A patient in Ca Mau was prescribed 18–19 diagnostic imaging tests during one outpatient visit, according to a report by the provincial social insurance authority. Healthcare costs claimed under compulsory health insurance are rising faster than the number of visits.
A report signed by the Ca Mau social insurance authority on October 14 said some healthcare facilities were not using test and imaging results efficiently. Facilities sometimes repeat the same services because they do not recognize or check results from earlier examinations, forcing patients to start the process again.
Many tests in one visit
The report recorded a case in which one patient received 18–19 laboratory and diagnostic imaging services during a single outpatient visit.
During the first nine months of 2026, the province recorded 4,706,447 health insurance treatment visits, up 2.46% from the same period in 2025. Total costs submitted for insurance payment exceeded VND 2,539 billion, an increase of VND 434.5 billion, or 20.65%.
Outpatient care accounted for 4,420,196 visits and VND 1,423 billion in costs. Inpatient treatment accounted for 286,251 visits and more than VND 1,116 billion. After nine months, the costs submitted by facilities had reached 93.57% of the annual estimate.
The Ca Mau social insurance authority said facilities were not controlling costs effectively. Broad use of tests and imaging at private facilities has declined less than required, while it has tended to increase at public facilities. The share of inpatient treatment is rising, and the average length of stay remains high.
The authority also said there are no specific criteria for deciding whether high costs are unreasonable or whether a test is inappropriate or unnecessary. Reviewers have limited capacity, while some facilities provide general explanations after receiving warnings.
Estimated budget overrun of VND 787.5 billion
For 2026, Ca Mau was assigned a total health insurance treatment budget of VND 2,734.5 billion, including VND 2,713.6 billion for healthcare facilities.
Assuming fourth-quarter spending matches third-quarter spending, the authority estimates that costs submitted by facilities for the full year will reach about VND 3,501 billion. That would exceed the budget by VND 787.5 billion, or 29.02%.
The authority said the rise in costs also has objective causes. By September 30, all 64 communes and wards in the province had been recognized as safe zones. The number of health insurance participants reached 2,103,122, up by 198,791 from the end of 2025. Coverage rising from 80% to 100% for residents of safe zones also increased payments from the insurance fund.
Other factors included changes in service prices, the promotion of five public hospitals from level 3 to level 2, expanded specialties, new techniques, higher wages, changes in the disease profile, and the use of centralized medicine procurement results for 2026–2027.
The province currently has 130 facilities under health insurance treatment contracts, including 92 public and 38 private facilities. During the first nine months, eight facilities signed contracts for the first time, including two specialized hospitals and six general clinics.
Costs for Ca Mau residents treated outside the province also rose. There were 469,805 such visits during the first nine months, up 36.28% year on year. Costs reached VND 941.9 billion, up 35.06%.
When revenue and spending are balanced by source, the authority estimates the treatment fund at facilities at VND 2,343.4 billion. Total provincial spending, including primary care, patients arriving from other provinces and Ca Mau residents treated elsewhere, is estimated at VND 4,566.3 billion. The difference between revenue and spending on this basis is expected to be about VND 2,223 billion.
The authority said it would temporarily withhold payment for inpatient bed days recorded in the third quarter if the health department does not coordinate an adjustment and bring the bed count in settlement data into line with operating licenses before the accounts are finalized. It will also continue reviewing and refusing payment for costs incurred on holidays and Tet in breach of regulations.
The authority recommended more regular and surprise inspections, focusing on private facilities with rapidly rising costs, as well as criteria for identifying unusual spending and solutions to problems in review and payment. Forecast spending will be adjusted after notification from Vietnam Social Security, while preserving healthcare operations and the rights of participants.
For the last three months of 2026, the Ca Mau social insurance authority asked the health department to invite facilities with high indicators to direct meetings. They are expected to correct prescriptions for tests, imaging, hospital admissions and treatment duration so they match diagnoses and patients' conditions.
Sources: Thanh Niên
