Le Van Phuc, director of the Department of Health Insurance Implementation under the Viet Nam Social Security, said one of the payment methods for medical examination and treatment covered by health insurance, which is currently being applied, is to pay according to the price of medical services provided by medical facilities.

The selection of medical services has a very wide scope, he said.

 Le Van Phuc, director of the Department of Health Insurance Implementation under the Viet Nam Social Security

Thereby, it creates loopholes for the appointment of unnecessary medical services for patients with health insurance; abusing and profiting from the health insurance fund from both medical facilities and health insurance participants; causing waste and risk of overspending of the health insurance fund, he said.

Phuc said there are many types of the same drug, such as brand-name drugs, drugs belonging to the first group, the second group, the third group and the fourth group.

The price of brand-name drugs is always much more expensive, sometimes dozens of times higher than the price of drugs belonging to the groups, he said.

Similarly, medical supplies also have many types, for example, a heart stent costs from VND25 million (US$1,000) to VND50 million (US$2,000); an artificial vitreous has a price from VND2 million (US$80) to VND10 million (US$400), he said.

Data from the Viet Nam Social Security (VSS) showed that for the same patient with diabetes, the average cost of treatment in medical facilities is very different, he said.

For example, the cost of treatment for a diabetes patient can be VND1.5 million (US$60), VND1 million (US$40), VND700,000 (US$30) or VND500,000 (US$20) each month in different medical facilities, he said.

“Therefore, if we do not manage it well, if we have no specific regulations to manage it, the health insurance fund cannot meet treatment demand,” he said.

An appropriate payment method to ensure effective management and use of medical expenses in general and medical expenses covered by health insurance, in particular, is very necessary, he added.

VSS accompanies health sector

The insurance agency sent four teams to work with eight provinces and cities in August to solve difficulties and problems related to health insurance at medical facilities, in which medical examination and treatment for health insurance participants are covered by the health insurance.

Accordingly, officials of the insurance agency asked its branches in the provinces and cities to report difficulties and problems and suggest solutions to fix the situation.

Viet Nam Social Security promptly removes difficulties and problems at medical facilities that are covered by health insurance, ensuring health insurance participants’ benefits

The insurance agency will handle the difficulties and problems within its authority.

For the issues that need the intervention of other competent agencies such as the Ministry of Health, the insurance agency has urgently sent a document to the ministry asking for coordination in order to remove the backlogs.

According to Phuc, there are many reasons causing delays in the payment of medical expenses from the insurance agency to some medical facilities.

Under regulations, medical facilities, at which medical examination and treatment for health insurance participants are covered by health insurance, must fully explain the reason for the excess medical expenses covered by the health insurance fund, he said.

However, the explanations provided by the medical facilities are often slow, not keeping up with the final settlement period (as per regulations, October 1 of the following year is the deadline to complete the final settlement of the year before), he said.

Therefore, if in the period of April and May of the following year, a medical facility fails to send a complete dossier of explanation procedures, the insurance agency will not be able to summarise the expenses for the year, leading to a delay, he said.

The delay will be compounded by the following year's costs, he said.

Besides, some problems in mechanisms and policies also lead to delays in payment of medical expenses at some medical facilities, at which medical examination and treatment for health insurance participants are covered by the health insurance, he said.

Handling the excess medical expenses in the medical facilities is not within the jurisdiction of the health ministry and the insurance agency.

For the excess of 2021, the insurance agency has coordinated with the health ministry to propose to the Government to issue a temporary resolution to fix the situation, he said.

For the excess of the years 2019-2020, calculations showed that medical facilities spend inappropriately, so they cannot receive the payments from the insurance fund as per regulations, he said.

The insurance agency has always accompanied the health sector and medical facilities to actively find and implement solutions to remove difficulties and obstacles for the medical facilities, especially in the years 2020-2021 when the COVID-19 pandemic showed complex developments.

The insurance agency will continue to work closely with the health ministry to focus on amending and promulgating legal documents to fix shortcomings and find optimal solutions to reach long-term goals of ensuring benefits for health insurance participants.