Why do the Ministry of Health and Social Insurance have different opinions on medical service prices?

On July 15, Circular 15 of the Ministry of Health regulating the price of medical examination and treatment services under health insurance will take effect.

While the Ministry of Health believes that this adjustment of medical service prices will contribute to balancing the Health Insurance Fund by 2020 and controlling hospitals from abusing prescriptions to increase revenue, the Vietnam Social Security believes that some regulations in Circular 15 may make it easier for hospitals to abuse prescriptions to increase revenue.

Social insurance is concerned about abusing designation to increase revenue.

According to Vietnam Social Security, Circular 15 provides some standards for calculating medical service prices that are not close to reality, mainly based on survey results of upper-level hospitals to apply nationwide, leading to health insurance payment costs for some techniques being higher than actual costs.

In recent times, some hospitals have added more beds, which are too high compared to the number of medical staff, to increase revenue. When Circular 15 comes into effect, it will be even more difficult to control the abuse of prescriptions as mentioned above.

Mr. Le Van Phuc, Deputy Head of the Health Insurance Policy Implementation Department (under the Vietnam Social Security), said: “The design standard for each hospital bed to be paid requires an area of ​​5 square meters, but some medical facilities have increased it a lot. Hospitals have added many more beds close together and there is almost no way to walk.

At Thanh Hoa Children's Hospital, many extra beds were added. I went to the Traditional Medicine Hospital in Nghe An, where many extra beds were also added. There were even many cases where a patient had to climb over another patient's bed to get to his bed.

However, many hospitals believe that up to now, the Circulars of the Ministry of Health have had specific regulations, but when settling or inspecting and checking at medical facilities, the social insurance agency has issued its own regulations, causing hospitals to face many difficulties in paying health insurance.

Ms. Nguyen Thi Kim Phuc, Chief Accountant of Thai Nguyen Central General Hospital said: "Payment for hospital bed days for facilities with assigned beds is determined quarterly and the number of beds is determined for an entire unit.

However, when paying and settling, the Insurance side calculates by day and by Department, which causes inconvenience when we are exceeded in overloaded Departments and our settlement number is less than the actual number.

The issue that Vietnam Social Security is most concerned about is that Circular 15 has increased the maximum number of visits. Specifically, a doctor is allowed to see up to 65 patients in one day, while previously the maximum was only 35 visits.

Vietnam Social Security believes that this will lead to less time for each patient to be examined, affecting the quality of medical examination. In particular, it can lead to the situation of over-billing patients or finding ways to bring many patients to the clinic to increase revenue from health insurance payments.

Mr. Le Van Phuc, Deputy Head of the Health Insurance Policy Implementation Department (under Vietnam Social Security) said: "Vietnam Social Security will have a document guiding the Social Security of provinces and centrally-run cities to implement this Circular 15.

We also commit to seek the opinion of the Ministry of Health before issuing the document to create consistency in the implementation instructions. This document will be issued before implementing Circular 15, that is, before July 15.

Mr. Le Van Phuc also said that when implementing Circular 15, the Ministry of Health and hospitals need to publicize the standards for establishing medical service prices so that people can monitor the implementation and patients know what benefits they are entitled to. Because currently, hospitals are financially autonomous and implement a lot of socialization, health insurance patients still have to pay a lot of extra money without explanation...

In response to the proposals of the Vietnam Social Security, Mr. Pham Le Tuan, Deputy Minister of Health, said: “In the recent period, there have been difficulties in the implementation process because some contents of the Circular were not clear. Even the Ministry had to issue an official dispatch to explain. The Social Security Fund has also issued official dispatches in the process of managing the Fund, but it has also caused great frustration for the units, not knowing which management agency is responsible and which document to follow.

The Ministry of Health has reported to the Government and has been assigned the task of state management of Health Insurance. The Ministry of Health has agreed with the Ministry of Finance and Social Insurance to issue this price. We realize that Circular 15 still has some problems and will be adjusted accordingly in the coming time, based on the consolidation of circulars on adjusting health service prices.

The Ministry of Health also requested the Vietnam Social Security to direct local social security agencies to make timely payments to hospitals according to Circular 15, which will take effect from July 15.

If inappropriate prices are found, a written request must be sent to the Ministry of Health for timely adjustment to avoid the situation of unpaid prices, affecting the medical examination and treatment activities of medical facilities./.