Nghe An: Strengthening the management and use of health insurance medical examination and treatment cost estimates in 2022

The conference was attended by representatives of 66 health insurance examination and treatment facilities in the province. Photo: Thanh Chung

Proposal to pay 1,857 billion VND for medical examination and treatment under health insurance

The joint report of the Department of Health - Social Insurance of the province said: In 2022, Nghe An Social Insurance will sign contracts for medical examination and treatment.health insurancedirectly with 66/527 medical examination and treatment facilities. Including 01 central facility, 14 provincial facilities, 51 district facilities.

Estimated medical examination and treatment expenseshealth insuranceNghe An's budget for 2022 assigned by the Prime Minister in Decision 582/QD-TTg dated May 13, 2022 is 3,790,282 billion VND. In the first 6 months of 2022, the health insurance expenditure that medical examination and treatment facilities in the province requested to pay was over 1,857 billion VND. The budget utilization rate assigned to Nghe An is 49%, ranking 3rd nationwide (the national budget utilization rate is 39.99%).

Compared to the same period in 2021, the average total cost per medical examination and treatment visit was VND 954,705/visit, an increase of 15.9% (equivalent to an increase of VND 130,840/visit); the average number of inpatient treatment days was 7.29 days/treatment visit, an increase of 4.3%; the rate of inpatient treatment was 13.9%, an increase of 3.1% (equivalent to 9,019 visits); the number of out-of-line inpatient treatment visits was 28,468 visits, an increase of 0.8%.

The joint department of the Department of Health - Social Insurance of the province has issued a warning: The estimated cost of exceeding the total payment for the first 6 months of 2022 of Nghe An is over 279 billion VND.

Receiving patients with health insurance cards for medical examination and treatment. Photo: Thanh Chung

The Department of Health - Social Insurance of the province assessed that there are 8 groups of reasons for the increase in health insurance examination and treatment costs in the first 6 months of 2022, which are: People's demand for medical examination and treatment is increasing in both quantity and quality of technical services; shifting disease patterns increase the number of patients examined and treated after Covid-19. The technical quality and medical examination and treatment services of medical facilities in Nghe An are constantly improving.

In addition, the awareness of health insurance participants is not good, there are signs of increasing abuse from the health insurance card holders. Some medical examination and treatment facilities have not thoroughly grasped the responsibility of managing and using health insurance funds appropriately; there is still a situation of prescribing inappropriate technical services and drugs, leading to some unnecessary increases in health insurance examination and treatment costs.

In addition, there are other reasons such as: Impact of the policy of inpatient health insurance examination and treatment not in the right line, inpatient examination and treatment at provincial level; incomplete health insurance management mechanism, lack of technical regulations to control costs; limited service quality at lower levels leading to overload at upper-level medical facilities, increasing the cost of health insurance examination and treatment...

Overcoming subjective causes

At the conference, the delegates focused on discussing solutions for budget management and cost control of health insurance examination and treatment. The proposed solutions focused on overcoming subjective causes from medical facilities and proposed changes to some mechanisms and policies that are no longer reasonable.

Associate Professor, Dr. Nguyen Van Huong - Director of Nghe An General Friendship Hospital presented solutions and recommendations in the management and use of health insurance medical examination and treatment cost estimates in 2022. Photo: Thanh Chung

Concluding the conference, comrade Bui Dinh Long stated: Medical examination and treatment in the first 6 months of the year in Nghe An has been well implemented, highly appreciated by the people... Medical examination and treatment facilities have been aware of controlling the health insurance fund. However, compared with the budget, Nghe An still has risks of exceeding the 2022 budget when the budget usage is higher than the national average.

Vice Chairman of the Provincial People's Committee Bui Dinh Long requested: The Department of Health shall coordinate with the Social Insurance to strengthen the advisory work to help the Provincial People's Committee carry out state management of health insurance; strengthen the inspection, examination and handling of violations in the use of health insurance funds at units with abnormally high health insurance examination and treatment expenses, especially hospitals with high rates of hospitalized patients; review the actual number of hospital beds at medical facilities to ensure patient rights; re-evaluate the average inpatient treatment days at medical facilities; check the reasonableness of inpatient treatment prescriptions of a number of hospitals.

The Department of Health directs and guides medical examination and treatment facilities to strictly implement professional regulations in examination and treatment; consider developing medical services; provide adequate medicines, chemicals, medical supplies, and technical services within the scope of benefits for health insurance participants; promote the spirit of practicing thrift and combating waste.

Vice Chairman of the Provincial People's Committee Bui Dinh Long requested relevant levels, sectors and units to be truly responsible and closely monitor the use of health insurance medical examination and treatment cost estimates, ensuring good patient rights. Photo: Thanh Chung

The Provincial Social Insurance Agency regularly reports to the Provincial Party Committee, People's Council, People's Committee, and Vietnam Social Insurance on the implementation of health insurance policies in the locality, and the implementation of the budget for medical examination and treatment in the locality; speeds up the payment of outstanding health insurance medical examination and treatment costs for medical facilities; improves the quality of health insurance appraisal; regularly provides information, data, and warnings on medical examination and treatment indicators to the Department of Health to have solutions to direct health insurance medical examination and treatment facilities to organize proper implementation of regulations; coordinates with the Department of Health to promptly resolve problems and inadequacies arising in the process of payment and settlement of medical examination and treatment costs, ensuring the rights of medical facilities and patients.

Health insurance medical examination and treatment facilities need to focus on improving the quality of on-site medical examination and treatment; saving on prescriptions for tests, diagnostic imaging and other costs; prescribing inpatient treatment, technical services, paraclinical services, and reasonable drugs; developing specific plans and solutions to reduce the average treatment days and the average cost of a medical examination and treatment; proactively coordinating with the Social Insurance agency to periodically control costs; enhancing the application of information technology to connect and interconnect health insurance medical examination and treatment data, pushing daily data in a timely and accurate manner... providing adequate drugs, chemicals, medical supplies, technical services, reforming administrative procedures to create favorable conditions for people to access medical examination and treatment services./.