People pay hospital fees with health insurance
at the National Hospital of Otorhinolaryngology. Health insurance funds have
been misused. – VNA/VNS Photo Dương Ngọc
HÀ NỘI — Health insurance funds for medical
check-ups and treatment have been misused, becoming a “nightmare” with spending
that exceeds State limits, a health official has told local media.
In the
first half of this year, more than VNĐ30 trillion (US$1.3 billion) was spent, a
40 per cent increase over the same period last year and greatly exceeding this
year’s budget of about VNĐ2.1 trillion ($93.3million). This amount has climbed
to nearly VNĐ3trillion ($133.3million) as of July 18, Phạm Lương Sơn, deputy
general director of Việt Nam’s Social Insurance said.
Sơn
attributed the overspending to the number of health insurance cardholders
increasing 12 per cent in the period. However, the main problem was health
insurance cardholders and health facilities trying to make money from the fund,
he said.
“The
abuse of health insurance funds is happening in many places, at different
levels and becoming more sophisticated,” Sơn said.
Some
medical facilities take advantage of loopholes in policies or shortages of
human resources, supervising measures to abuse the fund, he added.
New
regulations state that patients can freely choose medical facilities at
district level to have medical examinations while enjoying similar benefits at
any facility. This change has led to the fact that many cardholders go to
different facilities for health check-ups several times in one day.
Statistics
from Việt Nam’s Social Insurance showed that in July, some cardholders had
medical check-ups 27 times per month.
These
fraudsters can get prescriptions worth VNĐ200,000 ($9) at each facility they
have the check-ups and then sell them to pharmacies for profit.
Commercialised health services
Sơn also
pointed out that the unnecessary use of CT Scanners, MRIs or expensive medicine
prescribed by doctors contributed to the problem.
The total
spending on testing, ultrasound, and endoscopic exams can reach VNĐ4 billion
($178,000) each month on average, Việt Nam’s Social Insurance revealed.
Việt
Nam’s Social Insurance will figure out the tests were for diagnosis or only for
regular health-check-ups, Sơn said.
Representatives
from private hospitals also contact local women’s associations and veterans’
associations to get residents to go for health-check-ups or offer discount
programmes for second time check-ups as promotional measures to increase health
check-ups demand and multiple spending from the fund.
Another
surprising figure is the surge of expense of distilled water test-tubes in
2014-2015. Many hospitals have switched from using glass distilled water
test-tubes to plastic ones, increasing the spending on the tubes by VNĐ15
billion ($667,000).
This
money could be used for health insurance for the poor, patients with cancer,
cardiac diseases, tuberculosis or HIV and save thousands of sick people, Sơn
said.
If the
spending exceeds 30 per cent of allocated funds, health insurance funds are
unable to fill the deficiency, Sơn said.
He said
that tightening the fund in the final months of the year is the key task of Việt
Nam’s Social Insurance. Social insurance agencies of localities must analyse
fee increases in health check-ups and treatment and co-operate with local
departments and sectors to take better control of the fund.
Sơn said
that consistent denial of payment must be applied for medical facilities
misusing health insurance funds. For example, this year, Phương Nam Clinic in
southern Cà Mau Province was denied health insurance check-ups and treatment
payment of VNĐ71 billion ($3.1million) due to alleged abuse of spending.
No comments:
Post a Comment