Improve regulations and guidelines to improve the effectiveness of health insurance policies.

Deputy Minister of Health Tran Van Thuan assessed that the conference was an important occasion to review the implementation of the Health Insurance policy in recent times; analyze the achieved results, point out the limitations and shortcomings that need to be adjusted; and at the same time, receive comments and contributions to complete the draft Decree to be submitted to the Government for consideration and promulgation.

On November 27, 2024, the 15th National Assembly passed the Law amending and supplementing a number of articles of the Law on Health Insurance. This is an important milestone, demonstrating the determination to reform administration, facilitate people, reduce paperwork, promote digital transformation and improve the effectiveness of health insurance policy implementation. The Law amending and supplementing a number of articles of the Law on Health Insurance takes effect from July 1, 2025, but a number of important provisions will be applied from January 1, 2025.

Deputy Minister Tran Van Thuan shared the outstanding new policies of the Law amending and supplementing a number of articles of the Law on Health Insurance. These are: Amending and updating the subjects of participation; adjusting the responsibility for paying health insurance, the method, payment period, responsibility for making a list of health insurance payment, and the validity period of the card.

Deputy Minister of Health Tran Van Thuan spoke at the workshop.

Accordingly, regulations on health insurance medical examination and treatment, including initial medical examination and treatment registration, patient transfer between health insurance medical examination and treatment facilities (according to the technical expertise level of the 2023 Law on Medical Examination and Treatment) allow patients to choose their initial medical examination and treatment facility as well as to transfer medical examination and treatment facilities flexibly, according to professional requirements.

Regarding the level of health insurance benefits when implementing the interconnection of health insurance examination and treatment, there will no longer be a distinction between administrative boundaries by province.

Patients are entitled to 100% of the benefits when examining and treating at the initial level nationwide, 100% of the benefits when examining and treating inpatients at the basic level nationwide, and 100% of the benefits when examining and treating at any basic or specialized medical facility that before January 1, 2025 is identified as a district level.

In particular, in some cases of rare diseases, serious illnesses..., patients are taken directly to specialized medical facilities for examination and treatment.

The new law also adjusts the ratio of expenditures for health insurance examination and treatment, reserve expenditures and health insurance activities from health insurance premiums; supplements the mechanism for payment of drugs and medical equipment transferred between medical examination and treatment facilities and payment of paraclinical service costs transferred to other facilities in case of shortage of drugs and medical equipment; supplements specific regulations on late payment, evasion of health insurance payment and measures to handle these cases and many other important regulations.

To ensure timely implementation, the Ministry of Health has submitted to the Government Decree 02/2025/ND-CP detailing and amending and supplementing Decree No. 146 (2018) and Decree No. 75 (2023).

The Ministry of Health is currently completing the draft of a new Decree, which includes three basic groups of contents: Detailed regulations and instructions for the implementation of the Law amending and supplementing a number of articles of the Law on Health Insurance; Overcoming difficulties and problems arising in practice when implementing Decrees No. 146, No. 75 and No. 02; Removing practical problems in health insurance examination and treatment and payment of health insurance examination and treatment costs.

In particular, focusing on some existing problems in payment in case of adjusting the size of hospital beds; Regulations on health insurance payment implemented on donated medical equipment but whose ownership cannot be established by the entire population before March 4, 2023; Regulations on payment for drugs, medical equipment, and chemicals for private medical examination and treatment facilities; Regulations on implementation roadmap and benefit rates for outpatient examination and treatment at basic medical examination and treatment facilities...

According to Tran Thi Trang, Director of the Department of Health Insurance (Ministry of Health), from July 1, new regulations of the Law amending and supplementing a number of articles of the Law on Health Insurance will take effect. It is very important to thoroughly and specifically implement, guide and disseminate new policies stipulated in the Law and new Decrees and Circulars; promptly answer any questions, difficulties or issues arising during the implementation process.

The Decree detailing and guiding the implementation of a number of articles of the Law on Health Insurance is expected to meet practical requirements, be easy to implement, and create consensus and a unified understanding for both social insurance agencies, medical examination and treatment facilities, and all people.

Ms. Tran Thi Trang also said that after the first three months of implementing a number of new regulations of the Law amending and supplementing a number of articles of the Law on Health Insurance, people have recognized the new policy as having positive value and more convenient procedures.

However, a new policy in the process of implementation cannot avoid confusion and some problems arise, so the authorities will have instructions and solutions to make the new regulations easy to implement and not cause problems.

Source: https://nhandan.vn/hoan-thien-cac-quy-dinh-huong-dan-de-nang-cao-hieu-qua-chinh-sach-bao-hiem-y-te-post868057.html