Management and use of Health Insurance Fund: Need consensus for common goals

(Baonghean) - Through warnings, letters, petitions..., we can see concerns about the quality of health insurance examination and treatment in Nghe An province.

For those who are interested in social networks, recently, you must have heard about a female manager of a medical facility who often goes on Facebook to discuss issues related to health insurance examination and treatment. Recently, this female manager expressed concern because the "overspending" and "fund failure" of health insurance has led to consequences, which are that medical examination and treatment facilities are falling into debt, from owing medical staff salaries; owing pharmaceutical and medical supplies organizations and enterprises money for medicine, chemicals; owing investment funds for infrastructure construction... This female manager also warned: There is a risk that by July 2017, most health insurance examination and treatment facilities in Nghe An will have to close because they "run out of funds".

Although this warning is personal, stemming from disagreement with the Social Insurance agency on the issue of health insurance fund settlement, the concerns and worries among health sector managers, cadres, and doctors regarding this issue are real! Therefore, many of them, in one way or another, have conveyed those concerns and worries to all levels and sectors in the province, even to the leaders of the Ministry of Health.

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As in a letter sent to Deputy Minister of Health Nguyen Viet Tien, a doctor confided: “...due to many factors, mainly objective, the health insurance fund has greatly exceeded the health insurance fund projected by the Social Insurance Agency. From there, a number of problems and concerns have arisen in all health care facilities regarding the appraisal of health insurance costs by the provincial Social Insurance Agency. The Social Insurance Agency has suspended and refused to pay a large amount of money without legal basis, inconsistent with the regulations and directives of the Ministry of Health, causing a situation of extreme tension and insecurity, greatly affecting health care activities…”.

Or in a petition sent to the health sector, a doctor said: “The current solutions of the provincial Social Insurance are not fundamental, not effective, not basic; mainly checking and giving out payment figures or “suspending” them to warn health care facilities. Many measures have also been proposed such as advising the provincial People's Committee to estimate health care costs for units, controlling paraclinical indications, restructuring prices according to Circular 37, calculating standards for medical examination and paraclinical examination, standards according to the hospital bed plan, taking attendance of inpatients... The above measures are not only not legally sound, but also greatly affect the quality and development of hospitals - the biggest goal that the health sector is striving for...”.

Through warnings, letters, recommendations..., we can see concerns about the quality of health insurance examination and treatment in the province. Because, in any industry or profession, to have good results, each individual must have a good working environment to focus on professional work. With the medical profession related to human life, this is even more necessary.

Today's medical industry, with the strong development of science and technology, has many modern equipment and a variety of quality medicines. However, to ensure good medical examination and treatment, the human factor is still fundamental. If we want doctors and medical staff to truly focus on their profession, we must create a favorable working environment and remove all psychological barriers, so that they can fully develop their professional abilities. And this is the responsibility of the managers of medical examination and treatment facilities; it is the responsibility of the state management system and of the whole society towards the medical industry.

Let's ask the question, why are health managers and doctors so concerned about the issue of health insurance? The answer is easy. Because, with more than 82% of the population participating in health insurance as it is now, the main source of income for medical examination and treatment facilities is from this fund. If the cost of health insurance examination and treatment is "suspended", the income of each doctor and physician will immediately be affected. And certainly, from this story, it is not difficult to imagine that health facilities, doctors and physicians will have plans to deal with the Social Insurance agency. The result is not yet clear, but it will certainly have a negative impact on the quality of medical examination and treatment, and people with health insurance cards will be disadvantaged.

The Party and the State always want all Vietnamese people to be interested in and take care of their health, so over the years, they have issued a series of policies to improve the quality of medical activities. And a typical policy is the implementation of universal health insurance. However, in recent years, there have always been difficulties and problems related to health insurance.

It is thought that many strong solutions are needed to ensure the safety of the health insurance fund, but any solution requires consensus and a common vision from related sectors, especially the health and social insurance sectors, to create a good environment, remove unnecessary troubles, so that cadres and doctors can focus on their profession, improve the quality of medical examination and treatment, and take care of people's health./.

Nhat Lan