Nghe An improves the quality of medical examination and treatment under health insurance, ensuring people's rights

Many new developments

In recent years, the medical examination and treatment system in Nghe An province has developed relatively completely in both scale and depth. Accordingly, up to now, the whole province has 527 medical examination and treatment facilities signed contracts for medical examination and treatment.health insurance, including 1 central-level facility, 12 provincial-level facilities, 54 district-level facilities (29 non-public facilities) and 460 commune-level facilities, agency and unit health facilities. In terms of non-public medical examination and treatment facilities alone, Nghe An currently ranks 4th nationwide.

Along with that, Nghe An Health sector has mastered and regularly deployed specialized techniques that many provinces and cities have not been able to do such as: Vascular intervention; kidney transplant; in vitro fertilization; open heart surgery; hip and knee replacement; cranial nerve surgery, spine... creating conditions for patients with health insurance in the province to receive high-tech medical examination and treatment right in their locality, reducing treatment and travel costs; contributing to reducing the burden on central hospitals.

From the beginning of 2023 until now, health insurance medical examination and treatment facilities in the province continue to have new developments to improve the quality of technical services, protection, and health care for people...

At Vinh City General Hospital, in the first 6 months of the year, there were 531,200 people coming for examination and treatment. In carrying out examination and treatment, the hospital continues to routinely and effectively perform specialized techniques such as urological surgery, digestive surgery, vascular-cardiovascular surgery, laparoscopic surgery of the pelvic area, along with specialized techniques of intensive resuscitation - anti-poisoning...

At this time, in addition to implementing techniques in the technical classification list of a class II hospital, Vinh City General Hospital has also implemented many new, specialized techniques of the provincial and central levels, such as: Endoscopic surgery of the thyroid gland through the mouth; left liver resection surgery to treat liver tumors and liver trauma; aortic aneurysm surgery; pancreaticoduodenectomy; cytological testing in the body using an automatic hematology analyzer; D-Dimer quantification...

Similarly, Nghe An Obstetrics and Pediatrics Hospital has also deployed many advanced techniques and new techniques in the specialized fields of Internal Medicine, Pediatrics, Obstetrics and Gynecology, prenatal and neonatal screening and diagnosis; bringing the total number of advanced techniques at the Central level to 382 techniques. The hospital has mastered a number of techniques that previously required support from experts from higher-level hospitals, such as: Open heart surgery; Cochlear implantation... With the synchronous coordination between many specialties, the hospital has successfully handled many difficult and complicated cases, such as the successful surgery to separate 4 congenitally fused fingers in a child; saving the life of a mother with a blood clotting disorder, causing massive postpartum hemorrhage.

As for Nghe An General Hospital, the unit has implemented 10,969 technical categories, belonging to many specialties and fields, including many high-level techniques. Associate Professor, Dr. Nguyen Van Huong - Director of Nghe An General Hospital said: With the support of all levels and sectors, especially the provincial Social Insurance agency, in 2023, the hospital has proposed a plan to develop new techniques, specialized techniques including 160 techniques, including 35 surgical techniques, nearly 70 emergency resuscitation and internal techniques, more than 55 new techniques, high-level techniques of the paraclinical system. In particular, the Hospital continues to develop advanced techniques in visceral vascular intervention, vascular malformations, visceral artery occlusion, superior gastro-mesenteric artery, general gastrointestinal vascular intervention, etc. With the advanced specialized techniques that have been and are being deployed, the hospital meets well the treatment needs of patients in the province, the North Central region and neighboring Laos.

For the benefit of the patient

Accompanying the health sector and medical examination and treatment facilities in the province in taking care of and protecting the health and ensuring the rights of patients, Nghe An Provincial Social Insurance has well implemented the policy.health insurancein the area in accordance with regulations, ensuring the rights of health insurance participants, improving the quality of patient care, managing and using health insurance funds reasonably, safely and effectively.

Information from Nghe An Provincial Social Insurance: In 2022, the Health Insurance Medical Examination and Treatment Fund paid health insurance medical examination and treatment costs for 5,094,256 people, an increase of 917,452 people compared to the previous year (of which outpatient examination and treatment was 4,361,683 people, inpatient examination and treatment was 732,573 people). The average cost of 1 outpatient examination and treatment was 305,624 VND, the average cost of 1 inpatient examination and treatment was 4,555,941 VND.

In the first 5 months of 2023, the Health Insurance Medical Examination and Treatment Fund paid health insurance medical examination and treatment costs for 2,263,974 people (of which 1,950,656 were outpatients and 313,318 were inpatients). The average cost per outpatient examination and treatment was 310,970 VND; the average cost per inpatient examination and treatment was 4,387,902 VND. The total cost of health insurance medical examination and treatment was more than 1,981 billion VND (of which outpatient costs were more than 606 billion VND and inpatient costs were 1,374 billion VND). The cost proposed for payment by medical examination and treatment facilities was more than 1,800 billion VND.

In addition to ensuring the rights of patients receiving medical examination and treatment under health insurance, Nghe An Provincial Social Insurance has also promptly "blown the whistle" on incorrect manifestations that affect the quality of medical examination and treatment under health insurance as well as infringe upon the rights of the majority of patients receiving medical examination and treatment under health insurance.

In 2022, through the appraisal of health insurance examination and treatment costs, Nghe An Provincial Social Insurance refused to pay 416,209 medical records, with an amount of 88.5 billion VND. In the first 5 months of 2023, Nghe An Provincial Social Insurance is expected to refuse to pay an amount of 12.7 billion VND (up to June 15, 2023), of which 71 million VND was paid for the appraisal of specialized topics of Vietnam Social Insurance...

The refusal of payment is made when Nghe An Social Insurance discovers that medical examination and treatment facilities have medical staff who are not qualified to pay; widely assign patients to inpatient treatment; prolong inpatient treatment; the number of patients coming for examination multiple times; adding more hospital beds affecting the quality of treatment, assigning unreasonable medical examination and treatment services, prescribing drugs against professional instructions... "Whistleblowing" is extremely important in saving the Health Insurance Medical Examination and Treatment Fund to reserve resources to improve the quality of medical examination and treatment as well as for the treatment of subsequent patients receiving medical examination and treatment under health insurance.

On April 12, 2023, the provincial Social Insurance and Nghe An Department of Health signed a program to coordinate the implementation of health insurance policies and laws in Nghe An province to continue to ensure and improve the rights of patients receiving health insurance examination and treatment in the period of 2023 - 2025.

Mr. Hoang Van Minh - Director of Nghe An Provincial Social Insurance said: To ensure the rights of patients receiving health insurance examination and treatment, in the coming time, the Insurance - Health sector will be determined to effectively implement solutions to promote the development of science and technology to improve the quality of health insurance examination and treatment and strengthen the management of health insurance examination and treatment funds, combating abuse and profiteering of health insurance examination and treatment funds.

The solution groups include: Regarding policy mechanisms; management of drugs and medical supplies; strengthening the work of appraisal, assessment, inspection and examination; communication. In particular, assigning the responsibility of health insurance medical examination and treatment facilities to manage and use the allocated funds in accordance with regulations, effectively and economically, ensuring the rights of people with health insurance cards; strictly controlling patients coming to medical examination and treatment facilities; ensuring the rights of health insurance medical examination and treatment for people with health insurance cards; raising awareness of responsibility in using health insurance funds effectively, reasonably and legally for the medical staff in the whole province, especially the heads of medical examination and treatment facilities./.