse or profiteering from the health insurance fund occurs; and they will be fully responsible before the law for the legality and accuracy of the records, documents, and data submitted to the Social Insurance agency for payment.

It is known that in the first 8 months of 2025, the cost of health insurance examination and treatment increased by 258 billion VND (up 15.6% over the same period in 2024) and is expected to continue to increase from now until the end of the year, which poses requirements for social insurance agencies and related units in managing and controlling the health insurance fund.

Thuy Hong

Source: https://baodaklak.vn/xa-hoi/202510/tang-cuong-kiem-soat-chi-phi-kham-chua-benh-bao-hiem-y-te-nam-2025-4570508/