Social Insurance - Health sector: Coordinate to ensure benefits for people

In particular, fundinghealth insurance examination and treatment, people's health care is increasingly improved; the rate of people accessing health services is increasing; the rights of health insurance participants are fully and promptly resolved.

Improve the quality of medical examination and treatment under health insurance

In the first 6 months of 2021, Nghe An General Hospital received many patients with health insurance cards (family health insurance cards) who came to the hospital for treatment. These were all serious patients, such as patient Dang Trong Thien in Long Thanh commune (Yen Thanh), health insurance card code GD4404016354956, suffering from thoracic and lumbar scoliosis, spinal disc herniation, acute back pain; or patient Pham Thi Xuan in Dien An commune (Dien Chau), health insurance card code GB4404018936634 (Health insurance card for people in households with average living standards), suffering from heart failure, mitral valve disease, chronic atrial fibrillation, asthma, pulp and periapical disease, spinal degeneration, idiopathic hypertension, neuralgia and neuritis...

Kidney transplant for patient at Nghe An General Hospital. Photo: Archive

For the two seriously ill patients mentioned above, Nghe An General Hospital had to perform long-term treatment and apply many advanced techniques in treatment. Previously, patients would have to pay huge hospital fees (in addition to the amount of health insurance paid) due to going beyond the prescribed level. Fortunately, from January 1, 2021, health insurance participants who go to the wrong medical examination and treatment facility at the provincial medical examination and treatment facility will have the health insurance fund pay for inpatient treatment costs according to the scope of benefits and levels of enjoyment as in the case of correct medical examination and treatment (stipulated in Clause 6, Article 22, Law on Health Insurance)...

Therefore, Mr. Dang Trong Thien was paid nearly 111 million VND by the Health Insurance Fund for his 15-day treatment; Ms. Pham Thi Xuan was paid over 100 million VND by the Health Insurance Fund for her 35-day treatment.

Cerebral vascular intervention at Nghe An General Hospital. Photo courtesy

The fact that patients with difficult economic conditions or from households with average living standards like Mr. Thien and Ms. Xuan are paid a large amount of money by the Health Insurance Fund for treatment clearly shows the humanity and superiority of the Health Insurance policy; as well as shows the good coordination between the Social Insurance agency and medical facilities in ensuring the rights of Health Insurance patients.

Doctor Trinh Xuan Nam - Deputy Director of Nghe An General Hospital said: “The Social Insurance Agency and our hospital always aim to ensure that the benefits of health insurance patients are best guaranteed, and treated with advanced techniques. The hospital always carefully studies the guidance documents of the Social Insurance Agency. When there are new services and techniques, the hospital promptly submits them to the Department of Health and the provincial Social Insurance for registration and approval to implement them for patients. The hospital always strictly controls the paraclinical indications as well as drugs and technical services, to do the best for patients. And vice versa, the provincial Social Insurance has always sent people to closely monitor and support the hospital to effectively implement the settlement of regimes and policies for patients at the unit. Therefore, there have been many seriously ill health insurance patients who have been treated with advanced techniques.”

To specify and implement the provisions of Clause 6, Article 22, Law on Health Insurance, dated December 21, 2020, the Ministry of Health issued Directive No. 25/CT-BYT on continuing to strengthen management and improve the quality of health insurance examination and treatment; Vietnam Social Security issued Document No. 4055/BHXH CSYT on implementing Clause 6, Article 22, Law on Health Insurance; Nghe An Social Security issued Document No. 335/BHXH-GĐBHYT on guiding a number of provisions in Article 22, Law on Health Insurance... In these documents, the requirements for medical examination and treatment facilities are to improve the quality of medical examination and treatment services; arrange and allocate the number of hospital beds in accordance with the scale, equipment and existing human resources; well control the appointment of inpatient treatment; Strengthen the application of information technology to ensure quality and effective service, reduce waiting time, avoid overload and assess and pay for health insurance examination and treatment costs in accordance with regulations; support the transfer of techniques and technical expertise to lower levels...

Also according to Dr. Trinh Xuan Nam: Implementing Directive 25/CT-BYT of the Ministry of Health and guiding documents of social insurance agencies at all levels, in recent times, the hospital has been and is continuing to promote the improvement of the quality of health insurance examination and treatment. Specifically, the hospital has strengthened the training of medical staff in terms of expertise and medical ethics; diversified types such as on-site training, sending to higher-level hospitals, postgraduate training, hands-on training, and specialized training. The hospital has selected specialties and techniques for in-depth development to meet the treatment needs of patients. The hospital has also invested in modern facilities and equipment; reformed administrative procedures; and paid attention to the quality of medical examination and treatment at clinics. With these efforts, in April 2021, the hospital was recognized by the Ministry of Health as a final-level hospital in the North Central region.

