Proposal to remove referral procedures for rare and serious diseases

Minister of Health Dao Hong Lan - Photo: GIA HAN

On the morning of October 24, Minister of Health Dao Hong Lan, authorized by the Prime Minister, presented to the National Assembly a draft law amending and supplementing a number of articles of the Law on Health Insurance.

Ms. Lan said that after 15 years of implementation, the Law on Health Insurance has truly come into effect with 93.3 million people, equivalent to 93.35% of the population participating in health insurance. However, the process of implementing the law has encountered difficulties, inadequacies, and limitations that need to be adjusted.

Among the difficulties and shortcomings are regulations on connecting and transferring routes. In addition, regulations on health insurance participants, the scope of benefits for health insurance participants; initial medical examination and treatment registration; methods of payment for medical examination and treatment costs... also have some shortcomings and limitations.

According to Ms. Lan, this draft law will focus 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 sync with the Law on Medical Examination and Treatment.

Specifically, the draft law amending regulations on medical examination and treatment at the right and wrong medical facilities (inter-hospital) is updated according to the technical expertise level of the 2023 Law on Medical Examination and Treatment.

Eliminate referral procedures for some rare and serious diseases... to be transferred directly to higher levels of expertise to reduce procedures, create convenience, reduce out-of-pocket expenses for people, and save costs for the fund.

Accordingly, the bill stipulates that patients are allowed to go to medical examination and treatment facilities at the basic or advanced technical level in case of diagnosis and treatment of certain rare diseases, serious diseases, diseases requiring surgery or using advanced techniques according to the list of diseases and techniques prescribed by the Minister of Health: 100% payment of medical examination and treatment costs for inpatient and outpatient health insurance according to the prescribed percentage of benefits.

Eliminate referral papers for some diseases

Among the 9 administrative procedures that have been reduced and reformed in the bill, there is also the elimination of referral papers for some rare and serious diseases... Patients can be examined and treated "through the line" of districts within the province.

Accordingly, in cases beyond the technical expertise, the health insurance medical examination and treatment facility is responsible for transferring the patient to another medical examination and treatment facility suitable to the patient's condition and the scope of professional activities of the medical examination and treatment facility to which the transfer is made.

Medical examination and treatment facilities with higher technical expertise transfer patients to the primary health insurance medical examination and treatment facility where the patient registered or provided initial medical examination and treatment to manage and monitor chronic diseases and use and dispense drugs and medical equipment for use by medical examination and treatment facilities with higher technical expertise, using technical services according to the professional capacity of the facility where chronic diseases are managed and monitored.

A person with a health insurance card who goes to a medical examination or treatment facility not registered for initial health insurance examination or treatment, and during inpatient treatment discovers a disease outside the scope of expertise of the medical examination and treatment facility or the disease progresses beyond the professional capacity of the medical examination and treatment facility, shall be transferred to another medical examination and treatment facility that is appropriate to the patient's condition and the scope of professional activities of the medical examination and treatment facility to which the transfer is made.

Source: https://tuoitre.vn/benh-hiem-benh-hiem-ngheo-duoc-de-xuat-bo-chuyen-tuyen-20241024090349727.htm