Health insurance debt of more than 3,000 billion VND, sanctions lack deterrence

The total health insurance debt in 2016 was still quite high, up to 3,013 billion VND, of which the local budget owed 2,327 billion VND (accounting for 77.2% of the total health insurance debt), the rest was the debt of units, organizations and enterprises.

By the end of 2016, the whole country had 75.91 million people participating in health insurance (HI), an increase of 6.25 million people compared to 2015, bringing the universal health insurance coverage rate to 81.9%, reaching the target 4 years ahead of the target of Resolution 21-NQ/TW of the Politburo and Resolutions of the National Assembly.

The quality of medical examination and treatment by health insurance needs to be improved. Illustrative photo

It is expected that by the end of 2017, the health insurance coverage rate will reach 84.1% and gradually approach the universal health insurance coverage rate.

The health insurance coverage rate is so high, but it is not really sustainable: the subjects paid by the state budget and supported by the state budget account for 65.2% of the total number of health insurance participants. In 2016, 10/63 provinces did not complete the health insurance coverage target assigned by the Prime Minister in Decision 1167/QD-TTg, which are also the provinces where the health insurance fund deficit occurred.

This is the information provided in Report No. 859/BC-UBVĐXH14 that the Committee on Social Affairs has just sent to the National Assembly.

In particular, through the review, the Committee on Social Affairs determined that the revenue and expenditure activities of the Health Insurance Fund still have many limitations and problems. The total health insurance debt in 2016 is still quite high, up to 3,013 billion VND, of which the local budget owes 2,327 billion VND (accounting for 77.2% of the total health insurance debt), the rest is the debt of units, organizations and enterprises.

The cost of health insurance management in 2016 was nearly double that of 2015. Although it was in accordance with regulations (maximum 5% of total health insurance revenue), the reason for the sudden increase compared to 2015 is unclear. "In the settlement table, there was no item that increased by nearly 200% such as the cost of health insurance fund management," said the report signed by the Chairwoman of the Committee on Social Affairs, Nguyen Thuy Anh.

While the work of clearing and settling health insurance costs still faces difficulties due to the fact that the health insurance policy and law system still has some contradictory, overlapping and difficult-to-implement contents (leading to the situation where many hospitals owe large sums of money to pharmaceutical companies, causing public outrage), the situation of abuse and profiteering of health insurance funds by health insurance facilities and participants tends to increase.

Although in 2016, through appraisal work, the Social Insurance agency refused to pay over 1,785 billion VND of health insurance treatment costs due to violations of regulations, in general, the work of checking, inspecting and appraising health insurance is still limited.

With nearly 3,100 officials working in health insurance appraisal, in 2016 alone, on average each official working in appraisal had to appraise and settle about 51,600 health insurance records, equivalent to having to process more than 140 records per day, making it difficult to avoid errors.

In addition, the sanctions for violations in the field of health insurance stipulated in Article 49 of the Law on Health Insurance are not strong enough and lack deterrence. The responsibility of the health insurance appraisal agency has not been clarified when the later appraisal results negate the previous appraisal results.

According to Sggp.org.vn