Social Insurance points out irregularities in the use of health insurance funds, medical facilities say that social insurance causes difficulties

Comrade Le Minh Thong - Member of the Provincial Party Committee, Vice Chairman of the Provincial People's Committee chaired the working session on the implementation of the 2018 health insurance expenditure estimate and some issues in health insurance health insurance. Photo: Duc Dung

There is a phenomenon of abuse of health insurance funds.

In 2018, the Social Insurance signed medical examination and treatment contracts with 546 medical facilities in Nghe An province, including 24 general hospitals, 10 specialized hospitals, 13 general clinics, 2 specialized centers, 484 commune health stations and equivalent. In the first quarter of 2018, the whole province had 1,151,231 medical examinations and treatments with health insurance payments of over 740 billion VND.

According to statistics from Vietnam Social Security, the first 6 months of the year usually use about 45% of the total annual expenditure, however, in the first 6 months of 2018, Nghe An province used 55.8% of the total budget for 2018. Accordingly, the medical examination and treatment expenditure of health insurance cards issued by Nghe An in the first 6 months of the year was 1,817 billion VND, exceeding the budget by 170 billion VND.

Speaking at the meeting, Mr. Le Truong Giang - Director of Nghe An Social Insurance analyzed the reasons for the increase in health insurance expenditures, in which he noted: The rate of drug use in health insurance payments nationwide accounts for 34%, Nghe An accounts for 25%, while the rate of use of test and diagnostic imaging indications is high compared to the whole country... This shows that health insurance expenditures in Nghe An are skewed towards costs with salary structure, related to hospital revenue.

Director of Provincial Social Insurance pointed out the abuses in using the Health Insurance Fund. Photo: Duc Dung

Some medical facilities have not used the health insurance fund effectively, leading to a high average cost for a health insurance examination and treatment; the situation of inpatient treatment, prolonging the treatment time when not really necessary, leading to high costs for hospital beds but low costs for treatment drugs; the situation of using hospital beds beyond the plan occurs in many medical facilities, adding more beds outside the plan does not ensure the criteria for meeting medical human resources and facilities; the appointment of technical services is widespread, not in accordance with the procedures of the Ministry of Health, even the hospital's medical records request payment for 1 main disease with 10 secondary diseases.

Medical facilities face difficulties in paying health insurance premiums

At the meeting, Mr. Dau Huy Hoan - Deputy Director of the Department of Health pointed out the difficulties of medical facilities when implementing health insurance examination and treatment, which are: Payment and advance payment of expenses according to health insurance examination and treatment contracts are still slow, causing difficulties for units, affecting professional activities; the health insurance payment process still has many difficulties and problems due to inconsistent regulations.

Discussing at the meeting, representatives of some medical facilities said: In addition to the subjective reasons mentioned above, the increase in health insurance costs in Nghe An also has objective reasons such as: large population, when connecting to the network, people want to be examined and treated; Nghe An has a well-developed health system, applying many high-tech medical services... leading to high costs of medical examination and treatment.

Surgery for a patient at Vinh City General Hospital. Photo: Tu Thanh

The slow payment of health insurance medical examination and treatment costs causes many difficulties for medical facilities, even not having enough salaries to pay doctors and nurses; owing money for medicine, supplies...

Therefore, it is recommended that the Social Insurance, together with the Nghe An Department of Health, report to the Vietnam Social Insurance to adjust the annual budget, ensuring the cost of health insurance examination and treatment for people and the operation of medical facilities; it is recommended that the budget must be assigned based on the implementation of each year, not forcing the budget; allowing hospitals to open more voluntary health examination and treatment services, examinations on demand to reduce the pressure and expenditure of the health insurance fund.

Speaking at the meeting, comrade Le Minh Thong requested medical units and facilities to inspect and rectify the abuse of the health insurance fund that the provincial Social Insurance has pointed out; the provincial Social Insurance needs to make payments to the health insurance fund according to state regulations, not causing difficulties for medical facilities; must manage the health insurance fund well; in difficult conditions, it is necessary to "cut one's coat according to one's cloth", ensuring the rights of the people as well as medical facilities.