New proposal on health insurance medical examination and treatment

Many proposals on health insurance examination and treatment have been made by the Ministry of Health with the desire to increase benefits for people participating in health insurance.

Update list of health insurance drugs

To further meet people's health insurance examination and treatment needs, according to a representative of the Ministry of Health, this agency is making many proposals related to health insurance examination and treatment.

Specifically, Ms. Tran Thi Trang, Director of the Department of Health Insurance (Ministry of Health), said that the Ministry of Health is updating the list of health insurance drugs to reduce out-of-pocket expenses so that low-income people can access high-priced drugs with good treatment effects.

Accordingly, the updated list of health insurance drugs is quite large, with about 200 types. Therefore, it is necessary to carefully consider to choose drugs that meet the requirements of treatment effectiveness, as well as payment rates suitable to the payment capacity of the health insurance fund and the co-payment capacity of the people. In addition, the Ministry of Health will also consider removing from the list of health insurance drugs drugs that are not effective in treatment or treatment costs, to reduce the burden on the health insurance fund.

The new point of updating the list of health insurance drugs this time is through medical technology assessment to recommend businesses to adjust drug prices appropriately, in order to increase the payment rate, helping low-income people access drugs with high prices and good treatment effects.

According to Ms. Trang, the Ministry of Health is drafting a Circular amending and supplementing a number of articles of Circular No. 35/2016/TT-BYT dated September 28, 2016 of the Ministry of Health promulgating the List and rates and payment conditions for medical technical services within the scope of benefits of health insurance participants.

In addition, there are four policies in the proposal to build a revised Law on Health Insurance that the Ministry of Health is carrying out to improve the quality of medical examination and treatment.

Firstly, adjust the subjects participating in health insurance in accordance with relevant legal regulations.

Second, adjust the scope of health insurance benefits in accordance with the contribution level, balance the health insurance fund and health care requirements in each period.

Third, adjust relevant health insurance regulations according to the level of technical expertise in medical examination and treatment and promote the role of grassroots health care in primary health care and health insurance medical examination and treatment.

Fourth, allocate and use health insurance funds effectively.

Accordingly, the Draft Law on Health Insurance Amendment proposes to adjust the maximum management cost from 5% as currently regulated to a maximum of 4% for health insurance fund management activities. The remaining 1% is added to the health insurance medical examination and treatment fund.

Ms. Tran Thi Trang said that the total budget added to the health insurance medical examination and treatment fund each year is about 1,100 billion VND and will be allocated and regulated from the beginning of the year for medical examination and treatment facilities.

Interdisciplinary coordination to improve quality

Regarding the work of medical examination and treatment under health insurance, the Ministry of Health proposed to develop a Law amending and supplementing a number of articles of the Law on Health Insurance. In particular, it proposed to amend and supplement a number of regulations on the scope of benefits, levels of health insurance benefits and adjust the rate of health insurance payment for a number of cases where the technical expertise level of medical examination and treatment under health insurance is not appropriate.

Minister of Health Dao Hong Lan said that the Ministry of Health will continue to coordinate with relevant ministries and sectors to focus on implementing a number of tasks and solutions. First of all, it is necessary to continue to thoroughly understand the role of health insurance as one of the important tasks in the work programs of Party and government agencies.

It is necessary to continue promoting propaganda work; maintain and sustainably expand the number of people participating in health insurance, especially those participating in family health insurance, striving to reach 95% of the population by 2025, and over 95% of the population by 2030.

The Ministry of Health will continue to improve the health insurance policy mechanism, especially the policy to support health insurance participation for workers, their relatives, and vulnerable groups. Review and ensure that no subjects are left out, and health insurance coverage reaches all groups in society.

In addition, focus on researching and gradually expanding the scope of benefits for health insurance participants, especially benefits that help prevent and treat diseases early and remotely to meet the needs of care, protection and improvement of people's health, calculate and propose appropriate contribution levels to ensure the balance of the health insurance fund...

The Commander of the health sector also pledged to urgently complete the mechanism for managing bidding, purchasing, and using drugs and medical equipment in a cost-effective, efficient, and transparent manner. Innovate the method of payment for health insurance medical examination and treatment costs between medical examination and treatment facilities and social insurance agencies, ensuring publicity and transparency; improve the effectiveness of health insurance appraisal work, ensure good control of health insurance medical examination and treatment spending, and protect the rights of participants and medical examination and treatment facilities.

Source: https://baodautu.vn/de-xuat-moi-ve-kham-chua-benh-bao-hiem-y-te-d220143.html