Accordingly, to ensure the balance of the cost estimates for medical examination and treatment under health insurance assigned by the Prime Minister in 2024, ensuring the rights of health insurance participants, and at the same time, improving the quality of medical examination and treatment under health insurance, the People's Committee The City requires agencies and units, based on their assigned functions and tasks, to continue implementing solutions to effectively manage and use medical examination and treatment costs covered by health insurance in 2024.

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It is known that in 2023, medical examination and treatment facilities and units in Ho Chi Minh City have strengthened management and control of medical examination and treatment spending on health insurance, contributing to ensuring legal rights and benefits for patients, effective management of health insurance medical examination and treatment fund, ensuring legal rights for patients.

It is clearly stated that the City Social Insurance is required to proactively review, evaluate and analyze data on medical examination and treatment costs covered by health insurance on the appraisal system under the regulations at  Point d, Clause 10, Article 1 of Decree No. 75/2023/ND-CP of the Government; Timely notify medical examination and treatment facilities with health insurance that have high indexes compared to facilities of the same class, same level, same specialty, etc. so that medical examination and treatment facilities can proactively manage effectively manage and use medical examination and treatment funds covered by health insurance at the unit, ensuring the balance of the City-wide budget assigned in 2024, and at the same time, adjusting irrationalities in inpatient treatment indications, prescribed drugs, medical supplies, technical services... in accordance with the provisions of law.

Improve the quality of assessment and enhance the application of information technology in the assessment of medical examination and treatment costs covered by health insurance; Strengthen the development and implementation of specialized expertise to comprehensively manage medical examination and treatment costs throughout the City; Resolutely refuse to pay unreasonable and illegal expenses; Regularly review the conditions for signing medical examination and treatment contracts with health insurance in accordance with the provisions of the Law on Medical Examination and Treatment, the Law on Health Insurance and Decree No. 146/2018/ND-CP; Regularly monitor and urge health insurance medical examination and treatment facilities to implement regulations on data standardization and transfer data to the health insurance appraisal system immediately after completing the treatment period under guiding documents of the Ministry of Health…

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The Ho Chi Minh City Department of Health strictly shall implement the Directive No. 10/CT-BYT dated September 9, 2019 of the Ministry of Health on strengthening the prevention and combat of abuse and profiteering of health insurance funds. Coordinate with the City Social Insurance to direct the organization of inspection and examination of medical examination and treatment covered by health insurance; Bidding, supply, management and use of drugs, chemicals, medical supplies and payment of medical examination and treatment costs covered by health insurance at medical examination and treatment facilities under management; Prevent and promptly detect acts of abuse, fraud, and profiteering of health insurance funds, and report to competent authorities to strictly handle violations of health insurance.

The City People's Committee also requested the Department of Health to direct medical examination and treatment facilities in the area to develop plans, manage and use the health insurance medical examination and treatment fund, and at the same time, seek for solutions to manage medical examination and treatment and expenses for medical examination and treatment covered by health insurance ensure strictness and efficiency... Actively propagate and guide patients to perform medical examination and treatment covered by health insurance using chip-imbeded citizen identification cards as directed in Official Dispatch No. 931/BYT - Insurance dated February 28, 2022 of the Ministry of Health and Official Dispatch No. 533/BHXH-CSYT dated March 1, 2022 of VSS guiding the pilot implementation of medical examination and treatment covered by health insurance using citizen identification cards attached chip. Promptly resolve difficulties and problems that arise in practice and the process of implementing assigned medical examination and treatment expenditure estimates under health insurance...

For Directors of medical examination and treatment facilities, the City requires them to held bidding to purchase drugs, chemicals, and medical supplies fully and promptly to meet treatment needs, without allowing patients to have health insurance. Buy your own medicine and medical supplies within the coverage of the health insurance fund. The list of purchased drugs must ensure a reasonable structure between drug groups, consistent with the scope of professional activities of the medical examination and treatment facility, reduce the proportion of original brand-name drugs, and increase the use of drugs according to regulations. Centralized bidding results at national and local levels. For the procurement of medical supplies, medical examination and treatment facilities are requested to refer to the winning bid prices for medical supplies across the country updated on the electronic information portal of Vietnam Social Security to ensure procurement. efficient and economical.

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Improve the operational efficiency of the Drug and Treatment Council and clinical pharmacy work; Control the prescription, use of drugs, order tests, order technical services and strictly comply with diagnosis and treatment instructions, technical procedures, and patient care procedures. Develop regulations and standards for inpatient hospitalization of medical examination and treatment facilities in accordance with professional requirements, number of hospital beds, equipment and human resource conditions in accordance with Directive No. 25/CT -BYT…

Regarding the issuance of certificates of job leave to enjoy social insurance, ensuring the principle of correct patient, in accordance with the patient's health status and professional guidance of the Ministry of Health. Absolutely do not make false documents and issue social insurance retirement certificates to people who are not eligible... Regularly disseminate and thoroughly educate medical staff about Article 215 of Health Insurance Fraud of the Penal Code 2015, Resolution No. 05/2019/NQ-HDTP dated August 15, 2019 of the Council of Judges of the Supreme People's Court, which guides the application of Article 215 on Health Insurance Fraud. The head of a medical examination and treatment facility is responsible before the law if violations occur in the unit or field of work assigned to manage and be in charge./.