Proposal to establish an independent appraisal organization for settlement of health insurance treatment costs

Mr. Ho Phuc Hop - Member of the Standing Committee, Head of the Provincial Party Committee's Propaganda Department, Head of the Culture - Social Affairs Department, Provincial People's Council chaired the meeting. Photo: Minh Chi

Currently, the network of medical facilities has been widely developed from the provincial level to communes, wards and towns. Infrastructure has been invested, the quality of human resources has been improved, IT application has been promoted, cumbersome procedures for patients have been reduced, and many high-tech services have been provided in medical examination and treatment (KCB).., contributing to creating favorable conditions as well as meeting the increasing demand for medical examination and treatment of the people, including those participating in health insurance.

Accordingly, the number of patients with health insurance cards coming to medical facilities for treatment increases every year. In 2017 alone, it reached more than 4.7 million visits and in the first quarter of 2018, it was over 1.1 million visits.

However, according to Deputy Director of the Department of Health Dau Huy Hoan, the biggest contradiction and inadequacy today is that the health insurance policy increasingly creates conditions for health insurance participants to access technical services and minimizes the amount of health insurance patients have to pay, leading to increasing medical service costs, while the health insurance fund is still limited.

The imbalance between revenue and expenditure of the health insurance fund leads to slow funding for medical facilities, causing difficulties for medical facilities, especially autonomous facilities.

Mr. Dau Huy Hoan also proposed to study the establishment of an independent appraisal organization for payment and settlement of health insurance medical examination and treatment costs.

Acting Director of the Department of Health Duong Dinh Chinh admitted the "loopholes" in the grassroots health system. Photo: Minh Chi

Deputy Head of the Culture - Social Affairs Committee, Provincial People's Council Nguyen Thi Lan expressed concern about the limited quality of medical examination and treatment at the grassroots level; some medical facilities and staff have not been granted practice certificates, meaning they do not perform medical examination and treatment according to the health insurance regime.

This creates a reality of a lack of patients at the grassroots level and overload at the upper level; this is also the reason for the increase in medical examination and treatment costs, because the medical examination and treatment costs at the upper level are higher. In addition, the Deputy Head of the Department of Culture and Society also pointed out the fact that the bidding and supply of drugs to medical facilities, especially at the lower level, is not timely, affecting the medical examination and treatment work as well as ensuring the rights of patients;

Ms. Nguyen Thi Lan also pointed out the lack of transparency in technical procedures and treatment regimens for health insurance patients and assessed the actual number of beds to ensure patient rights.

Explaining the above concerns, Acting Director of the Department of Health, Duong Dinh Chinh, admitted that the biggest gap in the health sector at present is at the grassroots level; this is an issue that the sector is also focusing on to handle but it will take time.

Mr. Chinh also affirmed that the industry will coordinate with the Health Insurance Agency to review and unify the number of beds needed in medical facilities, ensuring the rights of patients; at the same time, it will resolutely issue practice certificates to commune-level health stations...

Head of the Culture and Social Committee of the Provincial People's Council Ho Phuc Hop concluded at the conference. Photo: Minh Chi

Concluding the meeting, Head of the Culture - Society Committee, Provincial People's Council Ho Phuc Hop requested the health sector to continue to synchronously deploy solutions to improve the quality of management of medical facilities, especially paying attention to improving the quality of medical staff in diagnosis, treatment and attitude in serving patients.

Emphasizing the importance of grassroots health care, the Head of the Department of Culture and Society also requested the Department of Health to pay attention to strengthening the medical staff at lower levels, along with granting practice certificates to this team, to overcome the situation of well-invested facilities, but not having specialized staff and certificates to practice.

Head of the Culture - Social Committee, Provincial People's Council Ho Phuc Hop also requested the Department of Health and Social Insurance, within their authority, to review and supplement coordination regulations and properly implement the regulations to resolve difficulties and shortcomings that are arising to effectively implement the common goal of protecting the rights and health care of the people.