The nationwide report on the payment status of health insurance examination and treatment cost for the first four months of the year by the Department of Health Insurance Implementation indicates that, according to data from facilities requesting settlements recorded in the Monitoring System as of May 9, 2024, in 63 provinces and cities (excluding expenditures from the Ministry of National Defense's Social Insurance Agency and the People's Public Security Insurance Agency, during the first four months of the year, the number of health insurance medical care visits increased by 5.63% compared to the same period last year...
The evaluation shows that the health insurance medical examination and treatment cost in some localities tend to increase significantly, while the rate of timely data integration remains low. Therefore, in the coming period, provincial and city social security offices, along with health departments at all levels need to coordinate more closely and continue to strengthen measures to effectively control the health insurance medical examination and treatment cost in 2024, ensuring the safety and efficiency of the fund and safeguarding the rights of health insurance participants.
At VSS’ conference on controlling the cost of health insurance medical care, the delegates focused on evaluating the increase in the number of visits, medical care  cost, and average inpatient and outpatient treatment  cost; the rates of medical procedures such as: emergency care, laboratory tests, and inpatient treatments; additionally, they analyzed and assessed the unusual increase in the number of visits and medical examination and treatment costin certain provinces;... Several provinces and cities such as: Hanoi, Ho Chi Minh City, An Giang, Dien Bien, Nghe An, Can Tho,etc... provided direct reports and explanations regarding the increase in health insurance medical examination and treatment costin the first four months of 2024, as well as proposed several solutions to effectively control these  cost in the future.
Speaking at the conference, Deputy General Director Nguyen Duc Hoa requested that provincial social security offices seriously evaluate and identify the causes of the increase in health insurance medical care  cost. He emphasized the need for close coordination with health departments and medical care facilities to share information, change mindsets, and collaborate in implementing health insurance medical care; focus should be placed on addressing unreasonable factors in drug procurement and medical procedures; additionally, the application of information technology in task execution should be strengthened... He also stressed the importance of being decisive and enhancing responsibility in managing the health insurance fund, along with inspection and auditing activities to promptly detect, correct, and handle violations of health insurance law.

Latest health insurance medical examination and treatment procedures
Specifically, Article 15 of Decree 146/2018/ND-CP, amended in Decree 75/2023/ND-CP, regulates medical examination and treatment procedures under health insurance as follows:

(1) When examining or receiving medical examination and treatment, health insurance participants must present a health insurance card with a photo or a citizen identification card; in case of presenting a health insurance card without a photo, they must also present one of the following identification papers with a photo issued by a competent agency or organization or a certificate issued by the commune-level police or other papers certified by the facility. education student management place;

Other legal identification documents or level 2 electronic identification documents as prescribed in Decree 59/2022/ND-CP.

(2) Children under 6 years old who come for medical examination and treatment only need to present their health insurance card.

In case the child has not been issued a health insurance card, a copy of the birth certificate or a copy of the birth certificate must be presented; In cases where treatment is required immediately after birth without a birth certificate, the head of the medical examination and treatment facility and the child's parent or guardian must sign the medical record to confirm payment as a basis for payment. prescribed in Clause 1, Article 27 of Decree 146/2018/ND-CP and is responsible for this confirmation.

(3) Health insurance participants who are waiting for the card to be reissued or changed to a health insurance card when coming for medical examination or treatment must present an appointment letter to reissue or change the health insurance card issued by the social insurance agency. or organizations or individuals authorized by the social insurance agency to receive applications for card reissuance or card replacement according to Form No. 4, Appendix issued with Decree 146/2018/ND-CP and one type of document. Proof of that person's identity.

(4) People who have donated body parts for medical examination and treatment must present the documents specified in (1) or (3). In case treatment is required immediately after donation, the head of the medical examination and treatment facility where the body parts were taken and the patient or the patient's relatives must sign and confirm the medical record as a basis for payment according to regulations. specified in Clause 2, Article 27 of Decree 146/2018/ND-CP and is responsible for this confirmation.

(5) In case of referral for medical examination and treatment, health insurance participants must present the referral record of the medical examination and treatment facility and referral certificate according to Form No. 6 Appendix issued with Decree 146/ 2018/ND-CP. In case the referral document is valid until December 31 but the treatment period has not ended, the referral document can be used until the end of the treatment period.

In case of re-examination as required for treatment, health insurance participants must have a re-examination appointment from the medical examination and treatment facility according to Form No. 5 Appendix issued with Decree 146/2018/ND-CP .

(6) In case of emergency, health insurance participants can go for medical examination and treatment at any medical examination and treatment facility and must present the documents specified in (1) or (2) or (3). ) before leaving the hospital. At the end of the emergency period, the patient is transferred by the medical examination and treatment facility to another department or treatment room at that medical examination and treatment facility for continued monitoring, treatment or referral to another facility. Other medical examination and treatment facilities are determined to be at the right medical examination and treatment level.

Medical examination and treatment facilities that do not have medical examination and treatment contracts with health insurance are responsible for providing patients upon discharge from the hospital with valid papers and documents related to medical examination and treatment costs to Patients pay directly to the social insurance agency according to the provisions of Articles 28, 29 and 30 of Decree 146/2018/ND-CP.

(7) Health insurance participants during the period of business travel, mobile work, intensive study in the form of training, training programs, and temporary residence are entitled to initial medical examination and treatment at medical examination facilities. medical treatment at the same level or equivalent to the initial medical examination and treatment registration facility written on the health insurance card and must present the documents specified in (1) or (2) or (3) and one of The following documents (original or photocopy): work paper, decision to send to school, student card, proof of temporary residence registration, school transfer paper.

(8) Medical examination and treatment facilities and social insurance agencies are not allowed to stipulate additional medical examination and treatment procedures covered by health insurance in addition to the above procedures.

In case medical examination and treatment facilities or social insurance agencies need to photocopy health insurance cards and documents related to medical examination and treatment of patients to serve management work, they must do so on their own. make copies, do not ask the patient to make copies or pay for this expense.

Decree 75/2023/ND-CP takes effect from December 03, 12. Except for Clause 2023, Points a and b, Clause 1, Clauses 2, 3, 4 and 5, Article 6 of Decree 1/75/ND-CP will apply from October 2023, 19.