CÁC NGUYÊN NHÂN BỊ CƠ QUAN BẢO HIỂM XÃ HỘI THÀNH PHỐ HÀ NỘI TỪ CHỐI THANH QUYẾT TOÁN CHI PHÍ KHÁM BỆNH, CHỮA BỆNH BẢO HIỂM Y TẾ TẠI BỆNH VIỆN TRUNG ƯƠNG QUÂN ĐỘI 108, GIAI ĐOẠN 2021-2023

Abstract

Objective: To describe the reasons for the rejection of medical examination and treatment (KCB) reimbursement by the Social Insurance Agency of Hanoi for health insurance (BHYT) at the Military Central Hospital 108 (TWQĐ 108) during the period of 2021-2023. Research Method: A retrospective analysis of quantitative data from summary reports and medical treatment reimbursement records at the TWQĐ 108 during 2021-2023. Results and Recommendations: The total KCB expenses approved for reimbursement by the Social Insurance Agency of Hanoi reached 99.7% in 2021 and 2022, and 99.6% in 2023. Reasons for rejection by the social insurance agency include categories related to medical indications, statistical issues, and information technology. We recommend that the hospital conduct further studies on the advantages and challenges in health insurance reimbursement processes to gain a more comprehensive understanding, facilitating more effective management.