Nghe An strengthens management and effective use of health insurance examination and treatment funds

Risk of over budget 17%

Information from the Steering Committee for the implementation of social insurance policies,health insuranceNghe An province: According to Decision No. 877/QD-TTg of the Prime Minister dated July 20, 2023 on the allocation of the budget for medical examination and treatment under health insurance in 2023, Nghe An is assigned 4,191.25 billion VND (this budget has taken into account the increase in the basic salary).

In the first 6 months of 2023, the whole province used 52.74% of the budget assigned by the Prime Minister in 2023. And with the development of medical examination and treatment expenditures in the first 6 months of 2023, it is expected that in 2023, the whole province will spend 4,912,573 billion VND, exceeding 700 billion VND compared to the assigned budget, corresponding to a 17% budget surplus if there are no control solutions (in 2022, the whole province used 110% of the budget assigned by the Prime Minister, exceeding the budget by 379,818 million VND, corresponding to a 10% budget surplus).

Mr. Hoang Van Minh - Director of the Provincial Social Insurance said: The subjective reason leading to the situation of spending exceeding the assigned budget is that some leaders of medical examination and treatment facilities are not highly aware of their responsibility to manage and use the medical examination and treatment fund reasonably, economically and effectively. There is still a situation of unreasonable designation of technical services, drugs and medical supplies; widespread appointment of patients for inpatient treatment, not in accordance with regulations... leading to the medical examination and treatment indexes in the first 6 months of 2023 increasing compared to the same period in 2022, higher than the national average index, increasing the cost of medical examination and treatment.

Also according to the Steering Committee for the implementation of social insurance and health insurance policies in Nghe An province: In the past, the coordination between state management agencies in inspecting and examining the implementation of health insurance policies has not been regular and consistent; the level of penalties for violations in the field of health insurance is still low, so it is not enough of a deterrent... Therefore, the fact that the police agency investigated, dismantled the chain of creating fake medical records, profiting from health insurance and arrested 14 subjects is very encouraging. Thereby, it has pointed out the profiteering tricks, as well as the shortcomings and loopholes in management work.

In Nghe An, the cumulative number of people seeking medical examination and treatment in the first 6 months of 2023 was 2,739,134; an increase of 536,652, equivalent to an increase of 24.4% over the same period last year. The total amount of money that medical examination and treatment facilities requested to be paid in the first 6 months of the year was 2,210,658 million VND, an increase of 289,139 million VND, equivalent to an increase of 15% over the same period last year. Nghe An Social Insurance has refused to pay the costs of medical examination and treatment facilities that requested payment in violation of regulations in the first quarter of 2023, with an amount of 19.5 billion VND.

Enhance responsibility, strictly handle violations

Faced with the risk of exceeding the budget, the Steering Committee for the implementation of social insurance and health insurance policies in Nghe An province has set out a key task for the last months of 2023, which is to effectively manage and use the budget for medical examination and treatment under health insurance in 2023. Vice Chairman of the Provincial People's Committee Bui Dinh Long - Deputy Head of the Standing Committee of the Steering Committee requested all levels and sectors to strengthen control solutions: The Provincial Social Insurance promotes communication work, focuses on promoting good people and good deeds and promptly criticizes negative behaviors and intentional violations of the Law on Health Insurance; thereby contributing to limiting, preventing and preventing the situation of profiteering from health insurance funds, protecting the rights of health insurance participants. The Provincial Social Insurance directs and supervises the implementation of the budget for medical examination and treatment under health insurance assigned by the Prime Minister, ensuring compliance with regulations.

The Department of Health shall strengthen measures to manage and use the health insurance fund in a reasonable, effective and economical manner, within the budget assigned by the Prime Minister; strengthen discipline, strictly handle acts of fraud and abuse of the health insurance fund; direct, inspect, and evaluate medical examination and treatment work and management of health insurance examination and treatment funds at medical examination and treatment units (in the last 6 months of 2023, organize inspections at 10 units with the highest and unusually high cost increases); preside over and coordinate with the Social Insurance and relevant agencies to strengthen advisory work to help the Provincial People's Committee implement state management of health insurance through inspection, examination, and handling of violations; strictly handle violations, and have solutions to prevent abuse and profiteering of the health insurance fund.

The Provincial People's Committee and the Steering Committee for the implementation of social insurance and health insurance policies in Nghe An province also assigned the Provincial Police to coordinate with relevant agencies to continue to expand the investigation of health insurance fraud to strictly handle them according to the provisions of law.

Immediately after the instructions of the Provincial People's Committee, the Steering Committee for implementing social insurance and health insurance policies of Nghe An province, on August 9,Nghe An Department of Healthorganized an online conference with all medical examination and treatment facilities in the province with the content of strengthening the management and effective use of health insurance examination and treatment funds. At this meeting, Nghe An Department of Health directed medical examination and treatment facilities to strengthen the control and effective use of health insurance examination and treatment funds; provide adequate medicines, chemicals, materials, and technical services within the scope of benefits for health insurance participants; step up the inspection and supervision of compliance with regulations and professional instructions of the Ministry of Health with the aim of providing safe and effective treatment in the direction of saving on medical examination and treatment costs.

Mr. Nguyen Huu Le - Deputy Director of Nghe An Department of Health said: The Department has requested leaders of medical examination and treatment units to uphold their responsibilities, strengthen management, regularly monitor and inspect the professional activities of the units, implement solutions to save money, combat waste, control medical examination and treatment costs; promote propaganda, dissemination, and thoroughly understand the provisions of the Law on Medical Examination and Treatment, the Law on Health Insurance, Article 215 of the Penal Code on the crime of health insurance fraud. It is strictly forbidden to abuse and profiteering from life insurance funds, affecting the use of health insurance funds in any form. Leaders of medical examination and treatment units are responsible if violations of the law on health insurance occur at the unit./.

Thanh Chung