Deputy General Director of Viet Nam Social Security Nguyen Duc Hoa said since January 1, 2023, Decision No 3618/QD-BHXH, issued by the agency on December 12, 2022, together with the Health Insurance Assessment Process have come into effect.

Hoa, who chaired an online conference on April 3 on guiding the update of the list according to the decision, said the process of health insurance claim review under the decision has fundamentally changed compared to the process of health insurance claim review according to Decision No 1456.

 Deputy General Director of Viet Nam Social Security Nguyen Duc Hoa chairs the conference

Therefore, the health insurance claim review software has been supplemented with features suitable to the assessment situation in the current period to deal with the increasing number of people participating in health insurance and the increasing number of medical records that require payment from the health insurance fund, he said.

Besides, standardising the format of output data to serve the management, assessment and payment of medical expenses and settlement of related policies in accordance with Decision No 130/QD-BYT issued by the Ministry of Health is also imperative, he said.

The decision is set to take effect on September 1, 2023.

Also at the conference, Duong Tuan Duc, director of the Vietnam Social Security’s Centre for Medical Claim Review presented the update of the list used at medical facilities covered by the health insurance fund.

Duc said the requirement of data communication has been specified in many important documents on medical examination and treatment covered by the health insurance fund.

Specifically, following Article 12 under Decree No 146/2018/ND-CP, it is necessary to promptly, accurately and fully update information on medical examination and treatment, covered by health insurance, and transfer data to serve management, supervision and payment of medical examination and treatment covered by the health insurance fund, he said.

Citing the inadequacy when it is not possible to fully manage the patient's medical-examination-and-treatment data, he said that when VssID – the digital social insurance application – has been operated to replace the printed health-insurance card, there have been cases in which a person who is receiving inpatient treatment at a hospital, still comes to another medical facility for examination, causing duplicate expenses.

 Duong Tuan Duc, director of the Centre for Medical Claim Review presents the update of the list used at healthcare facilities covered by the health insurance fund at the conference.

Besides, the Ministry of Public Security is currently building a national database on the population under a project and the project identifies that the portal is to receive the health-insurance-assessment-information system as the place to receive all medical information, including health records, medical examination certificates to serve the issuance of driving licenses, death certificates and birth certificates for all citizens, he said.

The portal will receive information about all citizens and medical facilities in the country, including citizens who do not participate in medical examination and treatment covered by the health insurance fund as well as medical facilities that do not sign contracts to provide medical examination and treatment covered by the health insurance fund, he said.

The move aims to build a national database on health to serve the management of the health sector, he said.

Article 13 of Circular 48/2017/TT-BYT, issued on December 28, 2017, by the health ministry also requires medical facilities and the Viet Nam Social Security to use a common code list and standardise output data in order to ensure timely, complete and accurate electronic data extraction to serve the management, assessment and payment of medical examination and treatment covered by the health insurance fund, he said.

Article 4 of Decision No 7603/QD-BYT, issued on February 25, 2019 by the health ministry orders that medical facilities and the Viet Nam Social Security complete the software to exploit and use a common code list and transfer electronic data from January 15, 2019, he said.

Delegates at the conference

“Thus, we have had a long time to adjust the list on the software, including those of the social insurance agency and medical facilities,” he said.

“However, the software of many localities has not met the standard format, the main reason is that the list has not been properly updated as required.”

As of March 2023, a report from the centre showed that the rate of updating information on the list is still low and some updated information is still inaccurate.

Specifically, the total number of health clinics and hospitals that have updated the list of departments, examination tables and hospital beds is 41.7 per cent; the list of medical staff is 23.7 per cent, the list of drugs is 16.4 per cent, the list of medical supplies is 62.3 per cent, the list of technical services is 36.4 per cent and the list of medical devices is 10.1 per cent.

The corresponding figures for health stations are 22.5 per cent, 41 per cent, 87.4 per cent, 40.3 per cent, 15.4 per cent and 12.3 per cent, respectively.

Long An Social Security Office, which has the highest rate of updating the list in the country, said since the beginning of 2023, implementing the direction of the Viet Nam Social Security, the office has identified that the work must be done as quickly as possible.

The Office for Medical Claim Review of Long An Province has actively contacted medical facilities to deploy the work and established a team to support medical facilities, which provide medical examination and treatment covered by the health insurance fund, to update the list and standardise the format of output data.

The office is always available to support medical facilities at any time, including outside ordinary working hours, and at weekends.