Social insurance is about billions of insurance payments

According to the Vietnam Social Security, in the medium term, the fund is still able to balance its revenues and expenditures.

Recently, patient Phan Huu Nghiem (36 years old, living in Vung Liem district, Vinh Long) was discharged from the hospital after 11 years of treatment at Cho Ray Hospital (Ho Chi Minh City) and was covered by the health insurance fund (HI). up to 38.3 billion.

Vietnam Social Insurance Agency (Social Insurance) believes that this is not an uncommon case, because many patients have been covered by the health insurance fund with such a “huge” amount over the past time.

Mr. Phan Huu Nghiem, who had hemophilia, was paid more than 38 billion VND by health insurance for 11 years of treatment, he said goodbye to the doctor to leave the hospital to go home. Photo: HOANG LAN

Tight escape thanks to health insurance

According to the results recorded from the health insurance assessment information system (Vietnam Social Insurance Agency), recently many cases of unfortunate accidents and illness have overcome a difficult period thanks to the health insurance fund to pay for the medical examination and cure.

For example, the patient has the HC49191120XXXXX card code (address at Hon Tre hamlet, Tien Hai commune, Ha Tien city, Kien Giang), who is paid by the employee and the employer.

This patient was treated twice at Cho Ray Hospital (HCMC). Phase 1, 3-month treatment with a total cost of 7.95 billion VND. In which, the biggest expense is the drug expense of 7.80 billion dong, the test fee is 22.91 million dong … The amount proposed to the health insurance fund to pay is 6.36 billion dong.

Phase 2, this patient treated for 10 days, the total cost of treatment is 3.07 billion. In particular, drug costs are up to 3.06 billion … The amount proposed to the health insurance fund to pay is 3.07 billion.

Another case is a patient with card number BT28383222XXXXX (living in An Binh Tay commune, Ba Tri district, Ben Tre), who is paid by the state budget.

This patient also treated two times at Cho Ray Hospital, total treatment cost and proposed payment fund is 5.68 billion. In particular, drug costs were 5.63 billion VND, blood money was 13.4 million VND …

And patients with card number BT28686216XXXXX (living in Trung Trach hamlet, Trung Thanh commune, Vung Liem district, Vinh Long), are subject to the state budget.

This patient has four rounds of treatment at Cho Ray Hospital, the total amount that the health insurance has to pay is more than 8 billion.

88

million people are participating in health insurance nationwide, accounting for 90.85% of the population. In 2020, social insurance has paid health insurance costs for over 167.2 million inpatients and outpatients, an increase of 28.4% compared to 2015.

Do not worry about breaking the fund in the near future

Talking to the reporter, Mr. Pham Luong Son, Deputy General Director of Vietnam Social Insurance, said that the patient’s medical expenses are covered by the health insurance fund up to hundreds of millions of VND, even billions of VND / batch. Value shows that social health insurance is a humane policy, far different from commercial health insurance. This means that employees only pay the percentage of salary (4.5%), but the benefit rate is not limited.

Of course, the patient’s benefit rate also depends on each group of subjects recorded on the health insurance card (with the rate of 80% -100%) and according to the list of drugs, medical supplies … paid by the fund.

Patients with high treatment costs often suffer from blood diseases, cancer … with long treatment periods and have to use expensive drugs.

“This is the interests of the participant and the insurance industry must ensure that right for them …” – Mr. Son affirmed.

Some readers are concerned that in 2019, the price of medical services will increase by 2% -10%, the awareness of health care of the people will be improved, so they go to more medical examination, whether the health insurance fund will be balanced. annual spending?

There is no limit to the insured’s right to search

Mr. Nguyen Trung Quy, Deputy Head of Health Insurance Policy Implementation Department, said that when people come to the medical facility to present all the procedures, the medical facility is responsible for receiving and doing the initial procedures. and organize examination for patients.

On the basis of documents established by the medical examination and treatment facility, the insurance industry will make full payment for the patient. “There are no regulations that limit the people’s right to medical examination and treatment with health insurance. And the responsibility of the insurance industry will determine which case is profitable, which case is not … “- Mr. Quy said.

Answering this question, Mr. Pham Luong Son said that the fund balance problem is always very difficult, painful and challenging not only for Vietnam but also in many countries around the world.

However, Vietnam is somewhat fortunate when the revised Law on Health Insurance 2014 adjusted target groups and introduced incentives to increase the number of people participating. Therefore, up to now, over 90% of the Vietnamese population participate in health insurance.

Besides, in the past, the health insurance fund also had a balance, so in the medium term, the balance fund could be collected and spent.

“However, the annual revenues and expenditures are imbalanced, spending more than revenues. So each year we have to build an estimate, thereby compensating a very large part of the cost, about 10,000-20,000 billion from the residual reserve of the fund to be able to spend … ”- Mr. Son said.

To solve the above problem in the long term, the deputy general director of Vietnam Social Insurance thinks that it is necessary to adjust the health insurance premium. Because at present, people contribute to the fund an average of 30-50 USD / person, while the benefit rate is up to 100-200 USD / person.

“So the proposal to increase the contribution to the health insurance fund has recently received a high consensus from the National Assembly, the Government, and ministries. However, the time, object, how we will calculate accordingly. For example, we increase only for the object that is closing low; for near-poor households, voluntary insurance participants increase moderately to maintain the sustainability of the participants ”- Mr. Pham Luong Son said.