Speaking at the conference, Deputy Director General of VSS, Nguyen Duc Hoa, stated that the conference aimed to evaluate the implementation of health insurance examination work in Q1, and was also a forum for social security agencies from provinces and cities to report on their organization and implementation work, as well as the direction and tasks for the last 9 months of 2023.

Increased cost of medical care covered by health insurance for Q1 2023

According to the report from the VSS, as of the end of Q1 2023, the number of health insurance examination cases was 40.39 million (increasing by 12.69 million cases, a 45.85% increase compared to Q1 2022); the proposed cost for social security agencies to pay was VND 26,976.2 billion (an increase of VND 7,697.3 billion, a 39.93% increase compared to Q1 2022). Therefore, compared to the health insurance fund in Q1 2023 (VND 23,737.4 billion, equivalent to 90% of the collected health insurance premiums), the current health insurance fund deficit is VND 3,238.8 billion.

VSS’ Deputy Director General, Nguyen Duc Hoa, chaired the online conference to evaluate the Q1 2023 health insurance examination results.

Some provinces with a significant increase in the amount compared to Q1 2022 were Hanoi (VND 1,628.9 billion), Ho Chi Minh City (VND 1,024 billion), Thanh Hoa (VND 315.21 billion), Nghe An (VND 250 billion), Thua Thien Hue (VND 187.36 billion), Dong Nai (VND 161.49 billion), Binh Duong (VND 154.95 billion), etc.

At the conference, Mr. Le Van Phuc, Director of Department of Health Insurance Implementation (VSS), shared some noteworthy points in the implementation results of health insurance policies based on data from settlement proposals recorded on the monitoring system of 63 provinces and cities. Accordingly, in Q1 2023, the number of health insurance examination cases nationwide increased by 46% compared to the same period in 2022, and the total health insurance payment increased by 40% compared to the same period in 2022. Specifically, there were over 40 million health insurance examination cases (36.4 million outpatient cases and 3.9 million inpatient cases), an increase of 46% compared to Q1 2022 (equivalent to an increase of nearly 13 million cases).

Le Van Phuc, Director of VSS’ Department of Health Insurance Implementation delivered a speech at the conference.

Phuc also forecasted an increase in the number of health insurance examination cases and health insurance payment for the remaining quarters of 2023. Specifically, it is expected that the number of health insurance examination cases in the first 6 months of the year will be 83 million, and the health insurance payment will be VND 58,000 billion.

In some localities, the prices of some drugs won in tenders have a large difference compared to the average winning bid price. After reviewing the average winning bid prices for drugs announced by the VSS in two phases of 2022, it was found that some provinces won tenders for drugs at a significantly different price from the average winning bid price. The cost of unused drugs also reflects in the distribution and use of drugs.

Controlling costs of medical care covered by health insurance, ensuring effective use of funds

At the conference, some localities also pointed out some objective and subjective reasons that have led to the increase in costs in their respective areas, such as the increase of multichannel referral from provinces to central cities, the increase of treatment for some high-cost disease groups, and the increase of inpatients referred to hospitals.

Deputy Director of the Center for Medical Claim Review Nguyen Tat Thao evaluates the assessment of health insurance in localities

Evaluating the health insurance examination work in localities, Mr. Nguyen Tat Thao, Deputy Director of the the Center for Medical Claim Review (VSS), said that in 2022, the Center had informed the local social security agencies of 71 topics, including 26 new topics and 45 old topics, with a proposed examination amount of VND 132.1 billion. As of April 17, 2023, the local social security  agencies reported that they had recovered VND 51.0 billion to the fund (with a recovery rate of 38.6%). According to Mr. Thao, one of the issues that needs to be addressed is that some provincial social security agencies have not seriously implemented the examination work.

Regarding the inspection of health insurance examination activities in the past, Ms. Nguyen Thu Huong, Deputy Director of the Inspectorate Department (VSS), said that the discovery of errors and recovery in units, including localities with a significant increase in health insurance costs, is still low. It is recommended that the inspection work be carried out according to the plan and carried out early in the year by the local social security agencies.

Social security agencies of provinces and cities attended the conference at various locations

In his concluding remarks, Deputy General Director Nguyen Duc Hoa emphasized that while the health insurance fund is limited, the rapid increase in health insurance examination costs requires continued improvement of responsibility and coordination with the health sector to effectively manage the fund. Local social security agencies must enhance their responsibility in carrying out health insurance examination tasks and evaluate them effectively.

Hoa requested that the local social security agencies report to the provincial/ city People's Committees monthly on the use and balance of the fund in their respective areas to jointly manage and monitor it. In particular, they should analyze data and timely detect any increasing costs that are not suitable. They should also control the prices of drugs and medical supplies, clarify any conflicts when healthcare facilities increase their prescriptions and use new, expensive drugs, but the average treatment duration is longer. Comparing different groups and monitoring the use of drugs and medical supplies is also important.