Nghe An strengthens cost control and uses health insurance funds economically and effectively

Accordingly, in order to use health insurance economically, safely, effectively and in accordance with the provisions of the Health Insurance Law, in addition to requiring units to continue to strictly implement Official Dispatch No. 745/SYT-NVY dated March 21, 2019 of the Department of Health on strengthening control of health insurance examination and treatment costs, the Director of the Department of Health of Nghe An province requires Directors of medical examination and treatment facilities in the area to identify health insurance examination and treatment management as a key activity with many different management methods aiming at the goal of not exceeding the allocated budget.

Conference to discuss solutions for managing health insurance medical examination and treatment funds. Photo: Ha Lien

The unit director or a member of the Board of Directors must have a firm grasp of and directly direct and manage the management of health insurance, with specific assignments and delegation of authority to each department related to health insurance. Data transferred to the Social Insurance Appraisal Portal must also be viewed as an important data source that regularly provides information for the management of health insurance of the unit.

The Department of Health requires medical facilities to regularly disseminate and propagate to change the awareness of staff in the unit, so that each staff member can improve their sense of responsibility in using fund resources.

Facilities need to strengthen monitoring of compliance with treatment regimens in all clinical departments, monitor testing orders, outpatient prescriptions, and appropriate inpatient treatment orders.

Direct the Drug and Treatment Council and the Science and Technology Council to review the list and types of drugs and medical supplies in a way that ensures treatment quality while saving costs.

On September 9, 2019, the Ministry of Health issued Directive No. 10/CT-BYT on strengthening the prevention and control of abuse and profiteering of the Health Insurance Fund. In order to promptly prevent abuse, fraud and profiteering of the Health Insurance Fund, the Ministry of Health requires the Directors of the Departments of Health of provinces and centrally run cities; heads of health care of ministries and branches to strengthen the work of advising on the implementation of state management tasks on Health Insurance, propaganda, education and dissemination of policies and laws on Health Insurance. In particular, attention must be paid to the contents related to medical examination and treatment under Health Insurance according to the provisions of the Law on Health Insurance and Resolution No. 05/2019/NQ-HDTP dated August 18, 2019 of the Council of Judges of the Supreme People's Court on Guidance on the application of Articles 214, 215, 216 of the Penal Code...

Proactively review, evaluate and analyze the situation of using health insurance funds, identify the causes, and correct subjective errors that lead to an increase in the allocated costs for health insurance compared to the same period: Appointing patients for re-examination according to referral papers (once) when it has not exceeded the expertise of the lower level or is not suitable for professional requirements for diseases that do not require re-examination appointments; admitting patients for treatment beyond the necessary level; prolonging inpatient treatment days; not implementing measures to reduce hospital overload such as transferring patients to lower levels when treatment is stable, technical transfer work, directing the level...

From the health insurance fund, primary health care in schools has received investment attention. Photo: Phuoc Anh

The specific and drastic instructions of the Department of Health for health insurance facilities in controlling and using the allocated budget in 2019 economically and effectively are considered important results from the efforts of the Social Insurance - Health sector to aim at the goal of using the health insurance fund economically and effectively for the benefit of health insurance card holders in the province.

From 2021, health insurance participants who need to see a doctor or receive treatment outside the provincial hospital will still be entitled to 100% of inpatient costs. This content is specifically stipulated in Clause 15, Article 1 of the Law amending and supplementing a number of articles of the Law on Health Insurance. Accordingly, in case a person with a health insurance card goes to a provincial hospital for medical examination and treatment outside the provincial hospital, the health insurance fund will pay 100% of inpatient treatment costs from January 1, 2021 nationwide.
Currently, if a patient receives medical treatment outside the provincial hospital, the health insurance fund will only pay 60% of the inpatient treatment costs. With this new policy, the financial difficulties for patients with health insurance will be somewhat reduced.