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 receive medical examination and treatment at Ea H'leo Medical Center. (Illustration photo)

Every month and quarter, the provincial Social Insurance shall proactively review, detect and promptly send warning information to health insurance-covered medical examination and treatment facilities about health insurance-covered medical examination and treatment costs that are higher than the average costs of medical examination and treatment facilities of the same technical level, the same type of general or specialized medical examination and treatment facility; sudden and unusual increases in costs, errors and inadequacies... so that medical examination and treatment facilities can check and review in accordance with the provisions of law in order to use the health insurance fund reasonably and effectively.

Strengthen the propaganda and dissemination of health insurance policies and laws to all classes of people in the province. Implement different solutions and forms of propaganda suitable for each group of participants towards the goal of universal health insurance coverage. Strengthen planned and unscheduled inspections at health insurance facilities to promptly detect, correct and handle violations according to regulations (if any).

The Department of Health shall preside over and coordinate with the provincial Social Insurance and relevant agencies to organize inspections and examinations of health insurance medical facilities that do not adjust unreasonably high health insurance medical costs according to recommendations and warnings of the social insurance agency. Preside over and coordinate with the provincial Social Insurance and relevant agencies to submit to competent authorities to amend regulations on payment methods for health insurance medical costs according to the provisions of the law on health insurance medical services to effectively control costs, ensure the quality of medical services, and convenience for patients and health care facilities; and ensure good implementation of the budget assigned by the Prime Minister .

Directing medical examination and treatment facilities to provide adequate medicines, chemicals, medical supplies, and technical services within the scope of benefits for health insurance participants, promoting the spirit of practicing thrift, combating waste in prescribing tests, inpatient treatment, and using services, especially technical services and expensive medicines, selecting and using medicines reasonably, prioritizing the use of quality medicines at appropriate prices, and drug group structure to ensure reasonable effectiveness. At the same time, directing medical examination and treatment facilities to seriously adjust the average health insurance medical examination and treatment costs that are higher than those of the same class, same line, and same specialty when receiving recommendations and warnings from the Social Insurance agency about costs that are higher than the average costs of medical examination and treatment facilities of the same class, same line, and same specialty...

Health insurance medical facilities use the health insurance fund economically and effectively in accordance with regulations, ensuring that health insurance medical expenses do not exceed the expected amount of expenses, taking full responsibility if there is any abuse or profiteering of the health insurance fund; taking full responsibility before the law for the legality and accuracy of records, documents, data, etc. requested by 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/