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A technician in Cho Ray Hospital is taking an MRI scan for a patient |
Leaders of various hospitals and provincial health departments reported that they have not obtained the settlement for medical examination and treatment costs from medical insurance for the past few years, creating much financial trouble in operation.
The Binh Dinh Province Health Department, for instance, cited that the amount of medical treatment cost from medical insurance was VND42 billion (US$1.74 million) more than the max settlement limit. The figures for Can Tho City and Hue Central Hospital are VND10 billion ($414.750) and VND57 billion ($2.4 million) respectively.
Statistics from Social Security agencies in 63 provinces and cities reveal that the total undelivered sum from Vietnam Social Security has reached VND7 trillion ($290.3 million). That leads to severe lacks of operation funds among many hospitals, and in turn causes a delay in payments for medical materials and medicines, which ultimately affects patient’s treatments.
Director of Cho Ray Hospital Nguyen Tri Thuc stated that the proportion of patients under health insurance accounts for more than 65 percent here. His organization offers medical services according to the prices approved by the State, while Social Insurance agencies only pay the costs in compliance with the monthly and quarterly assessment as well as the annual settlement according to the aggregate rate. This would result in the dependence of the total paid amount on treatment numbers and the previous year’s average costs by disease group. The exceeding amount is not immediately paid, meaning a reduction in revenue.
Other hospitals commented that in some cases, patients need special medicines or medical tests, while are limited in use as Social Insurance agencies will not pay for them.
To address the above problems, the Government has just introduced Decree No.75/2023/ND-CP on amending and supplementing a number of articles in Decree No.146/2018/ND-CP (stipulating and instructing how to implement the Medical Insurance Law).
Director Tran Thi Trang of the Health Insurance Department (Ministry of Health) shared that the release of Decree No.75/2023/ND-CP means breakthroughs in tackling existing issues, especially the content about eliminating the rule on total payment of medical examination and treatment costs covered by health insurance.
Instead, the payment is now based on actual costs, and hospitals are informed of the estimated amount that would be paid by health insurance as a foundation for their own financial plan that year. Also, according to new regulations, patients’ costs for medical technical services, medicines, and materials are given by health insurance in compliance with the applicable prices.
Deputy Head Le Van Phuc of the Health Insurance Policy Implementation Department (under Vietnam Social Security) said that the tardiness in distributing treatment costs to hospitals is mainly because of the exceeding amount compared to the total regulated payment as stated in Decree No.146/2018/ND-CP, issued on October 17, 2018 by the Government.
This means the medical insurance fund does not owe any sum. The above amount of VND7 trillion is the unsettled one according to Decree No. 146/2018/ND-CP as there is no legal foundation for such disbursement yet.
To adopt Decree No.75/2023/ND-CP as soon as possible so that medical institutes and patients experience no more trouble, Vietnam Social Security has directed its sub-units in all provinces and cities urgently review and calculate the exceeding costs in the years of 2019, 2020, and 2022 to that the needed money can be deliver this year.
The one in 2021, when the Covid-19 pandemic became more complicated, to ensure the maximum rights of people joining in medical insurance schemes, Vietnam Social Security already cooperated with the Health Ministry to propose that the Government introduce Resolution No.144/NQ-CP on November 5, 2022 to timely provide sufficient funds (VND4.33 trillion - $179.4 million) for medical treatments under health insurance.
Deputy Minister of Health Tran Van Thuan commented that the most awaited and welcomed part in Decree No.75/2023/ND-CP is to eliminate the rule on total payment of medical examination and treatment costs covered by health insurance. No longer will doctors have to consider the most optimal treatment regimens and calculate the cost so as not to exceed the hospital's assigned quota, which is extremely troublesome to them and may affect their professional decisions.
