New steps of the Ministry of Health in improving health insurance policy

Recently, the Ministry of Health has issued documents responding to voters' petitions after the 8th session of the 15th National Assembly, related to health insurance policy issues.

Recently, the Ministry of Health has issued documents responding to voters' petitions after the 8th session of the 15th National Assembly, related to health insurance policy issues.

These recommendations mainly revolve around issues such as updating the list of health insurance drugs, expanding the scope of health insurance payments, and supporting health insurance premiums for people in difficult circumstances.

The Party and State's health insurance policy aims to ensure people's rights, and the Ministry of Health will continue to research and adjust policies to better meet the health care needs of the community.

Voters in An Giang province have reported that the current list of health insurance drugs has not been updated promptly, especially for specific drugs for patients with underlying or incurable diseases.

Voters suggested that the health sector should pay attention to and add new, highly effective drugs to the health insurance list to meet people's medical examination and treatment needs.

Responding to this issue, Minister of Health Dao Hong Lan said that the Ministry of Health has issued Circular 37 dated November 16, 2024, stipulating the principles and criteria for developing and updating the list of health insurance drugs. The Ministry of Health is reviewing, amending and adding new drugs to the list, while removing drugs that are no longer suitable.

However, the addition of drugs, medical equipment, and technical services to the scope of health insurance benefits needs to be carefully considered to ensure the solvency of the Health Insurance Fund.

Voters in Binh Dinh province also proposed expanding the scope of health insurance payments for modern medical services such as magnetic resonance imaging, testing, and modern diagnostic and treatment methods.

According to voters, the current health insurance premium has increased, but the scope of payment is still limited, forcing people to pay large expenses themselves, especially low-income families.

Regarding this issue, the Ministry of Health said it had issued Circular 39 dated November 17, 2024, amending and supplementing a number of articles of Circular 35/2016, expanding payment conditions for a number of technical services, especially in cancer diagnosis and treatment, such as CT scans, tumor marker tests, and emergency blood filtration.

The Ministry of Health also emphasized that the continued expansion of payment scope must be based on the payment capacity of the Health Insurance Fund and the health insurance contribution level of the people.

One of the issues that voters in Tay Ninh province have reflected is that the health insurance premium increases according to the basic salary, but for low-income earners, workers without contracts, or housekeepers, participating in health insurance continuously becomes difficult.

To address this issue, the Minister of Health said the current health insurance premium is set at 4.5% of the base salary, pension, disability allowance, unemployment allowance, or base salary.

The Government has issued many support policies such as reducing health insurance premiums for groups such as meritorious people, the poor, the near-poor, ethnic minorities, and households with average living standards.

For those who do not receive salaries from the state budget, if they do not belong to the above groups, citizens can participate in family health insurance and enjoy a gradually decreasing contribution rate according to the number of people in the household.

The Ministry of Health also said that according to Decree No. 75/ND-CP in 2023, the Government has allowed localities to decide on higher health insurance contribution support levels for disadvantaged groups, such as workers without contracts or domestic workers and housewives.

In addition, the leader of the Ministry of Health affirmed that the current health insurance premium, although slightly increased, is still considered low compared to countries with similar socio-economic development conditions.

"We encourage people to actively participate in health insurance to ensure financial benefits when they encounter illness or disease," said the head of the health sector.

The Ministry of Health has been taking active measures to improve health insurance policies, from updating the drug list, expanding the scope of health insurance payments, to supporting health insurance premiums for disadvantaged groups.

However, to ensure the sustainability of the health insurance system, issues regarding costs and affordability of the Health Insurance Fund will always be carefully considered by the Ministry of Health, in order to protect the rights of health insurance participants in the most reasonable and effective way.

In addition to the above contents, according to the Ministry of Health, one of the notable points in the new regulations under Circular No. 37/2024/TT-Ministry of Health (Circular 37) is the level of health insurance benefits for participants.

Accordingly, from January 1, 2025, health insurance participants will be paid 100% of the medical examination and treatment costs at primary health care facilities nationwide by the Health Insurance Fund. For inpatient medical examination and treatment services at primary health care facilities, the payment level is also 100%.

In Circular No. 39/2024/TT-Ministry of Health issued on November 17, 2024 (Circular 39), the Ministry of Health emphasized the principle of "correct, sufficient and reasonable" in drug use.

The circular adds many new drugs to the list of drugs covered by health insurance, including drugs to treat rare diseases and chronic diseases.

The drugs in the list are classified and adjusted to prioritize modern treatment regimens, suitable for clinical practice and treatment needs in Vietnam.

In addition, the drug bidding process is specifically regulated to minimize drug shortages and ensure reasonable drug prices, helping people access high-quality drugs at low costs. The regulation also adds special drugs for children, the elderly and patients with rare diseases. Price support policies for vulnerable groups are also applied.

The health insurance payment process has been improved to reduce application processing time, helping health insurance participants receive benefits more quickly.

According to a representative of the Department of Health Insurance, Ministry of Health, the new regulations in Circular 37 and Circular 39 are expected to improve the benefits for health insurance participants, ensure more effective access to medicine, and contribute to improving the quality of medical examination and treatment services at all health care levels.

From 2025, patients with rare or serious diseases can be treated directly at specialized medical facilities without having to request a referral as before.

Cancer, lupus erythematosus, organ transplants, strokes and other serious illnesses will be covered 100% by health insurance when patients are treated at higher-level hospitals. This regulation helps shorten treatment time and minimize administrative procedures, while ensuring health insurance benefits for patients.

According to Circular 22/2024/TT-Ministry of Health, from January 1, 2025, if the hospital does not have the necessary medicine or medical equipment in the health insurance list, the patient will be refunded when purchasing medicine or equipment outside.

Refund conditions include: the hospital does not have the medicine because it has not selected a supplier or there is no alternative medicine.

Patients only need to provide invoices for purchasing drugs or equipment at pharmaceutical facilities, and will be paid according to the price listed on the invoice, not exceeding the hospital's prescribed payment level.

One notable point is that payment for medical examination and treatment costs at private hospitals will also have major changes.

From 2025, private medical facilities will be allowed to participate in the health insurance payment process for medical examination and treatment services. However, the payment level will be regulated according to the health insurance medical examination and treatment price of that technical service as prescribed or approved by the Provincial People's Council for local state medical examination and treatment facilities.

From 2025, health insurance participants will be paid for the medical examination and treatment costs within the scope of health insurance coverage when seeking medical examination and treatment upon request. The costs exceeding the health insurance coverage will be paid by the patient himself/herself.

This is an important improvement in facilitating patients to choose medical examination and treatment services on demand, while still ensuring benefits from the Health Insurance Fund.

Source: https://baodautu.vn/cac-buoc-di-moi-cua-bo-y-te-trong-viec-cai-thien-chinh-sach-bao-hiem-y-te-d253762.html