Don't calculate profit and loss when it comes to the Health Insurance Fund.

(Baonghean) - Recently, the Vietnam Social Insurance announced that Nghe An province will have to balance its own revenue and expenditure of the health insurance fund. Is this consistent with the principles and objectives of a social security policy?

The situation of the Vietnam Health Insurance Fund and Nghe An Province.

At the regular information conference on social insurance and health insurance policies organized by Vietnam Social Insurance on the afternoon of October 26, 2016, in Hanoi, Deputy Minister and Director General of Vietnam Health Insurance Nguyen Thi Minh stated that since 2010, the health insurance fund has saved thousands of billions of dong each year.

As of 2014, the health insurance fund had a surplus of approximately 5,200 billion VND. Deputy Minister and Director General Nguyen Thi Minh also added that the health insurance fund has sufficient reserves to cover the costs of this adjustment to medical service prices and is capable of balancing the fund until the end of 2017. Therefore, there is no need to consider adjusting health insurance contribution rates between now and the end of 2017.

Laparoscopic surgery at Thanh Chuong District General Hospital. Photo: PV

However, recently, Mr. Nguyen Minh Thao - Deputy General Director of Vietnam Social Security - stated that in 2017, the health insurance fund had to spend approximately 77,000 billion VND on health insurance-covered medical examinations and treatments for the people, resulting in a shortfall of about 8,000 billion VND. Therefore, the spending plan had to be assigned to the provinces. Based on that, the provinces assigned plans to the hospitals.

If there is a shortage of funds due to objective reasons, the province will allocate the necessary budget. If the province does not have the budget, it will report to the Prime Minister and the Vietnam Social Security will consider using the reserve fund to compensate for the shortfall.

Vietnam Social Security forecasts that in 2017, most localities will experience deficits in the health insurance fund for medical examination and treatment. Specifically, Da Nang, Nghe An, and Thanh Hoa are expected to each have a deficit of over 1,000 billion VND; Hai Duong, Quang Nam, and Quang Ninh will each have a deficit of over 500 billion VND; and An Giang and Thai Binh will each have a deficit of over 400 billion VND.

Previously, on May 19, 2017, the Vietnam Social Security issued Official Letter No. 1895/BHXH-CSYT to the People's Committee of Nghe An province stating: "The Vietnam Social Security will allocate health insurance funds for medical examination and treatment to each locality based on the province's health insurance revenue for the year, so that localities can proactively allocate and regulate the use of these funds."

With the Health Insurance Law No. 46/2014/QH13, the benefits of health insurance cardholders have increased, patients have access to high-tech medical services, and the quality of medical examination and treatment has improved. In Nghe An, the frequency of medical examinations and treatments for health insurance cardholders in 2016 was 1.1 times/year, an increase of 38% compared to 2015.

The total cost paid under the health insurance scheme was 2,513 billion VND, an increase of 67% compared to 2015 (an increase of 1,008 billion VND). In the first five months of 2017, the number of medical examinations and treatments at healthcare facilities increased by 20% compared to the same period in 2016 (an increase of 306,975 visits), and the total cost paid under the health insurance scheme was 1,281 billion VND, an increase of 46% compared to 2016 (an increase of 401 billion VND).

In previous years, Nghe An province had a surplus in its health insurance fund, and this surplus was remitted to Vietnam Social Security. According to preliminary statistics, in 2010, Nghe An's health insurance fund had a surplus of over 58 billion VND; in 2011, over 43 billion VND; in 2012, over 38 billion VND; and in 2014, over 81 billion VND (a total surplus of over 220 billion VND over the four years).

Now, with the policy changes, and given the unique characteristics of the health insurance participants in Nghe An as mentioned above, and the fact that Nghe An has to balance its own revenue and expenditure, will the rights of Nghe An health insurance participants be guaranteed?

Doctors examine patients at Nghe An Obstetrics and Pediatrics Hospital. Photo: PV

The role and activities of the social insurance sector need to be re-evaluated.

At a recent meeting between healthcare facilities, leaders from the Provincial Department of Health and Social Insurance, along with representatives from several healthcare facilities, raised the question: What is the purpose of using the surplus health insurance fund from previous years?

Why is it that when the cost of health insurance coverage for residents in the province exceeds the province's revenue, the Social Insurance agency doesn't use its reserve fund (which includes local contributions from surplus funds from previous years) to balance the deficit, but instead shifts the responsibility to the province? And then the province has to report to the Prime Minister before the Social Insurance agency considers using the reserve fund?

Has the Social Insurance agency fulfilled its responsibilities in this regard?

Opinions from healthcare facilities also suggest that the social insurance sector should not view the overspending of the health insurance fund too negatively, as it was a predictable outcome before the implementation of the inter-hospital referral policy.

Furthermore, health insurance is an important social security policy of the Party and the State, so the focus should be on operational efficiency, service quality, and the benefits that people receive, rather than prioritizing profit and loss.

Examining a patient at the Ophthalmology Department, Thanh Chuong District General Hospital. Photo: PV

In fact, in many countries abroad, there is also the phenomenon of spending exceeding revenue in the health insurance fund. To ensure the rights of participants, and to properly implement the principles, purposes, and humanitarian significance of a social security policy, the health insurance fund needs to be shared across regions and target groups, rather than imposing revenue and expenditure calculations on local authorities or medical facilities.

Given the limited state budget, to alleviate the financial burden on social security funds and policies, including the health insurance fund, macro-level solutions such as promoting public awareness campaigns to improve environmental hygiene, food safety, and healthy lifestyles to enhance living conditions and health could be considered. In other words, prevention is better than cure. Alternatively, a partial privatization of health insurance services could be considered.

Reporters' Team