Ensuring benefits for health insurance patients

Doctors at Vinh City General Hospital perform endoscopic surgery through a small tunnel. Photo courtesy

In Nghe An, not only Nghe An General Hospital but also many other medical examination and treatment facilities have been and are ensuring the rights of health insurance patients, such as Vinh City General Hospital. In recent years, the hospital has continuously developed techniques and improved the quality of medical examination and treatment. Currently, the hospital not only performs 100% of the technical list of district hospitals but also develops many advanced techniques of the provincial and central levels such as lithotripsy with small tunnels, joint replacement, endoscopic surgery of digestive cancer, ear-nose-throat endoscopy... Every day, Vinh City General Hospital receives from 2,000-2,200 patients for examination and treatment, of which, there are about 600 inpatients. The vast majority of patients here are patients with health insurance cards.

Measure blood pressure for patients visiting Vinh City General Hospital.

Dr. Pham Van Son - Deputy Director of Vinh General Hospital said: The hospital not only ensures maximum health insurance benefits for patients but also meets the requirements of patients. In addition, the hospital has provided other utilities in medical examination and treatment by organizing remote medical examination and treatment appointments via the website, software, returning test results and sending prescriptions via software connected to the hospital to ensure quality and effective service, reduce waiting time, and avoid overload. In order to promptly support people in conveniently paying for medical examination and treatment costs, reduce the time spent gathering and waiting to pay at the cashier, the hospital has deployed a variety of payment applications.

According to Dr. Pham Van Son: The hospital and the provincial Social Insurance agency have coordinated very well to resolve all arising situations, ensuring the best interests of health insurance patients. The hospital has worked with the Health Insurance Assessment Department of the provincial Social Insurance to help many patients with health insurance cards to be treated with advanced techniques without having to transfer to a higher level with a payment value of over 52 million VND, such as patient Ho Thi Lon in Hung Hoa commune (Vinh city) with a fracture of the left femoral neck, or patient Nguyen Hoang Dung in Quang Trung ward (Vinh city) with a left femoral head atrophy, L3 vertebral body collapse... In particular, recently, when the Social Insurance sector introduced the VssID-Social Insurance digital application using health insurance card images on mobile devices for medical examination and treatment, the hospital was the first unit in the province to apply it, meeting the needs of people with electronic health insurance cards.

Get a queue number for medical examination and treatment at Vinh City General Hospital via software. Photo for reference

Doctor Pham Van Son also affirmed: It must be said that Nghe An Social Insurance Agency plays a very important role in supporting the health sector to promote the improvement of the quality of health insurance treatment. The Social Insurance sector has ensured the progress and quality of signing health insurance treatment contracts with health insurance facilities; closely coordinated with the Department of Health in directing the implementation of health insurance policies, preventing and handling fraud and profiteering of health insurance funds; strengthened inspection, supervision, and timely correction of the situation of receiving inpatients for treatment in violation of regulations at health insurance facilities.

Mr. Thai Ba Thang - Deputy Director of Nghe An Social Insurance said: The provincial Social Insurance has directed the Health Insurance Appraisal Department and Social Insurance of districts and towns to regularly inspect and review facilities, equipment, human resources and the ability to provide medical examination and treatment services at medical examination and treatment facilities in accordance with the spirit of Directive 25/CT-BYT; regularly analyze and evaluate the development of medical examination and treatment at medical examination and treatment facilities to adjust to reasonable targets, at the same time monitor and supervise to ensure substantial changes at medical examination and treatment facilities; coordinate and support medical facilities to resolve difficulties and problems in implementing health insurance medical examination and treatment; absolutely ensure that no problems occur at medical examination and treatment facilities without being promptly resolved, affecting the rights of health insurance patients; especially during the period of preventing and fighting the Covid-19 epidemic.

Facial recognition at Vinh City General Hospital. Photo: Archive

Dr. Dau Huy Hoan - Deputy Director of Nghe An Department of Health shared: With the goal of ensuring the best benefits for health insurance patients, in the coming time, the health sector will continue to closely coordinate with the social insurance sector to improve the quality of health insurance examination and treatment, patient satisfaction; strictly implement the legal regulations on health insurance, medical examination and treatment; strictly prohibit acts of abuse and profiteering from the health insurance fund in any form, ensuring the safety of the health insurance fund; contributing to promoting universal health insurance.

As of June 2021, the whole province had 2,959,181 people participating in social insurance, health insurance, and unemployment insurance (UI). Of which, 2,869,934 people had health insurance, reaching 97.61% of the plan assigned by Vietnam Social Security. In the first 5 months of 2021, the whole province spent nearly 1,600 billion VND on health insurance examination and treatment (KCB) (including both inpatient and outpatient); an increase of 225,937 million VND, equivalent to 0.17% over the same period in 2020.

From June 1, 2021, patients with health insurance cards who come to receive medical examination and treatment can use the image of the health insurance card on the VssID-BHXH digital application instead of using paper health insurance cards. Nghe An Provincial Social Insurance has coordinated with medical examination and treatment facilities in the province to propagate and instruct people to install and use VssID and prepare all conditions so that people's medical examination and treatment using the VssID-BHXH digital application is always guaranteed to be quick and convenient.

Thanh Son