MỘT SỐ THUẬN LỢI, KHÓ KHĂN TRONG THANH QUYẾT TOÁN CHI PHÍ KHÁM CHỮA BỆNH BẢO HIỂM Y TẾ GIỮA BỆNH VIỆN ĐẠI HỌC Y DƯỢC THÀNH PHỐ HỒ CHÍ MINH VÀ CƠ QUAN BẢO HIỂM XÃ HỘI THÀNH PHỐ HỒ CHÍ MINH NĂM 2021 - 2022

Abstract

Objectives: Analyzing some advantages and disadvantages in settlement of medical expenses covered by health insurance between University Medical Center Ho Chi Minh City and Ho Chi Minh City Social Security Office in 2021-2022; Methodology: The cross-sectional study design using qualitative method with 05 in-depth interviews and 01 group discussion; Results and conclusion: The total cost of medical examination and treatment with health insurance at the hospital was enormous, reaching VND 885 billion in 2021, VND 1,281 billion in 2022. In the process of settlement of medical expenses covered by health insurance between University Medical Center Ho Chi Minh City and Ho Chi Minh City Social Security Office in 2021-2022, there were advantages such as the application of information technology in medical treatment management, the care from the Board of Directors. In addition, the hospital also faced difficulties in health insured expense payment policies, medical manpower, assessing health insured medical exammination and treatment expenses via health insurance data portal, hospital management and administration. Thus the hospital requires more self-inspection and systematic monitoring on health insured medical activies in accordance with the provisions of the law to minimize the lost of expenses expected to be covered by health insurance.