Deputy Director Nguyen Duc Hoa

Participants at the central location included representatives from the HI Policy Implementation Department, the Electronic SI, HI Payment Review Center, the Electronic HI Department, the Information Technology and Digital Transformation Center, along with representatives from several units under VSS. At the provincial and municipal Social Security locations, attendees included Directors, Deputy Directors in charge of HI policies, leaders of the HI Policy Department, and related officials.

Speaking at the conference, Mr.Hoa emphasized that the settlement of HI-covered medical service expenses is an important task in the management and use of the HI Fund. The effective implementation of this task not only contributes to ensuring the rights of HI participants but also creates favorable conditions for medical service facilities in the process of providing medical services.

Over the past period, VSS and local Social Security offices have proactively coordinated with the health sector and HI-covered medical service centers to implement the medical claim review, payment, and settlement of HI-covered  medical service expenses in accordance with the provisions of the law. Fund management has been increasingly strengthened; many solutions applying information technology and data analysis in HI  settlement have been promoted, contributing to the effective and transparent control of HI-covered medical service expenses.

However, there are some remaining difficulties and challenges related to determining the costs of HI-covered medical service expenditures exceeding projected expenditures during the implementation process, the methods for creating and adjusting projected expenditures at healthcare facilities, as well as standardizing the review and settlement of costs among relevant parties. Therefore, the conference was held to unify understanding and provide specific guidance on professional and operational content so that units can implement it synchronously throughout the system.

At the conference, representatives of the HI Policy Implementation Board disseminated and provided detailed guidance on the contents of Decision No. 582/QĐ-BYT dated March 9, 2026, of the Ministry of Health. Accordingly, the preparation of projected expenditures for HI-covered medical service must be based on the payment and settlement status of HI-covered medical service  costs of the previous year, the estimated implementation of the current year, and consider factors such as changes in disease structure, the scale of professional activities of the healthcare facility, the implementation of new technical services, changes in prices of  medical service prices, drug and medical supply, as well as other objective factors related to MET activities.

HI-covered medical service facilities are responsible for preparing projected expenditures for HI-covered medical service for the planned year and submitting them to the social security office where the contract is signed before July 10 each year for synthesis, monitoring, and as a basis for managing HI-covered medical service costs.

Compared to previous guidelines, Decision No. 582/QĐ-BYT has some notable new points such as: mandatory regulations for healthcare facilities to prepare projected expenditures for HI-covered medical service; the method for determining projected expenditures is simplified; additional guidance for healthcare facilities newly signing contracts for HI-covered medical service; and clearly defining how to determine average costs in case of changes in medical service prices or factors related to medical service activities.

According to the new guidance, determining the amount of HI-covered medical service costs exceeding projected expenditures that are paid by the HI fund must be based on a review of all HI-covered medical service costs, not a sample-based review. The review must ensure the conditions: costs are within the scope of benefits and levels of enjoyment of HI participants; medical records and documents are legal and complete; payment data matches the electronic data sent to the social security office and has been verified as eligible for payment.

The reviewing process is also specifically regulated. When expenditures exceed projections, the social security office will notify the healthcare facility to provide an explanation. Within 15 days of receiving the notification, the healthcare facility must submit a report explaining the reasons for exceeding the projected expenditures. Based on this report, the provincial Social Security office takes the lead in coordinating with the Department of Health and the healthcare facility to review and assess the reasons for the increased expenditures, consider the results of inspections, audits, and related assessment topics to determine which expenditures are eligible for payment by the HI fund.

According to regulations, provincial and municipal Social Security office must complete the review, synthesis, and finalization of healthcare expenditures exceeding projected expenditures before May 10 each year to report to the competent authorities for consideration and settlement.

At online meeting points, representatives of Social Security offices from several provinces and cities exchanged and discussed difficulties and obstacles in the process of conducting assessments, payments, and settlements of HI-covered medical service costs in their localities.

The discussions focused on clarifying the methods for preparing and adjusting projected HI-covered medical service expenditures; how to review and determine expenditures exceeding projected expenditures; as well as the coordination mechanisms between the Social Security offices, the Department of Health, and healthcare facilities in the process of controlling HI-covered medical service costs. Many localities also shared experiences in enhancing the application of information technology and leveraging data from the HI Assessment Information System to promptly detect and flag unusually high costs.

In his concluding remarks at the conference, Mr.Hoa acknowledged and highly appreciated the proactiveness of local Social Security offices in coordinating with healthcare facilities to effectively implement the assessment, payment, and settlement of HI-covered costs in the past.

To ensure the accurate, timely, and high-quality settlement of HI medical expenses for 2025, Mr.Hoa requests that provincial and municipal social security offices continue to thoroughly grasp and strictly implement legal regulations on HI, especially the guidelines in Decision No. 582/QD-BYT of the Ministry of Health. Simultaneously, disseminate these regulations fully to relevant professional departments to ensure consistency in implementation. Enhance coordination with healthcare facilities in the area to review and compare data, identify medical expenses exceeding projected expenditures, and clarify the reasons for increased spending, particularly objective factors such as increased visits, the introduction of new techniques, changes in disease patterns, or policy changes. Continue to improve the quality of HI assessment, promote the application of information technology, and effectively utilize data from the HI Assessment Information System to promptly detect and prevent unreasonable costs.

Emphasizing upcoming tasks, Deputy Director Nguyen Duc Hoa urged units throughout the social security system to continue promoting a sense of responsibility, proactivity, and flexibility in implementation, contributing to the safe and effective management and use of the HI Fund, ensuring the best possible benefits for HI participants, while also supporting healthcare facilities in fulfilling their mission of caring for and protecting people's health.