Accordingly, in order to ensure the balance of health insurance examination and treatment expenditure estimates assigned by the Prime Minister in 2024, ensure the interests of health insurance participants, and at the same time, improve the quality of health insurance examination and treatment, the City People's Committee requires agencies and units, based on their functions, the assigned task continues to implement solutions to effectively manage and use health insurance examination and treatment costs in 2024.

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

The document stated clearly that, the City Social Insurance Office is required to actively review and evaluate and analyze data on health insurance examination and treatment costs on the assessment system as prescribed at Point d, Clause 10, Article 1 of the Government's Decree No. 75/2023/ND-CP; promptly notify health insurance examination and treatment establishments with high indicators compared to establishments of the same class, same route and same specialty,... so that medical examination and treatment establishments can actively manage and effectively use funds for medical examination and treatment of health insurance at their units, ensuring the balance of the city-wide estimate assigned in 2024, and at the same time adjusting irrationalities in inpatient appointments, prescribe medicines, 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 health insurance examination and treatment costs; strengthen the development and implementation of thematic assessment to comprehensively manage medical examination and treatment costs at the area; resolutely refuse to pay unreasonable and unregulated expenses; regularly review conditions for signing contracts for medical examination and treatment of health insurance in accordance with 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 examination and treatment establishments to comply with regulations on data standardization and transfer data to the Health Insurance Assessment System immediately after the end of treatment under the guidance documents of the Ministry of Health...

The Department of Health of Ho Chi Minh City is requred to strictly implement Directive No. 10/CT-BYT dated September 9th, 2019 of the Ministry of Health on strengthening the prevention and control of acts of abuse and profiteering of health insurance funds. Coordinate with the City Social Insurance Office in directing the inspection and inspection of health insurance examination and treatment; bidding, supplying, managing and using drugs, chemicals, medical supplies and payment of health insurance examination and treatment costs at medical examination and treatment establishments under their management; prevent and promptly detect acts of abuse, fraud and profiteering of health insurance funds, report to competent authorities to strictly handle violations of health insurance.

The City People's Committee also requests the Department of Health to direct medical examination and treatment establishments in the area to develop plans and manage the use of health insurance examination and treatment funds, and at the same time, have solutions to manage medical examination and treatment and health insurance examination and treatment to ensure strictly, effective... Actively propagating and guiding patients to carry out medical examination and treatment with health insurance with citizen identity cards with chips as directed in Official Dispatch No. 931/BYT-BH dated February 28, 2022 of the Ministry of Health and Official Dispatch No. 533/BHXH-CSYT dated March 1st, 2022 of Vietnam Social Security guiding the pilot implementation of medical examination, health insurance treatment with citizen identity cards with chips. Promptly solve difficulties and problems arising in practice and the process of implementing the assigned health insurance examination and treatment expenditure estimate...

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For directors of medical examination and treatment establishments, the City requires bidding for the procurement of drugs, chemicals and medical supplies adequately and promptly to meet treatment needs, so as not to let patients with health insurance have to buy drugs and medical supplies within the scope of payment of the health insurance fund. The list of drugs procured must ensure reasonable structure among drug groups, conform to the scope of professional activities of medical examination and treatment establishments, reduce the proportion of brand-name drugs and increase drug use according to the results of centralized bidding at national and local levels. For the procurement of medical supplies, it is recommended that medical examination and treatment establishments refer to the winning bids for medical supplies nationwide updated on the portal of VSS to ensure efficient and economical procurement.

Improve the operational efficiency of the Drug and Treatment Council, clinical pharmacy work; control the prescription and use of drugs, the appointment of tests, the appointment of technical services and the strict observance of diagnostic and treatment instructions, technical procedures, and procedures for caring for patients. Formulate regulations and criteria for admission to inpatient hospitals of medical examination and treatment establishments in accordance with professional requirements, number of hospital beds, equipment and human resources conditions in accordance with Directive No. 25/CT-BYT...

Regarding the issuance of certificates of leave from work to enjoy social insurance, ensure the principle of right patients, suitable to the health status of patients and professional guidance of the Ministry of Health. Absolutely do not make false documents and issue certificates of leave from work to enjoy social insurance for ineligible people... Regularly disseminate and thoroughly educate health workers about Article 215 of the crime of health insurance fraud of the 2015 Penal Code, 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. Heads of medical examination and treatment establishments shall take responsibility accountable to the Law  if violations occur in their assigned units or fields of work.