Improved efficiency in management and use of Health Insurance Fund

01/10/2023 03:55 PM

On September 28, Vietnam Social Security (VSS) opened a scientific workshop “Effective management and use of Health Insurance Fund: international experience and reality in Vietnam”. The hybrid event was presided over by VSS Deputy General Director Nguyen Duc Hoa at the VSS’s headquarters in Hanoi and connected with VSS offices and healthcare sector branches in all 63 cities and provinces across the country.

In attendance also included domestic and foreign experts from the World Bank, University of Sydney (Australia) and Hanoi University of Public Health, who shared opinions and recommendations in various fields: experience in designing health insurance benefit packages to effectively use the Health Insurance Fund; experience in using technological applications to monitor the management of Health Insurance Fund; Applying medical technology assessment in listing health insurance-based drugs; among others.

In his opening remarks, VSS Deputy General Director Nguyen Duc Hoa said “Under the leadership and direction of the Party and Government, Vietnam has made positive progresses in improving healthcare services, expanding the health insurance coverage and ensuring the rights and benefits of the insured. However, the social security industry has also been facing challenges in enhancing the management of Health Insurance Fund, ensuring justice for all in the access to healthcare services.”

According to the VSS Deputy General Director, the contribution levels to the Health Insurance Fund have basically stayed the same since 2009 (besides specific changes in line with increased basic salary levels over the years), whilst benefits of participants are expanding plus a significant increase in costs from new replacement materials and expanded list of medications.

“Which solutions are needed to effectively manage the Health Insurance Fund to ensure all three objectives: protecting the rights of health insurance participants; financial capacity of the Health Insurance Fund; and most importantly, ensuring the quality of healthcare services that correspond to the increasing prices of healthcare services?” Hoa raised the issue, to which VSS seeks to harmonise the rights of three parties: health insurance participants are guaranteed the best benefits: social security offices effectively manage the Health Insurance Fund; and medical facilities ensure revenue for smooth operations.

VSS Deputy General Director Nguyen Duc Hoa delivers a speech at the workshop

“The Health Insurance Fund is contributed by the people and supported by the State budget, therefore, for an effective management of the fund, it is the responsibility of not only social security offices but the whole political system as well as participants,” said the VSS Deputy Director General.

Speaking about challenges facing the Health Insurance Fund currently, Director of VSS’ Department of Health Insurance Implementation Le Van Phuc said after 10 years since the Law on Health Insurance was implemented, the revenue and expenditure from the Health Insurance Fund have both increased approximately eight times. After five years of implementing the amended Law on Health Insurance, the expenditure for medical examination and treatment has doubled. The healthcare expenditure in 2016 increased by 45 per cent compared to 2009, and for the first time the healthcare fund became imbalanced. Although Vietnam had two surplus years in 2020 and 2021 (due to COVID-19 social distancing measures, the number of people using medical examination and treatment services decreased and the State budget covered COVID-19 treatment costs), the fund became imbalanced again due to the payment for previous years’ outstanding balance.

Phuc said to address the challenge of “ensuring revenue and expenditure balance”, in addition to maintaining and sustainably developing the universal health insurance coverage rate, it is crucial to improve the efficiency of the Health Insurance Fund, ensure its sustainability, and protect the financial well-being of health insurance participants.

 Experts at World Bank attend the Workshop

Health insurance benefit packages

Sharing international experience in designing health insurance benefit packages to effectively management the Health Insurance Fund, Christophe Lemiere, Program Leader for Human Development for Vietnam at World Bank said the packages should include emergency healthcare services; clear information; expand the level of benefits for existing priority services before expanding the benefit package. Additionally, it is necessary to remove low-value services before expanding the benefit package; regulate the modification cycle; and engage relevant parties including the people, in the process of designing benefit packages.

The WB expert noted that it is essential to pay due attention to upgrading health insurance benefit packages as it ensures the financial capability/sustainability/efficiency of the Health Insurance in which it is necessary to eliminate inappropriate healthcare services. The upgrade of the benefit packages is also compatible with objectives of the healthcare system.

According to the WB expert, some lessons of experience can be applicable in Vietnam, which include  an overall assessment of health insurance benefit packages, including disease prevention services; clarification of health insurance benefit packages (each service and level of medical facility/suppliers) for common chronic diseases; tighter control over the provision of economically inefficient healthcare services (for example, unnecessary hospitalisation); establishment of units assessing efficiency of medical technology and making financial records for healthcare service costs using standarised methods.

Prof. Dr. Hoang Van Minh, rector of Hanoi University of Public Health said in context of Vietnam’s Health Insurance Fund’s imbalance in revenue and expenditure, there are two main solutions that can be considered: increased revenue and reduced expenditure. However, under the socio-economic circumstance of Vietnam, the most feasible solution is to reduce expenditure through renewing payment methods and rationalising expenses.

And the most efficient tool for cost-effectiveness goals is the use of Health Technology Assessment (HTA) throughout the policy-making process: from building a drug and healthcare services inventory to assessing budgetary impacts, said Prof. Dr. Minh, adding that the tool has been successfully applied in many countries such as Thailand, China, the UK, Australia, and South Korea. At present, the use of HTA in Vietnam has been included in certain documents, including the Government’s Decision No 122/QĐ-TTg dated October 1, 2023 approving the National Strategy to protect, care for, and improve public health in the 20211-2022 period, with a vision to 2030. The Ministry of Health has also regulated the use of HTA in formulating lists of health insurance medications and in drug price negotiations.

A general view of the workshop

Applying technologies to manage Health Insurance Fund: world trend

Addressing the workshop, Assoc. Prof. Cheryl McCullagh, University of Sydney, Chief Product Officer at Beamtree spoke about the efficiency of applying technologies in monitoring the management of Health Insurance Fund. According to the expert, technological applications will support sustainable healthcare funding by ensuring high-quality operations with standadisation and fewer errors, helping maximise the use of available resources.

Deputy Director of VSS’s Center for Medical Claim Review Nguyen Tat Thao said “the application of technologies in monitoring expenditures from the Health Insurance Fund has always been updated and supplemented by VSS to ensure highest efficiency. Before 2017, health insurance-based medical costs reviews were conducted manually on the basis of patients’ dossiers. In the 2017-2022 period, the reviews were conducted manually and automatically. With the addition of professional software, medical claim reviews have mostly been done automatically since early 2023, through the use of AI.”

VSS has proactively implemented specialised inspections; and issued warnings for healthcare facilities with abnormal cost increases, improper medical examination and treatment, duplicate healthcare for patients, excessive use of health insurance cards, medical examination and treatment after death, among others.

A representative of the Ministry of Health said effective management of the Health Insurance Fund is not the sole responsibility of any single body, but requires the collective responsibility of all.

Deputy Head of the health ministry’s Department of Health Insurance Nguyen Tri Dung said relevant bodies from the ministry and VSS are closely working together to monitor medical examination and treatment costs as well as to