Ensure maximum benefits for medical examination and treatment under health insurance

According to many patients, medical examination services often have quick procedures and high quality, while using health insurance requires long waiting times and the quality of service is not guaranteed. Some hospitals, especially in specialties such as oncology, cardiology, orthopedics, obstetrics and pediatrics in big cities, are facing overload, leading to long waiting times for patients with health insurance cards.

At large hospitals such as Viet Duc Friendship Hospital, Bach Mai Hospital or Cho Ray Hospital, people have to come very early, lining up from 4-5 am to get a number and ticket, in return, the medical examination and treatment fee covered by health insurance is only about 50,000 VND/time. Meanwhile, patients who use services, especially those with specialists, associate professors, and doctors, can save time and the quality of medical examination and treatment is also better, although the cost is much higher (a specialist examination can cost up to 500,000 VND).

To address this issue, one of the notable improvements in the new health insurance policy is the reduction of disparities in medical examination and treatment services at hospitals. Accordingly, the Ministry of Health has introduced specific measures to improve the quality of services at public hospitals, while improving fairness in the payment of health insurance medical examination and treatment costs. The new policy allows for the expansion of 100% payment of medical examination and treatment costs at primary public health facilities, reducing the financial burden on people.

Ms. Vu Nu Anh, Deputy Director of the Department of Health Insurance (Ministry of Health) said that an important improvement from 2025 is the payment of 100% of medical examination and treatment costs at primary medical examination and treatment facilities and basic health insurance facilities. According to Circular No. 37/2024/TT-BYT, health insurance participants will have all medical examination and treatment costs paid by the Health Insurance Fund, helping people access quality medical services without worrying about costs. This is especially important in reducing the burden on upper-level hospitals and ensuring that people can receive timely health care at the grassroots level.

Another highlight of the new regulations is the permission for private medical facilities to participate in the health insurance payment process. From 2025, private hospitals will be allowed to pay health insurance for medical examination and treatment services. However, the payment level will be regulated according to the health insurance examination and treatment price of that technical service, approved by the Provincial People's Council for local public medical facilities.

Notably, the new health insurance policy is the update of the list of health insurance drugs. Previously, this list still had many limitations, especially for specific drugs for patients with underlying diseases, chronic diseases, or serious diseases. Circular 37/2024/TT-BYT has helped solve this problem by regulating the principles and criteria for building the list of health insurance drugs.

From 2025, the list of health insurance drugs will be expanded, adding many new drugs, including drugs for treating rare and chronic diseases. At the same time, drugs in the list will be classified and adjusted to prioritize modern treatment regimens, suitable for clinical practice and treatment needs in Vietnam. This Circular also stipulates specific drug bidding procedures to minimize drug shortages, ensure reasonable drug prices and help people access high-quality drugs at low costs.

The above regulation brings hope to people, especially patients with difficult-to-treat diseases, when they can access modern treatments at costs covered by health insurance.

In addition to updating the drug list, the Ministry of Health also focuses on expanding the scope of health insurance payments for modern medical services. Some opinions have reflected that many new diagnostic and treatment services such as magnetic resonance imaging, tumor marker testing, and emergency blood filtration are not fully covered by health insurance, forcing people to pay part of the treatment costs themselves.

To address this issue, the Ministry of Health has issued Circular 39/2024/TT-BYT, expanding the scope of payment for a number of technical services, especially in cancer diagnosis and treatment. The above regulation not only helps reduce the cost burden for people, but also ensures that advances in medical technology can be widely applied, bringing maximum benefits to patients.

Source: https://baodautu.vn/dam-bao-loi-ich-toi-da-cho-kham-chua-benh-bao-hiem-y-te-d259673.html