Is the handling of health insurance overspending in Nghe An illegal?

(Baonghean.vn) - In response to the health insurance deficit, last May, Vietnam Social Security issued Official Letter No. 1895/BHXH-CSYT to Nghe An province, with the content proposing a solution to the strange deficit.in a localized manner, contrary to the provisions of the Law on Health Insurance.

Official dispatch No. 1895/BHXH-CSYT of Vietnam Social Security was issued on May 19, 2017. Here, Vietnam Social Security announced that in 2016, the whole country had a health insurance deficit of about over 6,000 billion VND; of which, the estimated health insurance deficit in Nghe An was about 948.9 billion VND!

People carry out procedures to receive medical examination and treatment at the Provincial General Hospital. Photo: Document

The content of the document affirms that in 2017: "Vietnam Social Security will allocate health insurance examination and treatment costs to each locality according to the health insurance revenue of the province used in the year so that the locality can proactively allocate and regulate the use". And if the health insurance examination and treatment costs exceed the provincial health insurance examination and treatment fund, then: "The provincial Social Security shall appraise and determine the objective reasons for the excess fund and report to the Provincial People's Committee for consideration of compensation from the local budget or other sources"; "In case the budget is not fully allocated, the Chairman of the Provincial People's Committee is requested to report and request the Prime Minister's direction".

This is considered a measure to "strengthen management and control of health insurance medical examination and treatment spending to ensure effective and economical use of the fund".

The reason why Vietnam Social Security has proposed the above handling direction comes from the subjective cause of the overspending, which is laxity in management, profiteering by medical facilities and some subjects with health insurance cards.

Regarding health insurance deficit, it is true that since the policy of connecting medical examination and treatment at district level was implemented, Nghe An (along with Thanh Hoa) is in the leading group in the country.

According to information from the responsible agency, the total revenue of the Health Insurance Fund of Nghe An in 2017 was about 1,983 billion VND; while the estimated expenditure for medical examination and treatment under the Health Insurance will be up to 2,707 billion VND. That means there will be a deficit of about 720 billion VND.

To be fair, there are subjective reasons for such overspending in Nghe An as pointed out by the Vietnam Social Security. However, it must be affirmed that in addition to subjective reasons, there are many objective reasons leading to overspending in health insurance.

It can be cited that the policy of connecting routes is implemented; the adjustment (increase) of medical service prices; besides, Nghe An is a province with a large number of ethnic minorities, and many policy subjects enjoy the state's treatment of health insurance; the medical examination and treatment facilities (district level) in Nghe An have relatively high quality, so they attract a large number of people from other provinces to come for medical examination and treatment...

If the deficit handling direction is implemented as Vietnam Social Security imposes in Official Letter 1895, then Nghe An will need hundreds of billions of VND from “local budget or other sources” every year to compensate. The question arises: If the local budget is not guaranteed and there are no other sources, how will the health examination and treatment under health insurance in Nghe An be maintained in the remaining months of 2017 and the following years?

Surgery for patients with health insurance at the Provincial General Hospital. Photo courtesy

To answer this question, the only way is to review the handling direction of Vietnam Social Security in Official Dispatch 1895 to see if it is correct or not!

Clause 4, Article 35 (Allocation and use of Health Insurance Fund) of the Law amending and supplementing a number of articles of the Health Insurance Law (also known as Health Insurance Law No. 46) stipulates: "In case the province or centrally-run city has health insurance revenue for medical examination and treatment less than the medical examination and treatment expenditure in the year, after assessing the settlement, Vietnam Social Security is responsible for supplementing the entire difference from the reserve fund".

Regarding the management and use of the reserve fund, Decree 105/ND-CP dated November 15, 2014 detailing and guiding the implementation of a number of articles of the Law on Health Insurance stipulates that it is to supplement the source of funding for health insurance examination and treatment for provinces and cities in cases where the amount of health insurance revenue for medical examination and treatment is less than the amount of medical examination and treatment expenses in the year.

Decree 105 also clearly states that in case the reserve fund is not enough to supplement the medical examination and treatment costs for provinces and cities, Vietnam Social Security shall report to the Vietnam Social Security Management Board on a solution before reporting to the Ministry of Health and the Ministry of Finance. The Ministry of Health shall preside over and coordinate with the Ministry of Finance to submit to the Government solutions to ensure sufficient and timely funding for medical examination and treatment under health insurance as prescribed.

According to the above regulations, it is clear that the direction of handling the health insurance deficit proposed by Vietnam Social Security is contrary to the provisions of the Health Insurance Law and the legal documents guiding the implementation of this law. And so, it can only be said that Vietnam Social Security is deliberately "kicking the ball of responsibility" to the localities, including Nghe An.

Furthermore, with the proposed handling direction, Vietnam Social Security itself is going against the principles and meaning of the universal health insurance program, which is fundamentally based on the spirit of mutual love and support so that all Vietnamese people can receive health care.

In short, strong solutions are needed to prevent health insurance fraud to properly manage the health insurance fund. However, the direction of handling health insurance deficit that Vietnam Social Security proposed in Official Letter 1895 is difficult to accept!

Nhat Lan