The draft Law on Health Insurance has been amended and supplemented, proposing to remove the referral procedure for some rare and serious diseases... to be transferred directly to a higher level of expertise to reduce procedures, create convenience, reduce out-of-pocket expenses for people, and save costs for the fund.
Continue At the 8th session of the 15th National Assembly on the morning of October 24, the National Assembly listened to Minister of Health Dao Hong Lan, authorized by the Prime Minister, present the Report on the draft Law amending and supplementing a number of articles of the Law on Health Insurance.
Supplementing the drug transfer payment mechanism
The Minister said that the draft Law amending and supplementing 40 articles focuses on amending and supplementing regulations that need to be unified and synchronized with related laws, overcoming urgent shortcomings of current laws, having full information and data, and reaching consensus.
Including regulations on transferring from 4 levels of medical examination and treatment to 3 levels of technical expertise to take effect from January 1, 2025 in accordance with the Law on Medical Examination and Treatment.
Some specific noteworthy contents were mentioned by the Minister, such as amending regulations on medical examination and treatment in the right and wrong line (inter-line) updated according to the technical expertise level of the Law on Medical Examination and Treatment in 2023.
Accordingly, the referral procedure for some rare and serious diseases... will be eliminated to be taken directly to a higher level of expertise to reduce procedures, create convenience, reduce out-of-pocket expenses for people, and save costs for the fund.
The draft also amends regulations on registration for medical examination and treatment. health insurance initial and transfer of patients between health insurance examination and treatment facilities to synchronize with regulations on technical expertise levels in the direction of creating more convenience for people and decentralizing and delegating authority to the Department of Health on initial health insurance examination and treatment registration and health insurance card allocation.
This amendment also adds a payment mechanism for transferring drugs in cases where drugs have been purchased according to the most convenient regulations of the new Bidding Law but there is still a shortage of drugs, in order to overcome the shortage of drugs and ensure the rights of health insurance participants, so that patients do not have to buy them themselves and have their rights guaranteed.
At the same time, updating the payment mechanism for paraclinical service costs transferred to other qualified facilities is currently regulated in the Government's decree.
Amend the regulation that social insurance agencies inspect the quality of medical examination and treatment to inspect the implementation of medical examination and treatment contracts to be consistent in function and avoid overlap with state health management agencies.
Supplementing a form of payment for special medical examination and treatment costs for armed forces and people in border areas, particularly disadvantaged communes, and islands.
In addition, the draft also adjusts the health insurance fund management cost ratio down by 1% from 5% to 4% to increase direct spending on medical examination and treatment from 90% to 91% from the beginning of the year, saving procedures, time for allocating and adjusting funds.
Need to fundamentally resolve problems in payment of medical examination and treatment costs under health insurance
After reviewing, the National Assembly's Social Committee basically agreed with the scope of amendments and supplements to the draft Law. According to the reviewing agency, the draft Law has expanded one step further, better ensuring the rights of health insurance participants when "providing medical examination and treatment".
Accordingly, the health insurance fund will pay as prescribed when going to medical examination and treatment in accordance with regulations in cases where patients can go to basic or specialized medical examination and treatment facilities in some cases of serious illness or critical illness; medical examination and treatment at primary medical examination and treatment facilities and some basic medical examination and treatment facilities nationwide and medical examination and treatment at specialized medical examination and treatment facilities with appropriate roadmap.
However, the Social Committee believes that it is necessary to carefully assess the impact on the ability to balance the health insurance fund as well as the organization and operation of the medical examination and treatment system, including primary health care.
Regarding payment for medicine and medical equipment transferred between medical examination and treatment facilities and settlement of medical examination and treatment costs covered by health insurance, the Social Committee highly appreciates the Government's proposal to supplement regulations on payment for medicine and medical equipment transferred between medical examination and treatment facilities, and costs of paraclinical services of patients who have been prescribed but must be performed elsewhere to ensure the rights of health insurance participants as well as to ensure quality and timeliness in medical examination and treatment.
However, to fundamentally resolve the rights of health insurance patients, it is recommended that the Drafting Committee continue to study the provisions in Clause 4, Article 31 on the payment mechanism through hospitals or directly to patients when they have to buy medicine, supplies, and medical equipment themselves, such as the payment of paraclinical service costs stipulated in Clause 5, Article 31.
The Social Committee also basically agrees with the regulations on advance payment, payment, and settlement of medical examination and treatment costs under health insurance in Article 32, but recommends that the Government have a mechanism to fundamentally resolve the difficulties in payment and settlement of medical examination and treatment costs between the Vietnam Social Security and medical examination and treatment facilities in the past.
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