Vietnam’s Social Security has urged social insurance agencies to avoid misuse of health insurance funds intended for medical check-ups and treatment.

People pay hospital fees with health insurance at the General Hospital in Quang Ninh Province. Health insurance funds have been misused.

Unreasonable costs in the management of funds should be eliminated to ensure the fund is used effectively, Nguyen Thi Minh, director general of Viet Nam Social Security, said at a recent online conference of social insurance agencies in various cities and provinces.

By the end of August, the country had used 82 per cent of its total health insurance fund, Lê Văn Phúc, deputy director of the Health Insurance Implementation Department, said.

Eight provinces used the funds to an extent that exceeded State limits, he said.

"Widespread fraud by both healthcare institutions and patients have drained the health insurance funds, and the tricks are becoming more sophisticated and difficult to detect," Phúc said.

The social insurance agency discovered a range of violations, such as health insurance card abuse, requests for multiple payments for one-time check-ups or requests to pay for medicines and medical services that are not covered by the agency.

Clinics persisted in selecting, purchasing and using drugs and medical supplies that were not cost-effective, the Tiền phong (Vanguard) newspaper reported.

The agency has also denied payment for many drugs, technical services and medical supplies that are priced higher than the Government-approved prices for medical facilities.

According to Phúc, the cities and localities should focus more on analysing fee increases for health check-ups and treatment and on co-operating with local departments and sectors to take better control of the fund.

In the first six months of 2017, the social insurance sector recovered over VNĐ60 billion (US$2.6 million) from unregulated spending, said Tran Duc Long, director of the Inspection Department.

However, inspectors continue to face difficulties in dealing with violators who do not voluntarily pay the penalty, while the authority of social insurance agencies is not clearly defined in legal documents, he said.

Many violations have not been investigated or handled in time due to a lack of human resources, Long said.

To partially remove difficulties in the management of health insurance funds and to ensure the right and proper benefits for people, Pham Luong Son, deputy director general of Việt Nam Social Security, said the localities should pay more attention to drug procurement through bids.

Abusive behaviour and profiting off health insurance funds must be handled strictly, Son said. 

VNS