Vietnam Social Insurance (VSS) said: Throughout the policy implementation process, the Social Insurance sector has always accompanied patients and medical facilities, considering protecting the legitimate rights of health insurance participants as a key task, so that every health insurance participant wishes to access timely, complete and fair health insurance services.
During the implementation process, Vietnam Social Insurance always complies with legal regulations on management and use of the Health Insurance Fund; at the same time, it attaches importance to the principles of publicity and transparency, creating unity in compliance with legal regulations between the Fund management agency and medical examination and treatment facilities.
The current problems are mainly caused by inadequacies in mechanisms and policies, and some legal regulations are not synchronous and incomplete.
Faced with that reality, as an agency organizing and implementing social insurance and health insurance policies, Vietnam Social Insurance has proactively and promptly reported to the Ministry of Health, the Ministry of Finance and competent authorities for consideration and resolution to best ensure the rights of policy beneficiaries.
Regarding the reflection that some health facilities have not been paid for health insurance examination and treatment costs due to exceeding previous years' estimates as prescribed in Decree No. 75/2023/ND-CP dated October 19, 2023 of the Government and the Prime Minister's decisions to allocate annual estimates, Vietnam Social Insurance said that this is one of the problems in the policy mechanism that the Government has assigned the Ministry of Health to preside over and coordinate with relevant agencies to develop a Project to completely resolve outstanding health insurance examination and treatment costs from 2025 onwards, and submit to the Government in the third quarter of 2025.
In a serious and optional spirit, Vietnam Social Insurance is working with ministries and branches to urgently review, report and propose solutions to ensure feasibility, effectiveness and compliance with legal regulations.
Vietnam Social Insurance affirms that in all cases, the rights of health insurance participants are always guaranteed in accordance with the provisions of law.
At the same time, Vietnam Social Insurance will continue to proactively coordinate closely with relevant agencies to remove difficulties, handle obstacles, ensure the harmony of patients' rights, maintain stable operations of medical facilities and maintain the sustainability of the Health Insurance Fund.
Previously, the Ministry of Health sent a document to Vietnam Social Insurance (VSS) regarding the payment of health insurance (HI) medical examination and treatment costs exceeding the estimate and not yet recovering the cost of technical services performed on medical equipment that has not been fully established and owned by the entire population before March 4, 2023.
According to the Ministry of Health, the Ho Chi Minh City Department of Health has repeatedly made recommendations about this situation of late payment. In 2023, health insurance medical facilities in Ho Chi Minh City will have costs exceeding the estimate of 557.5 billion VND; this figure in 2024 is expected to be about 1,950 billion VND.
Ho Chi Minh City Social Insurance has appraised, appraised and sent to Vietnam Social Insurance, and is at the same time recovering costs for technical services performed on medical equipment that have not completed procedures to establish public ownership.
The Ministry of Health said that the failure to pay and the prolonged waiting time for payment for costs exceeding the estimate has caused many facilities to face difficulties in funding sources, an imbalance in revenue and expenditure, outstanding medical supplies from businesses and directly affecting the rights of health insurance participants.
With the costs of implementing on medical equipment that have not been fully established and owned by the entire people, the Ministry of Health has issued an official dispatch requesting Vietnam Social Insurance to temporarily suspend the collection until a decision is made by the Government. The Ministry is also synthesizing and reporting to the Government on this issue.
Regarding costs exceeding the 2023 estimate, the Ministry of Health requested that Vietnam Social Insurance urgently report to the Ministry of Finance for submission to the Government for approval, in order to promptly pay to medical examination and treatment facilities, including Ho Chi Minh City. With the expected increase in 2024, the Ministry requires compliance with the provisions of the Law on Health Insurance and related decrees.
The Ministry of Health also emphasized that Vietnam Social Insurance needs to direct provincial and municipal Social Insurance to advance health insurance examination and treatment costs according to the rate and number of advance payments prescribed in Article 32 of the Law on Health Insurance, in order to ensure funding to serve people and maintain medical examination and treatment activities.
