Abstract
Objectives: Describe the results of reimbursement 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. The study was designed based on cross-sectional descriptive study method, using secondary data on health insurance payments. The total cost of medical examination and treatment with health insurance at the hospital was enormous, reaching 885 billion VND in 2021, 1,281 billion VND in 2022. The total comprehensive settled expenses with Social Insurance reached 99.96% in 2021 and 99.85% in 2022. In 2021, the rate of medical payment refusal in testings was the highest, accounting for 69.80%, followed by operations-procedures with 23.95% and medications accounting for 5,75%. In 2022, meditations refusal accounted for 63.70%, medical supplies for 19.33% and operations-procedures with 12.28%. In 2021-2022, the hospital did not exceed the total payment of medical expenses covered by health insurance. The causes of settlement refusals are drugs already included in surgery/procedure packages, mis-applying prices of technical services, inapproprate drug and testing prescriptions on medical records. The hospital need to invest strongly in information technology, effectively support medical staff in managing medical records, enhance inspections and reviews of drug and medical supply billing when performing surgery/procedure. Keywords: Settlement results, health insurance
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