Hospitals bear debt pressure due to exceeding health insurance spending estimates
According to a representative of a first-class hospital in Ho Chi Minh City, the hospital's medicine debt to pharmaceutical companies alone accounts for more than 50% of the amount not covered by health insurance, while the revenue is not enough to cover the shortfall from the delay in payment exceeding the health insurance estimate at this hospital.
"We have to prioritize paying staff salaries first, while the pharmaceutical company would like to pay gradually," the hospital representative shared.
Due to prolonged debt, some pharmaceutical companies were upset, forcing hospitals to pay in advance for essential drugs. Otherwise, the risk of drug shortages will directly affect the rights of patients. "We do not dare to leave medicine lacking, but the pressure to repay the debt is huge," he said.
The main reason comes from the fact that the health insurance assigns annual spending estimates, requiring hospitals to package within the assigned limit. However, when the number of patients increases, the disease becomes more severe or the price of drugs and supplies escalates, the actual cost easily exceeds the estimate. This excess was not paid immediately, causing the hospital to suffer a debt.
This situation not only affects the purchase of drugs but also affects investment in equipment, consumables and other activities. Like a family, when spending more than the plan, the excess will become a debt, the hospital representative compared.
According to estimates, in the past two years alone, the hospital's outstanding debt has exceeded the estimate by over 30 billion VND. Although this is not a new phenomenon, the severity is increasing, especially in upper-level hospitals, where treatment costs are higher.
Explaining why it exceeded the spending estimate to receive health insurance payment
A leader of a final hospital for pediatric patients said that in 2019, the unit had an estimated excess of 11 billion VND in medical examination and treatment expenditure and had been almost completely paid by health insurance after a full explanation. In 2023, the ceiling exceeded 14 billion VND and is still in the process of being explained for payment.
According to this person, health insurance cannot "pre-estate" the entire amount exceeding the estimate immediately, because it is necessary to ensure that the expenditure is reasonable and in accordance with regulations. The cause of overcoming the ceiling often comes from the hospital's professional development, increased reputation, and attraction of more patients, especially in severe and complicated cases. Health insurance still creates conditions, but requires hospitals to strictly comply with regulations on expertise, technical categories and bidding and procurement.
Both sides are for the rights of patients. The hospital must standards all procedures; the health insurance will support timely and complete payments when the documents are transparent and reasonable, he emphasized. If the hospital shops at more than market prices or does not follow the procedures, the health insurance will not accept payment.
The leader affirmed that the close coordination between the hospital and health insurance, both ensuring finances and improving professional quality, is a key factor for the fund to be used effectively and best serve patients.
Ho Chi Minh City Social Insurance is waiting for guidance on how to resolve the issue
Regarding this issue, Ms. Nguyen Thi Thu Hang - Deputy Director of Ho Chi Minh City Social Insurance - said that in 2023, the cost of health insurance examination and treatment in Ho Chi Minh City exceeded the estimate by more than 743 billion VND. This amount has been appraised by Ho Chi Minh City Social Insurance in coordination with the Ho Chi Minh City Department of Health, and proposed to be paid by Vietnam Social Insurance.
To date, the amount exceeding this estimate has been paid 186 billion VND by Vietnam Social Insurance under its authority, the remaining 557 billion VND has been submitted by the Ministry of Finance to the Prime Minister to be assigned to the Ministry of Health to propose a handling method.
In 2024, the cost of health insurance examination and treatment in the whole city will continue to exceed the estimate by more than 1,900 billion VND. Ho Chi Minh City Social Insurance is waiting for guidance from competent authorities to resolve this issue.
