HCM CITY — An independent council for professional assessment of health care techniques, medicine and clinical records should be established to determine which payments can be covered by the health insurance fund, experts have recommended.

The assessors currently working for Việt Nam Social Insurance do not have sufficient qualifications, doctors said at a meeting held on Monday in HCM City.

“Few assessors are doctors,” said Dr Nguyễn Đắc Lực, head of Y Đức General Health Clinic, in Đồng Nai Province’s Biên Hòa City.

Many of the assessors are accountants or graduates of two-year pharmaceutical training courses, and lack expertise to determine which techniques and medicines are proper for patient treatment, Lực said.

Many of them claim that clinic doctors write unnecessary prescriptions and treatments which should not be covered by the heath insurance fund.

“These decisions cause severe harm to doctors’ self-respect,” Lực said.

Nguyễn Duy Bách, chairman of board at ITO Hospital Sài Gòn-Đồng Nai, said that because of these decisions, hospitals would be responsible to pay back to the social insurance agency the expenses for prescriptions and treatment that are not covered by the health insurance fund.

Bách said that assessors’ reasons for nonpayment were unsatisfactory.

Phan Ngọc Hùng, director of An Phước Hospital in Bình Thuận Province, said the health insurance fund refuses to pay for testing to identify the blood type of pregnant woman going into labour at the hospital.

The reason cited is that the woman is not having a Caesarean and does not need blood transfusions.

Blood-type identification tests have to be done for any pregnant woman going into labour, he said, adding that it was necessary for the woman’s safety.

Dr Trần Đình Tuấn, deputy head of Tây Nguyên Eyes Hospital in Đắk Lắk Province, suggested that the Việt Nam Social Insurance develop clear guidance for health facilities and what should or should not be covered by payments from the fund.

Nguyễn Văn Đệ, chairman of the Việt Nam Private Hospitals Association, said that online assessment for health insurance payments was now being carried out.

Đệ suggested that Việt Nam Social Insurance’s assessors reduce the number of visits to health facilities for unnecessary assessments.

Nguyễn Minh Thảo, deputy general director of the Việt Nam Social Insurance, said there were more than 3,000 assessors. Only 1,000 of them are health officials.

Private hospitals should have updated legal documents about health insurance payments, he said, adding that Việt Nam Social Insurance is co-operating with Việt Nam Private Hospitals Association to update these documents.

Đệ of the Việt Nam Private Hospitals Association said the Việt Nam Social Insurance should apply the same health insurance coverage in both provinces and cities and that policies should be fair and equal among public and private health facilities.

Thảo said there was no difference in policies between public or private facilities.

As of the first quarter of the year, the country has 444 private health facilities providing exams and treatments covered under insurance, an increase from 418 last year, according to a report from Việt Nam Social Insurance. — VNS