Health insurance information inspection system has been completed, showing positive impacts

10/10/2019 11:30 AM


The National Assembly’s Decree No 68/2013/QH13 asked the Government to “complete the interconnection of information systems among social insurance agencies and medical facilities to improve administrative procedures, health insurance inspections, and management and use of the health insurance fund.”

Illustrative Image

To handle the task, the Government asked the Ministry of Health and Viet Nam Social Security to boost the application of IT in medical examination and treatment using health insurance.

The Ministry of Health issued several directives and regulations on the management, inspection and payment of health insurance including establishing a steering committee, approving the pilot project of IT application, regulating the extraction and transfer of electronic data, regulating the shared category code, issuing a list of medical examination and treatment expenses used at medical facilities, as well as inspecting and solving disputes in transferring data of medical facilities.

Viet Nam Social Security has completed the health insurance information inspection system, offered training for more than 2,000 inspectors and thousands of medical workers, improved health insurance inspection, management and use of the health insurance fund. At present, the health insurance information inspection system helps to accelerate the sharing of information between medical facilities and social insurance agencies, provide an information lookup tool, manage patient transfer, inspect health insurance cards, announce inspection results, supply tools to monitor the medical examination and treatment at medical facilities and payment of health insurance. Medical facilities can share test results and access patients’ medical records to avoid overlapping prescriptions, save medical expenses and improve the effectiveness of treatment.

The software is developed based on the health insurance inspection of Viet Nam Social Security with more than 10 tasks. It can automatically and electronically inspect all requested records, using more than 200 rules to detect overlapping records, or those with inappropriate benefit levels, categories or prices as regulated by the Ministry of Health.

The inspection software provides charts and maps to follow examinations, treatments and expenses at medical facilities nationwide. The visual indicators help to analyse, evaluate and detect abnormal fluctuations, increase treatment using health insurance and insurance payments in each province and all-level medical facilities. Epidemiological maps help to monitor and assess prevalence and incidence of chronic and acute diseases. This is an important source of information for disease surveillance and proactive disease prevention.

In 2018, the health insurance information inspection received and inspected 176.5 million electronic records with VND98.1 trillion (US$4.2 billion) of health insurance requested to be paid and connected 12,132 medical facilities with the percentage of shared information reaching 95.12 per cent.  In the five first months of 2019, the system received and inspected 72.2 million electronic records with VND40.4 trillion of health insurance requested to be paid. The health insurance information inspection system has been developed and updated with inspection rules to improve the management and use of the health insurance fund./.

VSS