Hanoi (VNA) - A newreport reveals that widespread frauds by both healthcare institutions andpatients have cost health insurance funds some 3 trillion VND (132 million USD)in the first four months of the year.

The report, released by Vietnam Social Security (VSS), lists some of the maintricks used by both healthcare institutions and patients to siphon money fromnational and local health insurance funds.

Duong Tuan Duc, Director of the Northern Centre for Health Insurance Review andAssessment, said that in the first four months of 2017, around 2,800 patientshad more than 50 health examinations, with quite a few of these people havingchecks more than 120 times.
In particular, 195 patients who had health checks in four different healthfacilities piled up a whopping 7.7 billion VND (338,600 USD) tab, Duc said.

Health care institutions were making up patients’ names for dispensing drugsand over-prescribing the use of hi-tech equipment like CT scanners, he added.

Nguyen Thi Yen, Deputy Director of the Department of Pharmacology and MedicalEquipment under the VSS, said that a rapid survey of 31 provinces and citieshad detected a big discrepancy of 121 billion VND (5.32 million USD) in drugprocurement thorough bids and purchases in the open market.
  
Several senior officials have spoken about this issue.

Pham Le Tuan, Deputy Minister of Health, said the abuse of healthinsurance increased recently, negatively impacting the people, Health InsuranceFund and the Social Security Fund.

“I should say that nefarious practices have been resorted to by both peoplewith health insurance and the health care institutions.

“Many people have cheated by using other people’s health insurance cards. Someof them have even reused expired health insurance cards by erasing the date andothers have had health checks in many facilities during a short period of timeto get drugs and other medical necessities,” he said.

In several health care institutions, medical practitioners have forged falsemedical records to claim financial settlements from health insurance agencies.

To deter such practices, the Ministry of Health has asked all health carefacilities to improve transparency and accountability in providing theirservices.

“We have also introduced IT applications in our insurance reviews andassessments. The applications have helped us detect malpractices," hesaid.

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According to the VSS, as of March 2017, the percentage of health facilitiesnationwide having their data connected with the VSS was just about 74 percent,making it hard to verify the accuracy of claims.

Bui Sy Loi, Vice Chairman of the National Assembly Committee on Social Affairs,said health insurance was a good way for all people to access health care.

“It is undeniable that health insurance has brought about a lot of benefits forthe people,” he said.

He also said that since the introduction of IT in all health care facilitiesnation-wide, concerned authorities have been able to track the flow of patientsas well as drugs described.

However, it is also true that many patients and health care facilities havetaken advantages of the imperfect present system to make profits forthemselves, Loi said.

“The MoF should take a close look at what has happened in the financialsettlement for patients using health insurance cards to see if there are anyloopholes or abnormalities in doctors’ prescriptions.

Meanwhile, the VSS has to closely watch and monitor the process to ensure thatfunds are used properly.”

Pham Khanh Phong Lan, National Assembly deputy from Ho Chi Minh City, saidthe Ministry of Health had not done well as a bridge between the VSS andthe hospitals.

She said a major part of the problem was that people participating in healthinsurance schemes made modest contributions, but wanted to extract much higherbenefits.

In addition, the health insurance management mechanism betweencentrally-managed cities and provinces was quite different. For example, Ho ChiMinh City, a centre for hi-tech applications and a place where serious casesfrom other localities are referred to, had an annual health insurance fund thatalways enjoyed surplus. This was attributed to efficient performance of themunicipal health insurance fund. In most localities, however, health insurancefunds were always in deficit.

“Another point I want to mention is the doctors’ drug descriptions. Thoughunder the Circular 11, the Ministry of Health, prohibit doctors fromprescribing brand name drugs for their patients, many doctors still do so. Thisis one of the reasons costing the insurance fund. Only in special cases shoulddoctors prescribe brand name drugs for their patients."-VNA