Health insurance medical examination and treatment costs increase rapidly over the years

Statistics from Vietnam Social Security show that over the past 15 years, the health insurance fund has paid nearly 1 million billion VND for health insurance medical examination and treatment.

Over the past 15 years, the health insurance fund has paid nearly 1 quadrillion VND for health insurance medical examination and treatment. In 2023, the amount of health insurance medical examination and treatment expenditure from the health insurance fund will be about 123 trillion VND, 8 times higher than in 2009. The health insurance fund has truly become an important financial source, contributing to taking care of people's health.

Statistics from Vietnam Social Security show that over the past 15 years, the health insurance fund has paid nearly 1 million billion VND for health insurance medical examination and treatment.

Along with that, the health insurance payment level and the list of drugs, medical supplies, and technical services covered by the health insurance fund are increasingly expanded, meeting the medical examination and treatment needs of health insurance patients.

Many expensive drugs and targeted therapies for cancer treatment are also included in the health insurance payment list. Expensive replacement materials such as artificial hip joints, arterial stents, etc. have been paid thousands of billions of VND by the health insurance fund every year.

Most recently, in the case of patient Nguyen Quoc Trinh (19 years old, in Thanh Hoa ) suffering from the extremely rare disease Pemphigus spongiformis, after 7 months of treatment at Bach Mai Hospital, with the health insurance fund paying nearly 800 million VND, he has returned to normal life.

It is estimated that by early May 2024, the number of people participating in health insurance nationwide will be over 90.2 million, an increase of 0.02% over the same period in 2023.

After 15 years of implementing the health insurance policy in Vietnam, many important achievements have been made: increasing the health insurance coverage rate to more than 93%; expanding the benefits of health insurance participants; improving the quality of medical examination and treatment; increasing the satisfaction rate of patients, with a nationwide survey of over 91%...

Since July 1, salary reform has been implemented, there have been changes in the contribution and benefit levels of health insurance for households and students.

Specifically, the monthly family health insurance contribution is as follows: The first person contributes 4.5% of the basic salary; The second, third, and fourth persons contribute 70%, 60%, and 50% of the first person's contribution, respectively;

From the fifth person onwards, the contribution is 40% of the first person's contribution. For students, the monthly health insurance contribution is 4.5% of the basic salary (the State budget supports 30%, students pay 70%).

For students, the monthly health insurance premium is equal to 4.5% of the basic salary (the State budget supports 30%, students pay 70%).

Currently, health insurance premiums are calculated based on the basic salary. People with health insurance cards who go to the hospital and the cost of medical examination and treatment is lower than 15% of the basic salary will have 100% of the medical examination and treatment costs paid by health insurance according to the provisions of Point d, Clause 1, Article 14 of Decree 146/2018/ND-CP.

The current basic salary is 1.8 million VND/month. However, according to Resolution 104/2023/QH15, the salary regime calculated based on the basic salary will be abolished from July 1, 2024.

Thus, from this point on, the health insurance premium and the medical examination and treatment cost benefits may be affected by changes in the basic salary.

It is known that, in order to increase the benefits for health insurance patients, the Ministry of Health proposed to supplement the regulation that patients diagnosed with certain rare diseases, serious diseases, diseases requiring surgery or using high technology can go to medical examination and treatment facilities with specialized departments at a higher level of technical expertise, or in some cases where the subordinates do not have sufficient professional capacity according to the regulations of the Ministry of Health, the Health Insurance Fund will pay 100% of the cost of medical examination and treatment according to the prescribed benefit level.

In addition, the Ministry also proposed to regulate the level of health insurance benefits of 100% of medical examination and treatment costs for some special cases that do not follow the order and procedures for medical examination and treatment under health insurance, transfer of patients between medical examination and treatment facilities under health insurance, and decentralization of technical expertise related to medical examination and treatment under health insurance.

This proposal helps people save on medical examination and treatment costs, travel costs and co-payment costs in case they have to go to a higher level of medical examination and treatment themselves.

According to the Ministry of Health, the solution to expand the scope of benefits for health insurance participants brings great economic value, saving costs for the Health Insurance Fund.

Early detection and timely treatment will help reduce the cost of treatment in the late stages, because when the disease is severe with complications, it will be necessary to use expensive drugs, special treatments, diagnostic techniques, and paraclinical tests.

Early diagnosis and treatment also help save money on disease prevention and costs to solve health and social problems.

For people, the solution of expanding early diagnosis and treatment of some diseases helps increase people's financial security thanks to early detection and treatment, helping to save on treatment, travel, and temporary accommodation costs compared to when the disease is severe, reducing co-payment costs for patients.

For children under 6 years old with severe acute malnutrition, health insurance payment for special nutritional products will help reduce the economic burden, because people with severe acute malnutrition have reduced ability to work in the future.

According to statistics, in 2023, the cost of treatment for 6 common cancer groups (breast, lung, liver, colon, stomach, prostate cancer) from the Health Insurance Fund is 6,186 billion VND.

For type 2 diabetes alone, in 2023, there will be more than 15,500,000 medical examinations and treatments with a cost of up to VND 6,766 billion, accounting for 5.6% of the Fund's total expenditure. For hypertension, in 2023, there will be nearly 23 million medical examinations and treatments with a cost of VND 6,015 billion, accounting for 4.9% of the Fund's total expenditure.

The Ministry of Health believes that if type 2 diabetes screening is implemented, the Health Insurance Fund will save an average of VND162.3 billion per year in the first 10 years of implementation. After 10 years of implementation, an average of VND162 billion per year will be saved.

With hypertension screening, the average cost to be paid is 88 billion VND/year in the first 10 years of implementing screening for people aged 18 and over. After 10 years of implementation, an average of 1,216 billion VND/year will be saved.

Regarding breast cancer screening, the Ministry of Health said that the average payment is 2,100 - 5,000 billion VND/year depending on the screening method. However, this cost will be significantly reduced if the age group of women screened is limited.

Source: https://baodautu.vn/chi-tien-kham-chua-benh-bao-hiem-y-te-tang-nhanh-qua-cac-nam-d219632.html