This has ignited intense debate. Many doctors expressed their fear that "over-prescribing" would lead to them having to "repay the money," while the pressure of treatment and the risk of missing pathologies are ever present.

Le Minh Hieu, deputy director of Ba Ria General Hospital, confirmed that the hospital required individual reimbursement, but only applies to cases of clear individual errors where staff were reminded and trained multiple times yet continued to repeat the mistakes.

According to Hieu, under the inspection and settlement report on health insurance-covered medical examination and treatment costs for the fourth quarter of 2025, the total amount rejected by the health insurance agency at the hospital exceeded VND900 million, while the amount recovered from individuals was only slightly over VND100 million. The remaining larger amount had to be paid by the hospital itself.

There are doctors whose prescriptions seldom result in rejected expenditures, but there are also those who continuously make errors despite repeated training and warnings. If the hospital must use collective revenue to compensate for those mistakes, the benefits and additional income of other staff will be affected. 

“This is also the consensus among staff who strictly comply with regulations to minimize disallowed costs. According to our research, many other medical facilities are also applying similar disciplinary measures,” said Hieu.

The issue of rejected expenditures is not new but is becoming increasingly tense and pressured as the assessment mechanism shifts heavily toward electronic data management.

Previously, assessments were mainly based on medical records and paper documents, often through random checks. The insurance agency and the hospital could directly cross-check each record when necessary.

Currently, all data is digitized and uploaded to the electronic assessment portal. The system automatically “filters for errors,” and the Social Insurance agency can perform thematic audits, then send the data lists back to the hospital for explanation.

The volume of data is enormous, reaching tens of thousands of records each quarter. With tight deadlines and a high volume of files, the hospital must mobilize significant human resources and time to review and justify costs, aiming to prove the necessity of expenditures and avoid "unfair" disallowed costs.

This has become one of the major pressures facing healthcare facilities.

Hieu stressed that the hospital has no regulations to restrict the prescription of sub-clinical services such as laboratory tests, diagnostic imaging, or treatment drugs for patients. At the same time, there is no policy to encourage widespread prescription or "abuse" of technical services to increase revenue.

However, the prescription of drugs and technical services must adhere to the principles of suitability, efficiency, and economy, ensuring correct professional indications and the best interests of the patient. This is also one of the solutions that helps the hospital control costs and avoid exceeding budget estimates, even in cases where the assessment process does not result in disallowed costs.

Doctors’ records

There is a saying among medical workers: “A good doctor is the one with the fewest disallowed costs.” According to Hieu, this partly reflects reality, both literally and figuratively.

In emergency situations, doctors always face difficult choices. If they do not prescribe full tests and sub-clinical procedures, they may miss dangerous lesions, compromising patient safety. Conversely, if they prescribe extensively to ensure a diagnosis, they risk having those prescriptions labeled as disallowed costs due to being deemed "unnecessary."

Medical staff are frequently reminded to focus on areas prone to rejected expenditures: incomplete medical records making it difficult to justify prescriptions; violations of contraindications or drug interactions; and prescribing technical services that do not follow the official protocol.

The hospital has established a Health Insurance Cost Monitoring Team, including a “pre-check” unit to review records before data is uploaded. This helps promptly detect errors and support explanations within the prescribed time.

However, because the number of records is enormous while human resources are limited, the most fundamental solution to limit disallowed costs is for each medical staff member to improve their professional capacity and master the legal regulations regarding HI payments.

Many cases requiring explanation or facing delayed payments stem from a lack of consistency in how regulations are understood between medical facilities and assessment agencies.

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