HA NOI — Social insurance inspectors have detected questionable practices at most medical units in 13 examined provinces and cities, which often involved the abuse of health insurance funds.
Bui Thi Coi, an 82-year-old woman, living in the northern mid-land Phu Tho Province went to the Phu Tho General Hospital after experiencing chest pains in connection with her lung cancer.
Coi had 15 ultrasounds, six electrocardiogrammes, five biochemical tests and two CT scans during eight courses of treatment from June 2010 to May 2011.
Coi was a typical case of a patient being unnecessarily and wastefully tested in a hospital, according to the inspectors, who added that tests were repeated even after consistently producing the same results.
She also was a victim of medical abuse because the cost of the tests took money from her pocket and from Viet Nam's health insurance fund.
The provincial social insurance agency also found another patient who underwent 10 HIV tests last year, which the inspector said was unnecessary.
The hospital recorded performing 20,000 HIV tests last year. Each HIV test costs US$2.5 for the normal method and between $5-7.5 for the modern method.
An anonymous officer of the agency told Tien Phong (Vanguard) newspaper that a hospital collected VND80,000 ($4) for each ultrasound scan, even though the hospital's only costs were the electricity bill and a small amount of chemical gel.
Based on prescription and clinical records, patients have to pay between 5-20 per cent of treatment fees and the rest is paid by the health insurance fund.
The wasted money from testing activities generates hundreds of thousands of dollars each year for hospitals throughout the country, according to the officer.
The Viet Nam Social Insurance Agency has also found rampant abuse of diagnostic imaging and testing services.
The agency has requested that hospitals reimburse their patients' money and has refused to pay for exorbitant medical bills. The total amount extorted from the health insurance fund is more than VND58 billion ($2.76 million), said the agency's Health Insurance Policy Implementation Department Director Pham Luong Son.
"Phu Tho ranks first among list of eight provinces nationwide plagued by health insurance fund overspending in 2011," he added.
Son said the agency rec-ently refused to pay VND30 billion ($1.4million) in health insurance premiums after an examination of the Phu Tho health insurance fund in 2011.
The maximum fine for technical services abuses is VND40 million (US$1,950).
"Current sanctions and punishments for violations are not strong enough to prevent medical units from engaging in unethical practices," said Son.
The agency said it would change assessment methods to strengthen the health insurance system.
A draft plan on insurance assessment has been submitted to the Prime Minister for approval, which would attempt to minimise overspending and violations in health insurance payments. The plan produced positive results when a pilot programme was implemented in HCM City last year, according to the agency. — VNS