Anticipating Numerous Challenges

In his opening speech, Deputy Director General Nguyen Duc Hoa emphasized that the entire sector has effectively implemented health insurance policies, earning high praise from the government. However, as we enter 2024, a mixture of favorable conditions and challenges poses significant hurdles, requiring the entire sector to unite and exert the highest level of responsibility to fulfill the assigned political tasks. In the remaining 9 months of 2024, many challenges lie ahead for health insurance work, including expanding insurance coverage as per established goals, safeguarding the rights of health insurance participants, and managing and utilizing the health insurance fund efficiently and in compliance with regulations.

Addressing the challenges in implementing health insurance policies, Deputy Director General Nguyen Duc Hoa pointed out that in 2024, we must continue to implement new regulations with significant impacts on health insurance work, especially those outlined in Government Decree No. 75/2023/ND-CP dated October 19, 2023, amending and supplementing certain provisions of Government Decree No. 146/2018/ND-CP dated October 17, 2018, Government Decree No. 96 guiding the Health Insurance Law, and Government Decree No. 24 guiding the Bidding Law...

Deputy Director General of VSS, Nguyen Duc Hoa, giving directions at the conference

Eliminating the provision on total payment thresholds requires VSS agencies to implement effective fund management solutions through budget allocation and monitoring contract execution processes. Although the regulations have been formulated, organizational implementation still faces numerous challenges.

Moreover, Government Decree No. 24/2024/ND-CP dated February 27, 2024, specifies certain provisions and measures for implementing the Bidding Law regarding contractor selection. Accordingly, the involvement of VSS agencies is limited to participating in the construction of contractor selection plans by centralized bidding councils. Therefore, VSS agencies will need to focus on participating in the appraisal of contractor selection plans for centralized procurement and price negotiation.

During the conference, units of VSS reported on the assessment of healthcare activities in the first 2 months of 2024 and the tasks for the remaining months of the year in controlling health insurance costs. They presented drafts of guidelines for budget allocation for health insurance expenses and the announcement of estimated health insurance expenditure for healthcare facilities, allowing localities to provide feedback before VSS officially issues formal guidance. The Medical Services Committee also presented guidelines for settling healthcare expenses in 2023 and synthesized and updated data from the C82-HD system for settlement review and the Center for Medical Claim Review presented a report evaluating the implementation of specialized appraisal topics in 2023.

Increasing HI-based Healthcare Costs

Sharing the implementation status of health insurance policies in the first 2 months of the year, Head of the Health Insurance Policy Implementation Committee (VSS) Le Van Phuc stated that VSS is actively involved in drafting legal documents related to the field of health insurance (Health Insurance Law; Pharmacy Law, circulars guiding healthcare service pricing, methods of health insurance cost payment according to DRG...)

Head of the Health Insurance Policy Implementation Committee (VSS) Le Van Phuc speaking at the conference

At the conference, the Health Insurance Policy Implementation Committee also instructed localities to implement the settlement of health insurance expenses in 2023 and synthesize and update data from the C82-HD system for settlement review. They presented a draft guideline for budget allocation for health insurance expenses and announced the estimated health insurance expenditure.

At the same time, several solutions were proposed to control health insurance costs in 2024. From the perspective of VSS, it is necessary to continue actively participating in the development of policies: amending and supplementing the Health Insurance Law; circulars regulating healthcare service pricing methods; replacing Circular No. 40/2015/TT-BYT.

Director of Center for Medical Claim Review Duong Tuan Duc delivered a speech

The Center for Medical Claim Review also shared a draft procedure for