Vietnam Social Security: 'There will never be a fund failure!'

(Baonghean.vn) - In the online conference providing information on social insurance and health insurance, a representative of Vietnam Social Security said that the deficit is only temporary.

In the spirit of looking straight at the nature of the problem, taking people's interests as the center, for the first time, Vietnam Social Security organized an online conference to provide information on social insurance and health insurance at 63 locations nationwide on the afternoon of October 31.

Mr. Pham Luong Son - Deputy General Director of Vietnam Social Security chaired the conference. Attending the conference were representatives of the Central Propaganda Department, the Ministry of Health, and press agencies.

At Nghe An bridge, representatives of the Provincial Party Committee's Propaganda Department, the Provincial Social Insurance and the Provincial Journalists Association co-chaired the conference; also attending were many reporters from local news agencies.

Conference scene at Nghe An bridge. Photo: Phuoc Anh

Health insurance appraisal system "makes it difficult" for hospitals?

Responding to concerns that the health insurance appraisal information system is "making it difficult" for hospitals when the rate of not accepting payment of the requested documents is still high, Vietnam Social Security affirmed that this is not the case.

According to the report of Vietnam Social Security, by September 2017, nationwide, there were 12,135 health insurance facilities connecting data to the health insurance appraisal information system, with an average rate of 96.3%. Through automatic appraisal, the system has not yet accepted payment of costs for more than 17.6 million records, accounting for 14.3% of the total number of requested records.

Overall model of system connection. Photo: Vietnam Social Security

Regarding the issue of refusing payment or the medical facility having to send requests to the system many times, Vietnam Social Security pointed out 5 reasons: The head has not really paid attention to applying IT in assessing and paying for health insurance costs; Not comparing and finalizing payment voucher information data with the shared list agreed with the Social Security agency; Electronic data does not compare the correct content and costs with documents stored at the hospital; Incorrectly calculating drugs and technical services paid according to the conditions and rates based on the regulations of the Ministry of Health; Incorrectly recording the rate of health insurance benefits for patients with a total cost of one medical examination and treatment lower than the equivalent of 15% of the basic salary, not having to make co-payment.

“Since the beginning of this year, Vietnam Social Security has put into use an automatic electronic appraisal system. Now is the era of transparency and publicity, everything is “exposed” on the screen. I affirm that from the leaders of the Social Security sector, the Department of Health, medical examination and treatment facilities to each medical staff, everyone can access this system to monitor whether there is abuse, profiteering or not, whether there is anything unusual in the request for payment of medical examination and treatment costs or not?” - said Mr. Pham Luong Son - Deputy General Director of Vietnam Social Security.

Nghe An leads the list of health insurance fund deficits

The issue of health insurance fund deficit was hotly discussed at the conference. The report of Vietnam Social Security showed that as of September 31, 2017, there were 122.6 million applications submitted for health insurance payment with the amount of 63,593 billion VND. Notably, among the 6 provinces with high health insurance fund deficit, Nghe An province topped the list with the amount of 919 billion VND.

Mr. Le Van Phuc - Deputy Head of the Health Insurance Policy Implementation Department, Vietnam Social Security, pointed out 7 main reasons leading to the unreasonable increase in health insurance examination and treatment costs, which are: Increased expenses due to unreasonable medical service prices; Failure to comply with prescribed norms; Inadequate statistics on payment for technical services; Abuse of test prescriptions; Unreasonable increase in the number of outpatient examinations and treatments and inpatient treatments, prolonging treatment days; Unreasonable purchase and use of drugs and medical supplies; Profiteering from health insurance funds.

Register for medical examination and treatment at Vinh City General Hospital. Photo courtesy

Analyzing the issue of not implementing the prescribed norms, some medical facilities in Nghe An were repeatedly "given" as examples: Vinh City General Hospital had a doctor examining 180 patients a day, 1 doctor performed 62 ENT endoscopy cases and 163 ultrasound cases/day (standard 15 minutes/ENT endoscopy case); Thai Thuong Hoang Hospital composite-filled 24 teeth/treatment, an average of 5 minutes/tooth (standard is 30 minutes)...

Regarding the prescription of unnecessary tests, Vietnam Social Security gave an example of Nghe An Obstetrics and Pediatrics Hospital prescribing many tests simultaneously with only diagnoses of bronchitis, rhinopharyngitis, etc.

In response to concerns about the health insurance fund going bankrupt, Mr. Le Van Phuc affirmed that the health insurance fund will never go bankrupt, and that the overspending is only temporary. The social insurance and health sectors are working together to take drastic measures to gradually resolve this issue.

New pension calculation puts female workers at a disadvantage?

At the conference, reporters from news agencies frankly questioned leaders of the Vietnam Social Security sector about "hot" issues.

Questions revolve around the story of “after 1 night, female workers lose 10% of their pension” according to the new pension calculation method from January 1, 2018. The Social Policy Department, Vietnam Social Security, affirms that the principle of social insurance is to contribute - receive, the higher the contribution, the higher the benefit and vice versa.

The new pension calculation method puts female workers at a disadvantage. Illustration photo: Internet

According to the 2006 Social Insurance Law, both men and women who retire after 15 years of work will receive a pension equal to 45% of the average social insurance contribution; from the 16th year onwards, for each year of work, men will receive an additional 2% until reaching a maximum of 75%, women will receive a priority of 3% until 25 years of work, receiving 75%. At that time, this priority was to ensure gender equity, helping women to have higher salaries.

According to the 2014 Social Insurance Law, male workers are calculated at 45% of the average monthly salary or monthly income for social insurance contributions when they have paid social insurance for 16 years and retired in 2018, 17 years and retired in 2019, 18 years and retired in 2020, 19 years and retired in 2021, 20 years and retired from 2022 onwards. In the case of female workers retiring from 2018 onwards, 15 years of social insurance contributions are calculated at 45% of the average monthly salary for social insurance contributions. After that, for each year of social insurance contributions, both male and female workers are calculated at an additional 2%, up to a maximum of 75%.

With this calculation, female workers who retire at 55 years old, instead of only needing to have 25 years of social insurance contributions to receive the maximum rate of 75% as before, from January 1, 2018, they must have 30 years of social insurance contributions to receive the maximum rate of 75%. The purpose of this calculation is to return to a fair order of contribution and benefit.

Reporters raised the question of whether or not to propose changes to the Law, given the fact that female workers are disadvantaged by the new regulations? Mr. Pham Luong Son - Deputy General Director of Vietnam Social Security said: “This issue has been raised since March and April, but until now there has been no satisfactory answer. Changing the Law is very difficult. The Social Security sector does not avoid it, we have a part of the responsibility. As the unit implementing the policy, but also the unit protecting the rights of workers, we continuously propose, advise, and give opinions until we get it right.”

Phuoc Anh