Check and strictly manage health insurance funds at medical examination and treatment facilities

(Baonghean.vn)- Voters in some localities petitionPeople should not be forced to use health insurance for treatment.hospitals with poor professional quality. Currently,Hospital transfers are still difficult for people.; k managementHealth insurance premiums are too lax, especially treatment facilities such as hospitals often add additional items to the bill. Suggestionfunctional sectorStrengthen inspection and strict management to protect people's rights.

Regarding this issue, the competent authority responded as follows:

Regarding regulations on initial health insurance registration and referral for health insurance treatment:

- According to the provisions of Article 8 of Circular 40/2015/TT-BYT dated November 16, 2015 of the Ministry of Health: Health insurance participants have the right to register for initial health insurance medical examination and treatment (hereinafter referred to as initial medical examination and treatment) at one of the medical examination and treatment facilities at the commune or district level, regardless of administrative boundaries, in accordance with the workplace, place of residence and the response capacity of the medical examination and treatment facility.

Health Department leaders inspect the smart medical examination card system at Quynh Luu General Hospital. (illustrative photo)

- At Point c Clause 1 Article 22 of Law No. 46/2014/QH13 dated June 13, 2014 stipulates: From January 1, 2016, the district-level health insurance system will be established nationwide, so health insurance participants, regardless of their initial health insurance examination and treatment registration at any health insurance facility, can choose to receive health insurance examination and treatment at district-level hospitals or lower nationwide, which is considered to be in the right line. Health insurance participants can choose the appropriate district-level health insurance facility for examination and treatment. Thus, the initial health insurance registration at Phu Dien Hospital is decided by the people themselves, not forced by any agency.

- Implementation of referrals of health insurance facilities: Cases where patients request referrals are mainly not based on professional requirements but on the patient's needs, based on the psychology of wanting to receive medical treatment at the provincial level. Some cases go directly to the higher level and are assigned to inpatient treatment, then return to the place of initial health insurance registration to request a referral. The above cases are not in accordance with the professional regulations and referral regulations of the Ministry of Health, causing pressure on health insurance facilities.

Management of health insurance funds at medical facilities

Medical examination and treatment and payment of health insurance medical examination and treatment costs are closely monitored by the Social Insurance agency in coordination with medical examination and treatment facilities according to the appraisal process issued by Vietnam Social Insurance.

Currently, at health insurance medical facilities, there are permanent or part-time appraisers responsible for appraising health insurance medical costs at that facility.

In addition to the supervision of the assigned agency, the supervision of health insurance card holders when going for medical examination and treatment is equally important, because the person going for medical examination has the right to refuse expenses that are not paid but are still included in the payment.

Patients being treated at Nghe An Oncology Hospital, (documentary photo, illustration)

Every quarter, the provincial Social Insurance agency coordinates with the Department of Health to establish many inspection teams to monitor the implementation of the Health Insurance Law and policies in the whole province, promptly detect and correct any problems, and resolutely refuse to pay expenses that are not in accordance with regulations.

However, the voters' reflections are received by the management agency, but because the voters' reflections are not specific, the work of handling individuals and groups that violate the law still faces many difficulties. Voters are requested to reflect each case in a very specific way so that the Department of Health can receive and handle it in accordance with the provisions of the law.

Solution:

- Assign responsibility to the heads of medical examination and treatment units to be responsible for organizing the implementation of health insurance policies, especially managing health insurance funds according to the provisions of law; especially strictly implementing Directive No. 29/2012/CT-UBND dated November 10, 2012 of the Provincial People's Committee on strengthening responsibility in using and managing health insurance funds; Directive No. 06/CT-BYT dated June 13, 2014 of the Ministry of Health on strengthening inspection and examination to prevent fraudulent acts and profiteering of health insurance funds at medical examination and treatment facilities.

Medical examination and treatment at Nghe An Obstetrics and Pediatrics Hospital, (documentary photo, illustration)

- Issue the following directives: No. 1015/SYT-NVY dated May 5, 2015 on strengthening and improving the quality of implementing health insurance policies; No. 2421/SYT-NVY dated September 28, 2015 on correcting administrative procedures for health insurance examination and treatment; No. 2490/SYT-NVY dated October 7, 2015 on correcting some shortcomings in health insurance examination and treatment; No. 849/SYT-NVY dated April 19, 2016 on implementing Directive 06 of the Ministry of Health; Hotline from the Department of Health to medical examination and treatment facilities to receive and resolve patients' problems when going for medical examination and treatment quickly, effectively and in accordance with regulations.

- Propagating health insurance policies and laws, regulations on rights and obligations of health insurance participants.

- The work of inspecting the implementation of health insurance policies and laws is carried out regularly among relevant agencies and units.

PV

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