Assigning the budget for medical examination and treatment under health insurance in 2024

Specifically, the Deputy Prime Minister assigned the estimated expenditure for health insurance examination and treatment in 2024 to be over VND132.7 trillion. Of which, the estimated expenditure for health insurance examination and treatment from 90% of health insurance revenue is VND123.7 trillion; the reserve for health insurance examination and treatment from health insurance revenue is over VND9,007 billion.

The Deputy Prime Minister requested the Social Insurance Management Council to be responsible for directing and supervising the implementation of the health insurance medical examination and treatment expenditure estimates assigned for 2024, ensuring compliance with regulations.

The Chairmen of the People's Committees of provinces and centrally run cities (Provincial People's Committees) are responsible for directing the provincial Social Insurance to preside over and coordinate with the Department of Health and relevant agencies to effectively manage and use the health insurance fund and estimate the costs of health insurance examination and treatment assigned; strictly implement the regulations on advance payment and settlement of health insurance examination and treatment costs according to the provisions of the Law on Health Insurance, Decree No. 146/2018/ND-CP dated October 17, 2018 of the Government detailing and guiding the implementation of a number of articles of the Law on Health Insurance; Decree No. 75/2023/ND-CP dated October 19, 2023 of the Government amending and supplementing a number of articles of Decree No. 146/2018/ND-CP dated October 17, 2018 and guiding documents.

Prevent abuse and profiteering of health insurance fund

The provincial People's Committee directs the Department of Health to preside over and coordinate with the provincial Social Insurance and relevant agencies to strengthen the advisory work to help the provincial People's Committee carry out state management of health insurance through inspection, examination and handling of violations; have solutions to prevent abuse and profiteering of the health insurance fund; inspect and examine health insurance medical examination and treatment facilities that do not adjust unreasonably high health insurance medical examination and treatment costs according to recommendations and warnings of the social insurance agency.

At the same time, direct the Department of Finance to transfer sufficient and timely state budget funds to pay and support health insurance payments for subjects guaranteed by the state budget; participate in the management of the health insurance fund according to regulations; direct medical examination and treatment facilities to perform medical examination and treatment, prescribe drugs and technical services in accordance with regulations and professional procedures issued by competent authorities; fully and promptly update information on health insurance medical examination and treatment and transfer data to the Social Insurance agency according to regulations so that appraisal and payment are accurate and timely; at the same time, direct medical examination and treatment facilities to proactively detect, review, inspect and adjust increased health insurance medical examination and treatment costs according to warning recommendations of the Social Insurance agency and make appropriate adjustments.

Strengthen communication work on health insurance, have solutions to mobilize people to participate in health insurance suitable for each target group to achieve the goal of developing health insurance according to Resolution No. 20-NQ/TW dated October 25, 2017 of the 6th Conference of the 12th Party Central Committee on strengthening the work of protecting, caring for and improving people's health in the new situation.

Implement health insurance quickly and simply

The General Director of Vietnam Social Security is responsible for directing Vietnam Social Security to assign estimates and notify the estimated amount of health insurance examination and treatment expenses, supplement the health insurance examination and treatment expenses, and finalize the health insurance examination and treatment expenses in 2024 according to the provisions of the Health Insurance Law, Decree No. 75/2023/ND-CP dated October 19, 2023 of the Government amending and supplementing a number of articles of Decree No. 146/2018/ND-CP dated October 17, 2018, to submit to the Management Board for approval; guide the documents, procedures, and organize the implementation of the health insurance regime to ensure quickness, simplicity, and convenience for health insurance participants.

Directing and guiding the Social Insurance of provinces and centrally run cities to advance, pay, and settle the costs of health insurance examination and treatment in accordance with the provisions of the Health Insurance Law and Decree No. 146/2018/ND-CP, Decree No. 75/2023/ND-CP; sending recommendations and timely warning information to medical examination and treatment facilities about the costs of health insurance examination and treatment that are higher than the average costs of medical examination and treatment facilities of the same class, same level, and same specialty.

Monitor payment of medical examination costs

The Minister of Health is responsible for presiding over and coordinating with the Social Insurance Agency and relevant agencies to submit to competent authorities amendments to regulations on payment methods for health insurance examination and treatment costs in accordance with the law on health insurance examination and treatment to effectively control costs, ensure the quality of medical services, and convenience for patients and medical examination and treatment facilities; and ensure good implementation of the budget assigned by the Prime Minister.

The Ministry of Health shall preside over and coordinate with the Social Insurance Agency and relevant agencies to strengthen inspection, examination and supervision of medical examination and treatment activities and payment of medical examination and treatment costs covered by health insurance to prevent abuse and profiteering of the health insurance fund; medical examination and treatment facilities shall not adjust unreasonably high medical examination and treatment costs covered by health insurance according to recommendations and warnings of the Social Insurance Agency.

Direct medical examination and treatment facilities to provide adequate medicines, chemicals, medical supplies, and technical services within the scope of benefits for health insurance participants, promote the spirit of practicing thrift, and combat waste in prescribing tests, inpatient treatment, and using services, especially expensive technical services and medicines; at the same time, direct medical examination and treatment facilities to seriously adjust the average health insurance examination and treatment costs that are higher than those of the same class, same level, and same specialty when receiving warning recommendations from the Social Insurance agency about the high costs compared to the average costs of medical examination and treatment facilities of the same class, same level, and same specialty.