Must balance health insurance fund while ensuring patient rights

(Baonghean.vn) - On the afternoon of December 15, the third session of the 17th Nghe An Provincial People's Council entered the question-and-answer session. Many delegates raised questions about the health insurance fund deficit to the authorities.

Responding to voters' questions sent before the meeting, Mr. Le Truong Giang - Director of Nghe An Provincial Social Insurance reported on the issues of health insurance fund overspending and social insurance arrears.

Mr. Le Truong Giang - Director of Nghe An Provincial Social Insurance reported and answered questions before the Provincial People's Council.

Accordingly, in the first 9 months of 2016, the province's health insurance fund had 1,321.468 billion VND. The total payment for health insurance facilities was 1,694.31 billion VND. The health insurance fund balance exceeded 372.843 billion VND, of which the increase in health insurance costs due to the increase in technical service prices was 210.066 billion VND and the impact of the health insurance policy of inter-line health insurance was 196.582 billion VND. The reason for the overspending was also due to the abuse of technology, services, drugs, etc. by health insurance facilities.

Although Nghe An had a deficit in the Health Insurance Fund in 2016, the total expenditure for the first 9 months and the entire year of 2016 is still within the assigned budget and within the ability to regulate and balance the Health Insurance Fund of Vietnam Social Security.

Delegate Dinh Thi An Phong requested clarification of the responsibilities of the provincial Social Insurance appraisers.

Regarding social insurance arrears, Mr. Le Truong Giang said: In 2016, social insurance revenue reached 1,867 billion VND, an increase of 162 billion VND compared to the same period in 2015; Social insurance arrears were 135,768 billion VND, accounting for 6.2%, a decrease of 11,957 billion VND compared to the same period in 2015 (the rate of social insurance arrears in the same period in 2014 was 9.4%, in 2015 was 7.1%)... Although social insurance arrears are still at a high level, they are lower than the same period in 2014, the same period in 2015 and lower than the national average. As of October 31, 2016, in Nghe An province, there were 256 enterprises that had stopped operating or disappeared, with a total debt of 11,515 billion VND.

Delegate Nguyen Van Hai questioned issues of health insurance management software and the rights of social insurance payers.

Entering the questioning session, delegates Dinh Thi An Phong (Nghi Loc), Nguyen Van Hai (Tuong Duong), Lo Thi Kim Ngan (Que Phong), Luc Thi Lien (Quy Chau) focused on questioning the content of the Health Insurance Fund deficit, with the following issues: What is the responsibility of the provincial Social Insurance agency when allowing the Health Insurance Fund to overspend? Clarifying the responsibility of the Health Insurance appraisal department - is there any collusion between this team and medical examination and treatment facilities? What are the measures of the provincial Health Insurance to ensure no overspending while ensuring the people's health insurance benefits? Does the provincial Social Insurance need to publicize the health insurance units that have large health insurance fund deficits?

Responding to questions from delegates, Mr. Le Truong Giang said: The deficit of the Health Insurance Fund in 2016 was predicted due to policy changes, but also because the Health Insurance Agency has not yet implemented timely inspections and checks, and is still confused. This is a subjective error, the Social Insurance Agency does not shirk this responsibility.

Delegate Lo Thi Kim Ngan proposed to clearly analyze the main causes leading to the deficit of the Health Insurance Fund as well as request the provincial Social Insurance to propose feasible preventive measures while ensuring the rights of patients.

The provincial Social Insurance's team of appraisers has 72 people, including 32 doctors, conducting appraisals of 54 medical examination and treatment facilities across the province. With such a force, supervision work must be carried out by mechanisms, policies and technology. Currently, the industry has not discovered any appraisers who cover up or collude with medical examination and treatment facilities. The provincial Social Insurance has issued an official dispatch to strengthen the management of this team. When detecting negative acts of appraisers, they will be strictly disciplined, forced to resign, or transferred to the investigation agency depending on the severity.

Payment from medical examination and treatment facilities is based on the service fee mechanism, which means the more technical and service indications, the more beneficial the medical examination and treatment facility is. The provincial Social Insurance resolutely refuses to pay for unreasonable indications. Recently, the provincial Health Insurance has noticed that: Medical examination and treatment facilities in Vinh city and surrounding areas have large deficits, medical examination and treatment facilities in mountainous areas have small deficits or even surpluses.

Delegate Luc Thi Lien proposed that the Health Insurance Fund publicly disclose the identities of medical facilities that have large deficits in the Health Insurance Fund.

To prevent overspending and ensure the rights of patients, in the coming time, the provincial Social Insurance will focus on advising the Provincial Party Committee and the Provincial People's Committee to develop subjects towards universal health insurance; Coordinate with the Provincial Inspectorate, Provincial Police, and Department of Health to inspect the use of health insurance funds at medical facilities, forecast developments in health insurance treatment to proactively deploy control solutions; Apply information technology in health insurance appraisal, regularly update patient data; Strengthen appraisal work at facilities with unusually increased costs to detect early abuse and profiteering.

To clarify the issue of health insurance fund deficit, the chairman of the question and answer session invited the representative of the Department of Health to explain the related content. Mr. Hoang Van Hao, Deputy Director in charge of the Department of Health, said: Comparing the medical examination data in 2016 and 2015, the number of medical examinations did not increase. However, the number of people going to medical examination and treatment at district-level medical facilities increased significantly, while the number at commune-level medical facilities decreased sharply. People used services and techniques with higher unit prices. The reason for the increase was that in the past year, Nghe An applied and mastered 175 new medical examination and treatment techniques.

Mr. Hoang Van Hao - Deputy Director in charge of the Department of Health further explained the reasons for the deficit in the Health Insurance Fund.

In addition to the above objective reasons, the representative of the Department of Health added: The subjective reason is that some units and individuals have not properly implemented the State's policies on health insurance, and have abused technical services and drugs. Meanwhile, the inspection and appraisal work has not met the requirements.

The solution to prevent the overspending situation in the health sector is: Enhance the responsibility of the heads of medical examination and treatment units, strictly handle violations; Thoroughly apply information technology in medical examination and treatment management and health insurance payment, eliminate the situation of going to one place in the morning and another in the afternoon; Research and apply the family doctor clinic model.

Chairing the meeting, Ms. Cao Thi Hien - Vice Chairwoman of the Provincial People's Council requested the Provincial Social Insurance and the Department of Health to strengthen coordination to prevent overspending due to profiteering and abuse.

Concluding the questioning session on the issues of health insurance fund deficit and social insurance arrears, the meeting chair highly appreciated the measures and action directions of the provincial Social Insurance. Vice Chairwoman of the Provincial People's Council Cao Thi Hien requested the health sector and Social Insurance to strengthen coordination in controlling the fund from the beginning of the year and strictly inspect and handle violations.

Regarding social insurance arrears, the provincial social insurance agency needs to enhance its responsibility in debt collection, proactively approach businesses, and ensure the legitimate rights of employees; publicly announce on mass media businesses that are slow to pay or have long-standing arrears; and coordinate well with the provincial Labor Federation to sue businesses with arrears./.

Thanh Son