On May 10, Mr. Nguyen Ngoc Huyen - Director of Social Insurance Region I (Hanoi) - said that by the end of April 2025, the number of people participating in health insurance was 8,127,224 people, an increase of 196,061 people compared to the same period in 2024, the health insurance coverage rate reached 95.35% of the population.
Region I social insurance in coordination with the Department of Health has advised the People's Committee of Hanoi City to direct the implementation of the estimates of medical examination and treatment (KCB) of health insurance in 2025 assigned by the Prime Minister. Implementing the notice of expected number of medical examination and treatment of health insurance in 2025 to medical facilities to grasp the funding source, strengthen management and control. To advance the funding for medical examination and treatment with health insurance with a complete, timely and timely and timely medical facility so that the medical facility will ensure funding for medical examination and treatment with health insurance.
Social Insurance Region I has completed the settlement of health insurance medical examination and treatment in 2024, and is focusing on settling in the first quarter of 2025 in accordance with the direction of Vietnam Social Insurance...
According to the Director of Social Insurance Region I, although there have been many solutions to effectively implement health insurance medical examination and treatment in the area, there are still some problems in the work of appraising health insurance medical examination and treatment costs.
That is, the cost of health insurance medical examination and treatment in the first 4 months of 2025 increased compared to the same period in 2024, the increase in expenditure was not similar to the number of medical examinations.
Mr. Nguyen Ngoc Huyen pointed out the cause of increasing costs, in addition to the cause of the increase in the number of people participating in health insurance, increasing the price of health services due to the base salary increase from 1.8 million to 2.34 million according to Circular No. 21/2024/TT-BYT, there are some subjective causes such as average cost, hospitalization rate, average day of treatment is still high, the indications exceeding the testing level, imaging of medical services ...
In addition, the cost of out-of-province patients continues to be high, accounting for 50% of total expenditure; the situation of the same disease but with large differences in costs between medical examination and treatment facilities (KCBs) with technical expertise and specialties; many specialized and basic hospitals that were previously city-level still receive and treat patients with common diseases, non-communicable diseases without complications that can be treated by grassroots health care;...
In particular, there is still a situation where many medical facilities extract data late compared to the regulations of Circular No. 48/2017/TT-BYT, sending data that is not in accordance with the standards according to Decision 3176/QD-BYT, having to replace data many times, affecting the management of the route, as well as the management, analysis, forecasting and advance payment of health insurance medical examination and treatment. Some CSKCBs have not yet implemented the standardization of 6 categories according to Decision 3618/QD-BHXH.
Every month, Social Insurance of Region I sends documents to medical examination and treatment facilities to inform them about the situation of increased costs, units with increased prices according to the provisions of Decree No. 75/2023/ND-CP. However, many medical facilities have not reviewed and adjusted.
Mr. Nguyen Ngoc Huyen emphasized that the time from now to the end of the year is only 7 months, with the goal of ensuring good benefits of health insurance, strict management and balance of the assigned estimates, regional social insurance I aims to control the funding source of medical examination and treatment of health insurance in 2025 in the assigned estimate, strengthen the protection of the rights of people with health insurance cards when going to medical examination. At the same time, synchronously implementing solutions and implementation results in order to achieve the set targets.
