Health insurance fund in deficit

Le Van Phuc, Deputy Director of VSI’s Department for Health Insurance Policy, said that health insurance spending in the first eight months of this year has reached over VND50 trillion (US$2.17 billion), accounting for 70% of this year’s planned allocation.

As many as 51 provinces and cities have overspent the fund. Some provinces such as Nghe An, Thanh Hoa, Thai Binh and Quang Nam, and Da Nang city overspent from VND500 billion (US$21.7 million) to VND1 trillion (US$43.4 million).

Quang Nam and Quang Trị reportedly used up 90% of the year’s allocation.

“If the overspending continues, the health insurance fund can only afford 2018 and 2019,” Phuc said.

Only two southern provinces – Dong Nai and Binh Duong and two cities - Hanoi and HCM City - are able to balance the fund.

These localities have a high number of health insurance card holders and have effectively utilised the fund, Phuc said.

VSI also estimated that the reserve fund to balance the health insurance fund will be exhausted by 2020.

It blamed the overspending for abuse by both health care organisations and patients aiming to siphon money.

Phuc said that some health care facilities ask patients to conduct unnecessary medical tests. Others have increased hospital fees by over 40% by adding more beds to allow unnecessary hospitalisations.

In Ha Tinh province, health care quality at some hospital departments is not ensured. They mobilise far fewer medical workers per bed than the standard of one worker per bed. Doctors still prescribe high-cost drugs instead of cheaper relevant ones.

According to VSI, health insurance overspending has also been blamed for increasing health care service prices, and a health insurance policy that came into effect early last year. 

People with health insurance cards at the district level can get health check-ups or treatment at any health facility they want within their own district without the requirement of showing referral papers as before. 

Many people have taken advantage of this new regulation to go to health care facilities many times for check-ups and to get free drugs.

According to Dam Hieu Trung, deputy director of VSI’s centre of health insurance assessment and multi-level payment in the northern region, in the first seven months of this year, there were over 91 million check-ups of health insurance card holders with total payment of nearly VND46.7 trillion (US$2.03 billion).

As many as 31 provinces have increased health examination and treatment spending by over 40% compared to the same period of 2016. Some provinces such as Kon Tum, Lang Son, Khanh Hoa provinces have increased the allocation by over 70%, he said.

Using its the supervision system, VSI discovered 1,580 patients having check-ups eight or more times in July.

For example, patient Tien Van B had 132 check-ups at seven health care facilities in the first eight months of the year. The total health insurance payment added up to more than VND30.3 million (US$1,317).

Phuc from the Department for Health Insurance Policy said that penalties imposed on health insurance fund abuse have not been strict. Except for criminal punishment for some cases, in some other cases, disallowed expenditure deductions are applied.

Trung said that VSI has asked provinces and cities to assess abusive actions, revoke illegal spending and publicise this information on local web portals.