Managing and utilizing the Health Insurance Fund: Consensus is needed for a common goal.

(Baonghean) - Through warnings, letters, and petitions, concerns about the quality of health insurance-covered medical examination and treatment services in Nghe An province are evident.

For those who follow social media, you've probably heard about a female manager at a medical facility who frequently discusses health insurance-related issues on Facebook. Recently, she expressed concern about the "overspending" and "fund depletion" of the health insurance system, which has led to serious consequences, including medical facilities falling into debt – from unpaid salaries for medical staff; debts to pharmaceutical and medical supply companies for medicines and chemicals; and debts for infrastructure development. She also warned that by July 2017, most health insurance-covered medical facilities in Nghe An province are likely to close due to a lack of funds.

Although this warning is a personal sentiment, stemming from disagreement with the Social Insurance agency regarding the settlement of health insurance funds, the concerns and anxieties of healthcare managers, officials, and doctors about this issue are real! Therefore, many of them, in one way or another, have conveyed these concerns and anxieties to various levels and sectors in the province, and even to the leadership of the Ministry of Health.

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As stated in a letter sent to Deputy Minister of Health Nguyen Viet Tien, a doctor confided: "...due to many factors, primarily objective ones, the health insurance fund for medical examination and treatment has far exceeded the fund projected by the Social Insurance agency. This has led to several problems and frustrations in all medical facilities regarding the assessment of health insurance costs by the provincial Social Insurance agency. The Social Insurance agency has withheld and refused to pay a significant amount of money without legal basis, and in violation of regulations and directives from the Ministry of Health, causing extreme tension and anxiety, significantly impacting medical examination and treatment activities..."

In a petition sent to the health sector, a doctor stated: “The current solutions of the provincial Social Insurance agency are not fundamental, effective, or basic; they mainly involve inspections to issue figures for disallowed or ‘suspended’ payments as a warning to medical facilities. Many measures have also been proposed, such as advising the Provincial People's Committee on medical examination and treatment budgets for units, controlling the prescription of paraclinical tests, restructuring prices according to Circular 37, calculating the quotas for medical examinations and paraclinical tests, quotas based on the bed plan, and inpatient attendance tracking… The above measures lack sufficient legal basis and significantly affect the quality and development of hospitals – the biggest goal that the health sector is striving for…”

Through warnings, letters, and petitions, concerns about the quality of health insurance-covered medical examination and treatment services in the province are evident. In any profession, achieving good results requires a positive working environment to focus on professional work. This is especially true for the medical profession, which deals with human lives.

Today, with the rapid development of science and technology, the medical field has many modern pieces of equipment and a wide variety of high-quality medicines. However, for effective medical examination and treatment, the fundamental factor remains the human element. To truly allow doctors and medical staff to focus on their profession, a favorable working environment must be created, and all psychological barriers must be removed, so that they can fully utilize their professional abilities. This is the responsibility of healthcare facility managers, the state management system, and society as a whole towards the medical sector.

Let's ask the question: why are healthcare managers and doctors so concerned about health insurance? The answer is simple. With over 82% of the population currently covered by health insurance, the primary source of revenue for healthcare facilities is this fund. If health insurance funding for medical examinations and treatments is suspended, the income of each doctor and medical professional will be immediately affected. And certainly, from this situation, it's easy to imagine that healthcare facilities and doctors will devise strategies to circumvent the Social Insurance agency. The outcome is unclear, but it will undoubtedly negatively impact the quality of medical care, and those with health insurance cards will suffer.

The Party and the State have always desired that all Vietnamese citizens receive attention and care for their health, and therefore, for many years, have issued a series of policies and guidelines to improve the quality of healthcare services. A prime example of this is the implementation of universal health insurance. However, in recent years, there have been difficulties and obstacles related to health insurance.

I believe that many strong measures are needed to ensure the safety of the health insurance fund, but any solution requires consensus and a shared vision from relevant sectors, especially the health and social insurance sectors, to create a favorable environment, remove unnecessary inconveniences, and thereby allow medical staff to focus on their profession, improve the quality of medical examination and treatment, and provide better healthcare for the people.

Nhat Lan