More than 214 billion VND of health insurance suspended for many years
The imbalance between revenue and expenditure at many public health facilities in Ca Mau has lasted for many years, directly affecting the income and lives of officials and employees in the health sector.
According to the Ca Mau Provincial Department of Health, the main reason is that revenue from health insurance medical examination and treatment has not been finalized in time, while regular expenses such as salaries, allowances, electricity, water, and medical supplies must still be ensured.
Along with that, the facilities at many grassroots health units are degraded, lacking manpower, lacking equipment, causing limited medical examination and treatment capacity, the number of patient visits decreases, reducing revenue. In the context that medical service prices have not fully calculated costs and financial autonomy is still low, many units fall into a situation of prolonged cash shortage.
Through review, the total cost of health insurance medical examination and treatment not paid by Vietnam Social Security in Ca Mau province in the period 2018 - 2024 is up to more than 214 billion VND. This outstanding amount is mainly expenses exceeding the ceiling, exceeding the fund, exceeding the estimate and exceeding the total payment level according to regulations.
Expenses exceeding the ceiling, exceeding the fund, exceeding the 2018 estimate are more than 8.2 billion VND. Expenses exceeding the total payment level for the 2019 - 2020 period according to Decree No. 146/2018/ND-CP are more than 35.5 billion VND. For 2023, expenses exceeding the estimate according to Decree No. 75/2023/ND-CP are more than 79.1 billion VND. In 2024, expenses exceeding the estimate continued to incur nearly 91.9 billion VND, related to many medical facilities in the province.
In addition to the above-mentioned outstanding amounts, health insurance medical examination and treatment costs in 2025 still have 10% that have not been advanced or paid after quarterly settlement, continuing to cause difficulties for medical facilities in balancing regular expenditure sources.
Recommendations for removal
Reality shows that for many years, most of the health insurance medical examination and treatment costs exceeding the estimate in Ca Mau have only been advanced 80% by the social insurance agency, and the remaining 20% has not been paid, leading to wage and allowance debts.
In 2019, the total cost of health insurance medical examination and treatment exceeded the total proposed payment level by more than 64.85 billion VND, which was appraised and accepted for more than 63.2 billion VND. However, after the advance of 80%, there are still 12.64 billion VND (20%) that have not been paid, related to 12 medical facilities.
In 2020, the total cost exceeding the total proposed payment level was more than 43.58 billion VND, which was appraised and accepted for more than 43 billion VND. After an advance of 80%, the amount not yet paid was more than 8.36 billion VND, belonging to 8 medical facilities.
For 2023, expenses exceeded the estimate by more than 122.4 billion VND, related to 28 medical facilities. In 2024, expenses included in the finalization exceeded 107.6 billion VND, related to 32 medical facilities.
Mr. Trinh Trung Kien - Deputy Director of Ca Mau Provincial Social Insurance - said that the expenditures exceeding the estimate have been appraised, summarized and reported to competent authorities for consideration. If paid, it will reduce pressure on medical centers.
To remove difficulties, the Ca Mau Provincial Department of Health proposed that the Provincial People's Committee continue to propose that Vietnam Social Security soon liquidate and finalize outstanding health insurance expenses, in order to stabilize finances for health units.
In the immediate future, the Department of Health proposes to prioritize temporary advances for outstanding health insurance medical examination and treatment costs for the 2019-2024 period of 4 health centers, with a total amount of more than 27 billion VND, to pay salary arrears and salary allowances for civil servants and employees.
As Lao Dong newspaper has reported, hundreds of medical staff in Ca Mau are owed salaries for many months, partly because medical centers do not have revenue sources, and health insurance has not paid the overspending part.
