Nghe An has a deficit of more than 1,000 billion VND in health insurance fund

(Baonghean.vn) - By the end of August, the health insurance fund had a deficit of VND1,020 billion. Meanwhile, the insurance and health sectors continue to have conflicting opinions that make patients anxious.

This was the main content discussed at the working session between the provincial National Assembly delegation and Nghe An Social Insurance on the afternoon of October 9, on the management and use of the health insurance fund and the implementation of Resolution No. 68/2013/QH13 dated November 29, 2013 of the 13th National Assembly on promoting the implementation of policies and laws on health insurance, towards universal health insurance.

Overview of the working session. Photo: Phuoc Anh

Health insurance fund deficit of 1,020 billion VND

According to the report of the provincial Social Insurance, as of August 31, 2017, the health insurance coverage rate reached 84.5%, higher than the national average rate of 82.6%.

In the first 8 months of 2017, the province's health insurance fund balance exceeded 1,020 billion VND. Nghe An is the province with the highest absolute health insurance fund deficit compared to other provinces in the country.

Mr. Le Truong Giang - Director of the Provincial Social Insurance said: "Compared to the allocated expenditure estimate for 2017, Nghe An has used 119% of the total budget estimate for the whole year and cannot ensure the implementation of the allocated budget for 2017. This is alarming because the first months of the year may always have smaller expenditures than the last months of the year."

Analyzing the reasons for the deficit in the health insurance fund, the head of the provincial social insurance sector pointed out three main issues: policy changes, an increase in the number of patients coming for medical examination and treatment, and outpatient and inpatient treatment costs higher than the national average.

Mr. Le Truong Giang - Director of the Provincial Social Insurance analyzed the reasons for the deficit in the Health Insurance Fund. Photo: Phuoc Anh

Specifically, from January 1, 2017, public health facilities in Nghe An province have adjusted their technical service prices according to the Official Dispatch of the Ministry of Health, including surgical and procedural allowances, on-duty fees and salaries of medical staff, thus the cost of health insurance examination and treatment has increased by 450 billion VND. On the other hand, the impact of the health insurance examination and treatment policy across the province has caused a huge increase in the number of patients going to district hospitals for examination and treatment in the whole province...

Mr. Le Truong Giang pointed out that the number of patients coming for medical examination and treatment has increased, but the assessment and classification of patients at medical examination and treatment facilities has not been carried out in accordance with the regulations of the Ministry of Health. Many hospitals have shown signs of attracting patients in many different ways.

In addition, in the first 8 months of 2017, total outpatient health insurance expenses increased by 23% (equivalent to 138 billion VND), total inpatient expenses increased by 44% (equivalent to 440 billion VND) compared to the same period in 2016.

The most disadvantaged are the sick.

Listening to the opinions of the provincial Social Insurance representatives at the meeting, Colonel Nguyen Huu Cau - Member of the Provincial Party Standing Committee, Director of the Provincial Police Department raised the issue: "In the "three-way" relationship: Social Insurance - Health - patients, it is clear that patients are the most disadvantaged. The Social Insurance and Health sectors have different explanations to ensure the stable development of their sectors. As elected representatives, we are most concerned about the interests of the people."

Colonel Nguyen Huu Cau requested the provincial Social Insurance to clarify the criteria and methods of operation of health insurance appraisers; Who sets the price of health insurance medical examination and treatment services?; Do the problems between the social insurance sector and the health sector need an independent agency to resolve later?

Colonel Nguyen Huu Cau raised a number of issues and requested the provincial Social Insurance leaders to explain. Photo: Phuoc Anh

Mr. Le Truong Giang - Director of the Provincial Social Insurance said that currently, the Social Insurance sector of Nghe An province has 33 appraisers, the standards and methods of operation are according to the regulations of the sector. As of August 31, 2017, the whole province has 59 medical examination and treatment facilities, so on average, each appraiser is in charge of appraisal work for about 2 medical examination and treatment facilities. Currently, the application of information technology has partly reduced the burden of appraisal work.

Regarding the issue of norms, Mr. Le Truong Giang said that the Social Insurance sector relies on the norms stipulated in Decision 3955/QD-BYT on technical and economic norms as the basis for establishing prices for medical examination and treatment services according to Circular 37/2015/TT-BYT and Decision 3959/QD-BYT 2015 on human resources and time norms for establishing prices for medical examination and treatment services.

In recent times, the provincial Social Insurance has had many solutions to control the cost of health insurance examination and treatment. Accordingly, it has discussed and negotiated to sign health insurance examination and treatment contracts with medical facilities throughout the province to strengthen fund management; applied IT to control medical examination and treatment costs; mobilized staff from professional departments to strengthen appraisal work; strengthened inspection and examination, resolutely refused to pay costs that are not in accordance with the process...

Deputy Head of the Provincial National Assembly Delegation Nguyen Thanh Hien concluded the working session. Photo: Phuoc Anh

Concluding the meeting, Mr. Nguyen Thanh Hien - Deputy Head of the Provincial National Assembly Delegation affirmed the humanity of the health insurance policy; at the same time, acknowledged the efforts of the Social Insurance sector of Nghe An province in implementing the policy.

With the difficulties, obstacles, limitations and shortcomings analyzed in the working session, Mr. Nguyen Thanh Hien requested the industry to pay more attention to propaganda work; continue to improve the quantity and quality of the appraisal team; be more responsive in forecasting the development of the health insurance fund and promptly have proposals and solutions to resolve them.

In addition, the provincial Social Insurance needs to continue to do a better job of coordinating with the health sector, closely linked to regular and extensive inspection and examination activities. After the working session, the provincial Social Insurance needs to have a written report for the provincial National Assembly delegation to study in depth and give opinions at the upcoming session.

Phuoc Anh