Taking advantage of health insurance fund: Going to the doctor 256 times/month

(Baonghean.vn) - Abuse of the health insurance fund continues to be a burning issue. In November 2017 alone, 5,409 people had 50 or more medical examinations. One woman had 256 medical examinations and was paid more than 142 million VND by the health insurance fund.

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These are the "hot" statistics given by Mr. Pham Luong Son - Deputy General Director of Vietnam Social Security at the online conference providing information on social insurance and health insurance at 63 points nationwide on the afternoon of November 29.

Conference scene at Nghe An bridge. Photo: Phuoc Anh

Tension in the "war" to exploit the health insurance fund

As of November 27, there were more than 149.7 million medical examinations and treatments nationwide; the amount requested for payment from the Health Insurance Fund was 77,547 billion VND. To date, 41,321 people have received payments from the fund ranging from 100 million VND to 1 billion VND, in particular, 27 people have received payments ranging from 1 billion to 4.5 billion VND.

According to the assessment of Vietnam Social Security, the Health Insurance Fund has performed well its social security function, acting as a "talisman" for those who are unfortunately sick or ill, especially those in difficult economic circumstances.

However, because of the great benefits of health insurance, a number of people have abused and profited from the fund. Mr. Pham Luong Son cited painful statistics: “In November 2017 alone, there were 5,409 people who went to the doctor 50 times or more. There was a woman who went to the doctor 256 times, and the health insurance fund paid more than 142 million VND; a man went to the doctor 201 times, and the fund paid more than 57 million VND.”

A spokesperson for Vietnam Social Security said that in these cases, local Social Security agencies have met, talked, and explained health insurance policies many times, but awareness is still very limited.

Regarding medical facilities, the story of profiteering from the health insurance fund has not yet cooled down. However, according to Mr. Pham Luong Son, since the implementation of the health insurance appraisal system, the control of fund profiteering behaviors has made positive progress. From the transparency and publicity of the appraisal system, along with the participation of propaganda agencies, in general, medical facilities have gradually gained more sympathy, understanding and coordinated more smoothly with the social insurance agency.

"Of course, if there is no transparency, we now have strong sanctions, which is the revised Penal Code with many strict criminal handling contents" - Deputy Director of Vietnam Social Security said, and emphasized that fighting against the behavior of profiting from the health insurance fund is a long-term "battle".

Voluntary social insurance is almost "standing still"

Pension payment in Linh Son commune, Anh Son district. Photo: Archive

Up to this point, nationwide there are 220,000 people participating in voluntary social insurance, this number only reaches 58.9% compared to the assigned plan.

“The voluntary social insurance data has almost stagnated. The number of participants is still very modest,” commented Mr. Nguyen Sy Dai, Head of Collection Department, Vietnam Social Security.

Analyzing the reasons, Mr. Nguyen Sy Dai said that for those participating in compulsory social insurance, employees are supported by agencies and business units to pay up to 70%, while the employees themselves only need to pay 30%. Meanwhile, those participating in voluntary social insurance must pay 100%.

From January 1, 2018, the State will support the social insurance contribution level for voluntary social insurance participants above the monthly social insurance contribution level according to the poverty line in rural areas, however, this support amount is not much. Meanwhile, the payment period is long, at least 20 years to be eligible for pension. This somewhat reduces the attractiveness of voluntary social insurance.

Frankly acknowledging the limitations, Mr. Pham Luong Son - Deputy General Director of Vietnam Social Security said that in the coming time, the Social Security agency will continue to coordinate with related sectors to overcome existing problems, ensuring the best interests of the people. Mr. Pham Luong Son also expressed his wish to have the support of press agencies so that information on social insurance and health insurance policies can be spread more widely./.

Phuoc Anh