Strong Effects from Administrative Procedure Reforms

10:31:30 AM | 13/8/2019

According to the biannual report on implementation of the National Assembly's Resolution 68/2013/QH13 on accelerated implementation of health insurance laws and policies towards universal health insurance, in 2018 - 2019, the social insurance sector has fostered information technology applications and carried out many solutions to simplify processes, procedures and records to facilitate people and organizations to perform health insurance transactions.

On administrative procedure reform, the social insurance sector has abolished and reduced many related administrative procedures. Specifically, it has eliminated some dossier components, and application and confirmation letters. Some procedures now only need regulations on declaration forms and lists. Employers only need to make initial declarations and change information in case of necessity. Until now, administrative procedures concerning ​​health insurance policy settlement have been reduced to four.

In addition, to provide favorable conditions for organizations and individuals, the Vietnam Social Security (VSS) actively reduced the time of implementing administrative procedures and issuing health insurance policies. Accordingly, the Law on Health Insurance 2008 stipulated that the time limit for issuing health insurance policies is 10 days and VSS brought it to five days. The Law on Amendments and Supplements to the Law on Health Insurance 2014 specified a 7-day time limit for issuing health insurance policies and VSS takes only three days and one day for emergencies, job change or information update.

Besides, the social insurance industry has diversified forms of receiving and returning administrative procedures. Currently, the Vietnam Social Security receives applications and delivers results in three forms: electronic transactions, postal services and single-window department.

On electronic transactions, VSS submitted to the Prime Minister for issuance of Decision 08/2015/QD-TTg dated March 9, 2015 on electronic transactions in the field of collecting social insurance, health insurance, unemployment insurance premiums and granting social insurance cards and health insurance cards. By using this method, applicants will not have to spend time traveling and waiting for health insurance registration at social insurance agencies. Since March 1, 2017, the social insurance branch has deployed electronic transactions in all fields: Collecting and issuing health insurance cards; solving and paying health insurance for both organizations and individuals.

On IT application to health insurance policy, the sector continued to digitize to improve management quality and efficiency as well as transparency for people and businesses.

In 2018 - 2019, the social insurance sector has continued to complete the Health Insurance Assessment Information System and coordinate with the health sector to standardize the list of items used at more than 12,000 medical facilities, synchronize data to the Health Insurance Assessment Information System, train more than 2,000 assessors and hundreds of health workers, and improve the effectiveness of health insurance assessment, management and use of health insurance funds.

Specifically, the Gateway Software allows receiving and exchanging information between medical facilities and social insurance agencies, providing search tools, managing inter-level treatment and hospital transfers, checking health insurance cards, informing assessment results, providing healthcare monitoring utilities in medical examination and treatment in health facilities and health insurance payment statistics. Especially, health facilities can cross-check test results delivered by other units, access historical medical records and treatment results of insured patients, avoid duplicated indications to save costs and improve treatment effectiveness.

VSS has deployed a “Multimedia interaction system for people and businesses with social insurance agencies" from April 2019 to support messaging insurance payment to insured people in case of medical examination and treatment or notifying insured households of policy expiration 30 days prior to the expiry date.

The Assessment Software is developed according to VSS health insurance inspection procedures with over 10 operations, with 100% of payment requests electronically inspected and over 200 rules integrated to detect record duplications, wrong benefit levels, wrong lists and wrong prices.

The software provides charts and maps for monitoring medical examination and use of funds nationwide. Visual maps help analyze, evaluate and quickly detect abnormal changes, increase medical examinations and treatments, and pay insured medical examinations and treatments in each province and health facilities at each level. In particular, epidemiological maps help monitor and assess disease developments, prevalence and incidence of chronic and acute diseases - an important source of information to monitor epidemics and actively prevent diseases.

By the end of June 2019, about 84.74 million people held health insurance policies nationwide, reaching 89.3% of the population, 1.2% higher than the target assigned by the Prime Minister in Decision 1167/QD-TTg.

In 2018, the Health Insurance Assessment Information System received and assessed 176.5 million electronic records and VND98,116 billion claimed for health insurance payment. Data interconnectivity reached 95.12% and was available in 12,132 medical facilities. In the first five months of 2019, the system got and inspected 72.2 million electronic records and VND40,438 billion claimed for health insurance payment.

Currently, the system has been further developed and updated with assessment rules to improve the quality and effectiveness of managing and using the health insurance fund. The Vietnam Social Security completed its tasks assigned by the National Assembly that “By the end of 2018, VSS will complete interconnecting the communication technology software system between social insurance agencies and hospitals to improve administrative procedures in medical examination and treatment, improve the effectiveness of health insurance assessment and health insurance fund management and use.”