Tác động của chính sách “thông tuyến” huyện trong khám chữa bệnh bảo hiểm y tế

Abstract

The Law on Health Insurance expands the right to choose a place of medical examination and treatment for participants of Health Insurance (HI) through the policy of bypassing the district from January 1, 2016. The study was carried out with the objective of describing the impact of the policy of “bypass” under the provisions of the Law on Health Insurance on the use of the health insurance fund. The study analyzed available data from the claim review information system managed by the social insurance agency from 2014 to 2021. The research results show that the policy of “bypass” at the district level has the following impacts: 1) Increased the number and cost of health care services at the district level, while decreased at the commune level; 2) Private health facilities degraded to class III and at the same time have other forms of promotion to attract patients and increase revenue); some patients went for medical examination and treatment many times; 3) The design of capitation payment had to be adjusted to be consistent with the regulation of "Bypass" which is the allocation of fixed funds according to the number of visits at the health facility. The district's "Bypass" policy makes it easier for people to access health services but may affect the efficiency of using the health insurance fund.