A new health insurance appraisal system will be operated on a pilot basis in five cities and two provinces from May to September this year.— Photo tapchitaichinh.vn
HÀ NỘI — A new health insurance appraisal system will be operated on a pilot basis in five cities and two provinces from May to September this year.
The information was revealed by deputy director of the Vietnam Social Security (VSS) Phạm Lương Sơn in a conference on health insurance held in Hà Nội.
The cities and provinces are Hà Nội, HCM City, Hải Phòng, Đà Nẵng, Cần Thơ, Nghệ An and Thanh Hóa.
Sơn said that the Law on Health Insurance regulated that social security agencies are responsible for appraising work and for appraisal results.
The appraisal results are the legal foundation for social security agencies to pay for medical examination and treatment expenses with health insurance. It is also the foundation to assess medical services’ quality and protect residents’ rights.
However, said Sơn, the number of people buying health insurance had greatly increased and their rights were growing larger, making appraisal work more difficult.
"A change in appraisal work is needed to inspect the health insurance fund," he said.
Since 2011, to meet changes in health insurance policies, which were regulated in the Law on Health Insurance 2008 and the amended Law on Health Insurance 2014, the Vietnam Social Security issued procedures to appraise health insurance in 2011 and 2015.
The problem, Sơn said, was while the number of health insurance documents waiting for payment had increased sharply, the VSS had not hired enough new workers to keep up.
For instance, about 130 million documents were awaiting payment in 2015 to the tune of of VNĐ50 trillion (US$2.2 billion). The number reached nearly 170 million documents and nearly VNĐ90 trillion ($3.9 billion) last year.
The VS estimated that to appraise 30 per cent of the total documents, each worker would have to work on about 63,000 documents per year.
To improve the difficulties, since the end of 2016, the VSS connected the data of all health insurance agencies and conducted electronic appraising nationwide, with some success.
With more than 80 million people buying health insurance and hundreds of millions of documents needing appraising every year, a safe, scientific and effective management system was really needed, said Sơn.
Thus after collecting ideas from experts from different localities, the new system was completed and would run as a trial from May to September. — VNS