There needs to be an independent agency to assess the health insurance fund.

(Baonghean) -Explaining the issue of connecting health insurance examination and treatment lines before the National Assembly's Committee on Social Affairs on March 1, 2017, General Director of Vietnam Social Security, Ms. Nguyen Thi Minh, raised a sad reality about the unhealthy competition of medical examination and treatment facilities, especially private facilities such as promotions, attracting patients with gifts, prescribing many technical services... causing the demand for medical examination and treatment to increase virtually.

In addition, the General Director of Vietnam Social Security also pointed out the increasing abuse and profiteering of health insurance funds from medical facilities such as: increasing the number of clinical tests and X-rays, health insurance patients going to medical examination and treatment many times a day, week, month to get medicine (from July 2016 to February 2017, there were over 1.2 million people participating in health insurance going to medical examination and treatment 2 times or more per month; 3 million visits many times in the same day, many times a month.

There were even cases of people going to see a doctor and getting medicine up to... 308 times in 23 places in 8 months (in Ho Chi Minh City), 197 times in 5 places (Ho Chi Minh City, Binh Duong), or there was a person in the 4th quarter of 2016 who went to see a doctor 160 times in 20 different facilities...

The reason for this explanation session is understood by everyone because recently the whole country has been "in an uproar" about the issue of health insurance fund deficit of up to thousands of billions of dong (Nghe An is the province with the second largest deficit in the country, only behind Thanh Hoa).

The reason for the large deficit in health insurance, in fact, did not have to wait until the General Director of Vietnam Social Security to point it out, but before that, it was also mentioned many times by relevant authorities, sectors and media agencies. However, what is the effective solution to prevent unfair competition, abuse and profiteering of the health insurance fund?

Checking the issuance of health insurance cards at Vinh City Social Insurance. Photo for reference.

Those in charge have proposed many solutions, most notably the opinion of Mr. Hoang Van Hao - Deputy Director in charge of the Department of Health during a working trip with the National Assembly delegation at the end of February: "In addition to the Social Insurance agency assigned to manage the Health Insurance Fund, the health agency implementing it, there needs to be another agency to independently assess, ensure objectivity and transparency in the implementation of the fund, and avoid abuse of the Health Insurance Fund...".

Think about it, the Social Insurance sector is not only assigned to manage the Health Insurance Fund but is also the agency directly paying Health Insurance expenses to units that have contracts for health insurance examination and treatment. Managing and paying money, the power of Social Insurance is really great.

And the reality is that any agency or unit that is given great power, while the monitoring mechanisms are lacking (or are still loose), is prone to abuse of power or exploitation of power.

The Social Insurance sector has a fairly large team of appraisers and inspectors. This team has the function of appraising, checking and controlling the implementation of medical examination and treatment at public and private hospitals that have contracted to provide health insurance examination and treatment. However, in the work of medical examination and treatment, to accurately, correctly and sufficiently appraise each case is really difficult.

It requires the appraiser to have solid medical expertise; and at the same time, must have practice. The appraisal team of the Social Insurance industry are of course trained people, but do not regularly have access to actual medical examination and treatment, so it is difficult to make an accurate assessment based on records alone.

Therefore, if there is no independent appraisal agency, allowing the Social Insurance to calculate the Health Insurance premiums in a rigid manner will cause difficulties for medical examination and treatment facilities; at the same time, people using Health Insurance for medical examination and treatment will also encounter many difficulties from medical examination and treatment facilities.

If the appraisal is lax, or worse, there is a compromise or collusion between the appraiser, inspector (or the Social Insurance agency) and the health insurance examination and treatment facilities, then, unfortunately, it will lead to a loss of health insurance funds.

The goal of the Party and the State is to implement universal health insurance, thereby ensuring that people enjoy the best health care benefits. Therefore, the safe management of the health insurance fund is extremely important. To do so, it is necessary to prevent overspending; not to allow abuse or other violations in the use of the health insurance fund.

Therefore, Mr. Hoang Van Hao's proposal to establish an independent appraisal agency is a good proposal and should be considered for implementation. If there is an independent appraisal agency for health insurance examination and treatment, it is believed that it will increase transparency and objectivity; reduce abuse and other violations in health insurance examination and treatment; and the health insurance fund will be better managed!

Nhat Lan