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Benefits of prevention are undoubted – more than half a million euro of damages avoided
Consultations provided by the health insurance fund specialists to the contract partners – medical institutions, pharmacies, orthopaedic companies, as well as the monitoring of statistical data obtained through the Sveidra information system last year allowed the Compulsory Health Insurance Fund (CHIF) to avoid 602 thousand euro of damages. This is 85% more than the actual damage found, which amounted to 325 thousand euro.
The patient funds responsible for the use of compulsory health insurance (CHI) contributions for all Lithuanian residents are constantly paying close attention to overseeing the activities of contractual partners. In recent years, the enhanced monitoring of data provided by treatment institutions through Sveidra information system, has prevented real damage to the CHIF budget. In 2019, the amount of damage avoided in CHIF exceeded the actual damage found in almost all areas of operation of local health insurance funds (HIFs).
Last year, specialists of the National Health Insurance Fund under the Ministry of Health (NHIF) and (HIF) inspected more than 1.1 million statistical personal treatment record cards submitted by medical institutions through the Sveidra system. It is under these cards that institutions are paid from the CHIF for the services provided to the population covered by personal health insurance. As a result of this inspection, after consulting with experts of the health insurance funds, medical institutions corrected the records in almost 33 thousand statistical personal treatment record cards. By making these adjustments in time, the CHIF avoided 602 thousand euro in the loss. In fact, the amount of damage determined last year, which enterprises ought to repay, amounted to 325 thousand euro, 13 thousand more than in 2018.
Last year, compared to 2018, higher damage was found during the assessment of the provision of specialist outpatient services (from 112.6 thousand euro to 146.7 thousand euro), prescriptions and adaptation of orthopaedic supplies (from 2 thousand euro to 45.6 thousand euro), reimbursement of medicines and medical aids, and its justification (from 17.3 thousand euro to 26.4 thousand euro), provision of nursing and supportive care and palliative care services (from 8.1 thousand euro to 26 thousand euro). Last year, less damage was found in the provision of inpatient active treatment services (from 61.8 thousand euro to 0.87 thousand euro), as well as day and outpatient surgery, monitoring and admission-emergency services (from 71.7 thousand euro to 56.6 thousand euro).
"Undoubtedly, the priority of patient funds is not to punish, but to consult in order to improve the performance of institutions and companies that have concluded agreements with health insurance funds. We always welcome doctors, pharmacists, other stakeholders to consult with our specialists on any issues of concern. Consultations are provided by phone, in writing, by e-mail, announcements are published on the websites of the state and local patient funds, presentations are held during various events. These are preventive measures that help to reduce the misuse of health insurance funds, ensure a successful dialogue between experts and inspectors," says Viačeslavas Zaksas, deputy director of the NHIF.
As he stated, specialists of health insurance funds alone, when interpreting the provisions of legal acts governing the procedure of health care services, reimbursing their costs with the CHIF funds, the procedures for reimbursement of the costs of prescriptions, issuing or purchasing compensatory medicinal products, encoding of inpatient and day surgery services and completion of medical records, and other issues, have provided over 190 000 consultations to institutions and businesses.
In 2019, a total of 663 inspections were performed in medical institutions, pharmacies and orthopaedic equipment companies, of which 520 were planned and announced in advance.
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Benefits of prevention are undoubted – more than half a million euro of damages avoided