Abuse of health insurance fund continues

A number of hospitals around the country were reported to have abused the health insurance fund. - Photo anninhthudo

According to data from the health insurance information system, there were as many as 83.8 million check-ups of health insurance card holders with total payment of VND46.9 trillion (US$2.23 billion).

Some provinces were reported to have overspent from the fund. Quang Ninh, Khanh Hoa, Tien Giang, Dong Thap and Bac Lieu provinces reportedly used over 56 per cent of the year’s allocation, Thanh tra (Inspectorate) online newspaper reported.

In the first half of 2018, the health insurance fund has paid for thousands of patients with high costs. Nearly 4,700 patients were paid between VND200 to VND300 million.

In particular, some patients with blood diseases treated at the National Institute of Hematology and Blood Transfusion, National Paediatrics Hospital had been paid VND2.8 billion by the health insurance fund, of which drugs for special treatment costs VND2.7 billion.

Apart from some special cases, the data showed abnormal trends in health insurance participation in many hospitals, mostly in appendicitis treatment, said Dam Hieu Trung, deputy director of VSI’s centre of health insurance assessment and multi-level payment in the northern region.

Over the last six months, the General Hospital in Vinh Phuc Province recorded 371 cases of peritoneal appendicitis, while 147 cases were recorded at Bắc Giang Province’s Luc Ngan General Hospital and 86 cases at the general hospital in Krong Pac District of Dak Lak Province.

"These are abnormal numbers in the treatment of this disease," he said.

VSI checked medical records of these facilities and found all examined patients in general hospitals in Dak Lak, Binh Duong, and Bắc Giang provinces did not suffer peritoneal appendicitis and several cases were also discovered in other hospitals.

Trung said peritoneal appendicitis is a complication when the patient suffers from appendicitis but is hospitalised late.

The cost of surgery for appendicitis is only VND1.4 million, while peritoneal appendicitis costs double.

Thus, for each case of peritoneal appendicitis, the facility will ‘seek benefits’ of about VND1.4 million from the health insurance fund. After inspection, VSI refused to pay for such cases, he said.

Health insurance abuse was becoming more widespread, increasing the cost of medical service and having a negative impact on the health insurance fund, said Trung.

He said some healthcare facilities advised patients to conduct unnecessary medical tests. Others have increased hospital fees by adding more beds to allow unnecessary hospitalisations.