Phân tích một số nguyên nhân từ chối thanh toán chi phí khám bệnh, chữa bệnh bảo hiểm y tế tại Trung tâm Y tế huyện Phú Giáo, tỉnh Bình Dương

Abstract

Objective: To identify some reasons for the refusal of payment for medical examination and treatment costs of covered healthcare insurance for at Phu Giao District Medical Center, Binh Duong province in 2022. Subject and method: Data were collected by retrospectives method on records and documents at this medical center from January 1, 2022 to December 31, 2022. Result: The results showed that a total of 2,927 records with VND 175,145,866 were refused payment under health insurance. There are 4 main groups of reasons leading to refusal to payment medical examination and treatment costs under health insurance. Of which, the cause of errors due to not updating documents and regulations has the highest total cost of rejected payments (61.55%) and is the most common with 2,215 records (75.67%). The group of causes due to professional errors of medical practitioners has the lowest number of records (2.87%) and the lowest cost of rejection (1.41%). Conclusion: The most common cause of errors is not updating or inappropriately applying documents and regulations, leading to denial of health insurance payments. Next are administrative procedure errors in the reception department; errors in standardizing data on the electronic information portal and professional errors of medical practitioners.