However, the regulation has been amended and the ceiling expenditure has been removed, according to Tran Van Thuan, Deputy Minister of Health.

The conference on deploying the government’s Decree 75, which amends and supplements some articles of Decree 146/2018 guiding the implementation of the Health Insurance Law, was held on November 16.

At the event, many clinical facilities and health departments complained that they have not got payment from health insurance agency for medical examination and treatment services given to insured patients because the old regulation is still applied.

Binh Dinh Health Department reported that the unpaid amount in the locality is VND42 billion, while the figures are VND10 billion in Can Tho and VND57 billion in Hue.

The problems in the regulation on the ceiling payment for medical services to insured patients have led to late final settlements. Because of this, hospitals are slow in making payments for medical materials and drugs, thus affecting their medical examination activities.

Le Van Phuc, head of the division on implementing health insurance policy under the Vietnam Social Security (VSS), said the estimated amount of money VSS has not paid is roughly VND7 trillion for 2019-2022.

According to Phuc, except for 2021, when Resolution 144 was implemented, VSS made payment for the excessive spending. For the three remaining years (2019, 2020 and 2022), VSS has requested local VSS departments to check documents in order to make payment to medical facilities.

“We have urged local agencies to complete their work, and we try to make payments in accordance with Decree 75 within 2023,” he said.

According to Phuc, Decree 75 changes the payment method for medical examination and treatment services with health insurance. Instead of setting the ceiling payment, VSS will pay based on the real prices of products and services used by medical facilities.

The ceiling total payment is understood as the maximum amount of money the health insurance fund will pay for services provided by medical facilities to insured patients within one year. The limits are set after considering the expenditure of the previous year and the possible increases/decreases of the next year.

When implementing the old regulation, the amount of money paid by health insurance fund was always lower than the real expenses that medical facilities had to pay because of increasingly high demand for medical services.

With Decree 75 taking effect, all the real expenses spent by medical facilities to treat insured patients will be reimbursed in full by VSS.

Linh Trang