HÀ NỘI — Health insurance funds for medical check-ups and treatment have been misused, becoming a “nightmare” with spending that exceeds State limits, a health official has told local media.

In the first half of this year, more than VNĐ30 trillion (US$1.3 billion) was spent, a 40 per cent increase over the same period last year and greatly exceeding this year’s budget of about VNĐ2.1 trillion ($93.3million). This amount has climbed to nearly VNĐ3trillion ($133.3million) as of July 18, Phạm Lương Sơn, deputy general director of Việt Nam’s Social Insurance said.

Sơn attributed the overspending to the number of health insurance cardholders increasing 12 per cent in the period. However, the main problem was health insurance cardholders and health facilities trying to make money from the fund, he said.

“The abuse of health insurance funds is happening in many places, at different levels and becoming more sophisticated,” Sơn said.

Some medical facilities take advantage of loopholes in policies or shortages of human resources, supervising measures to abuse the fund, he added.

New regulations state that patients can freely choose medical facilities at district level to have medical examinations while enjoying similar benefits at any facility. This change has led to the fact that many cardholders go to different facilities for health check-ups several times in one day.

Statistics from Việt Nam’s Social Insurance showed that in July, some cardholders had medical check-ups 27 times per month.

These fraudsters can get prescriptions worth VNĐ200,000 ($9) at each facility they have the check-ups and then sell them to pharmacies for profit.

Commercialised health services

Sơn also pointed out that the unnecessary use of CT Scanners, MRIs or expensive medicine prescribed by doctors contributed to the problem.

The total spending on testing, ultrasound, and endoscopic exams can reach VNĐ4 billion ($178,000) each month on average, Việt Nam’s Social Insurance revealed. 

Việt Nam’s Social Insurance will figure out the tests were for diagnosis or only for regular health-check-ups, Sơn said.

Representatives from private hospitals also contact local women’s associations and veterans’ associations to get residents to go for health-check-ups or offer discount programmes for second time check-ups as promotional measures to increase health check-ups demand and multiple spending from the fund.

Another surprising figure is the surge of expense of distilled water test-tubes in 2014-2015. Many hospitals have switched from using glass distilled water test-tubes to plastic ones, increasing the spending on the tubes by VNĐ15 billion ($667,000).

This money could be used for health insurance for the poor, patients with cancer, cardiac diseases, tuberculosis or HIV and save thousands of sick people, Sơn said.

If the spending exceeds 30 per cent of allocated funds, health insurance funds are unable to fill the deficiency, Sơn said.

He said that tightening the fund in the final months of the year is the key task of Việt Nam’s Social Insurance. Social insurance agencies of localities must analyse fee increases in health check-ups and treatment and co-operate with local departments and sectors to take better control of the fund.

Sơn said that consistent denial of payment must be applied for medical facilities misusing health insurance funds. For example, this year, Phương Nam Clinic in southern Cà Mau Province was denied health insurance check-ups and treatment payment of VNĐ71 billion ($3.1million) due to alleged abuse of spending. — VNS