Law No. 51/2024/QH15, amending and supplementing a number of articles of the Law on Health Insurance (HI), was passed by the National Assembly on November 27, 2024. From January 1, 2025, a number of new regulations will officially take effect, aiming to improve people's rights, especially patients with rare and serious diseases.
Patients excited about new policy
One of the new points of the revised Law on Health Insurance is that patients with rare or serious illnesses... do not need a referral letter. Accordingly, in cases where a patient has been diagnosed with a rare or serious illness or an illness requiring high technology (listed in the list of 62 groups of rare illnesses issued by the Ministry of Health), he or she can now go directly to a specialist without needing a referral letter. In this case, health insurance will cover 100% of the treatment costs.
In addition, patients who buy medicine from outside will be refunded. Accordingly, in case the doctor prescribes medicine or supplies that are covered by insurance but the hospital does not have the medicine at that time, the patient must buy medicine from outside, the social insurance (SI) will refund the patient.
However, to be paid directly, regulations must be met such as at the time of prescribing medicine, indicating the use of medical equipment without medicine, medical equipment bidding, procurement cannot select a contractor; medical facilities do not have alternative medicine; do not transfer patients to other medical examination and treatment facilities when the patient's health condition does not meet the conditions for transfer... The Social Insurance Agency will pay directly to the patient according to the quantity and unit price stated on the invoice purchased by the patient at the pharmaceutical business establishment.
Another important change is that the regulations on the list of drugs covered by health insurance are no longer classified by hospital class. The Ministry of Health has abolished the columns classifying the hospital using the drugs, and also removed notes on the payment rate and payment conditions of the drugs.
With the above changes, patient Nguyen Thi Ly, 64 years old, in Quang Thang ward, Thanh Hoa city, who is being treated at Thanh Hoa Provincial Oncology Hospital, happily shared: “Previously, every time I needed to be transferred to a higher-level hospital for treatment, I had to return to the original hospital to register for medical examination and treatment according to regulations. After that, I had to go through a series of procedures, from testing to requesting a referral, because lower-level hospitals do not have the means and machinery to treat cancer in depth, such as surgery, chemotherapy, radiotherapy or targeted therapy. These procedures often take a lot of time and cause a lot of inconvenience.”
Ms. Ly expressed her excitement with the new policy that will be applied from January 1, 2025: “Now, I do not need to go through the referral procedure but can go directly to a specialized level for treatment. I no longer have to be haunted by queuing up to register for examination, testing and waiting for referral instructions at a lower-level hospital, which is tiring, time-consuming and costly in terms of travel costs.”
Similarly, Ms. Nguyen Thi Huong, in Bac Son ward, Bim Son town, who is being treated at Thanh Hoa Provincial Oncology Hospital, happily said: “The new regulations of the Health Insurance Law help people with serious illnesses like me to skip many unnecessary steps and proactively go straight to the specialized level for treatment. Moreover, when the hospital lacks medicine, Ms. Huong has to buy medicine from outside, causing costly expenses. Now, with the new policy, if she meets all the conditions, she will be refunded according to the prescription she bought. This is a very practical policy, helping to reduce the economic burden for patients with rare and serious diseases."
Discussing the new regulations in the revised Law on Health Insurance, Dr. Nguyen Quang Hung, Deputy Director of Thanh Hoa Provincial Oncology Hospital, said: The new regulations help patients diagnosed with cancer, along with other groups of diseases in the list of rare diseases as prescribed, to go directly to specialized levels for treatment without having to go through referral procedures. This policy demonstrates the deep concern of the Party and State for people with serious illnesses, helping them reduce complicated administrative procedures and save treatment costs.
Need to understand the provisions of the revised Law on Health Insurance
After the amended Law on Health Insurance officially took effect, the Prime Minister issued Decree No. 02/2025/ND-CP dated January 1, 2025 amending and supplementing a number of articles of Decree No. 146/2018/ND-CP dated October 17, 2018 of the Government detailing and guiding measures for implementing the Law on Health Insurance, which was amended and supplemented by a number of articles in Decree No. 75/2023/ND-CP dated October 19, 2023 of the Government; the Ministry of Health issued Circular No. 01/2025/TT-BYT dated January 1, 2025 detailing and guiding the implementation of a number of articles of the Law on Health Insurance.
At the same time, the Ministry of Health has organized online conferences to deploy decrees and circulars to health departments across the country. Health departments organize online conferences to all local medical facilities. However, because the new law has just been applied, many patients do not fully understand the regulations and conditions for benefits, and have arbitrarily gone to specialized facilities without being eligible, leading to overload at higher-level hospitals and increasing unnecessary travel costs.
Mr. Nguyen The Soi, Deputy Director of Thanh Hoa Provincial Social Insurance, said: To ensure that health insurance participants enjoy the right benefits according to regulations, the Social Insurance agency is actively coordinating closely with medical facilities in the province to promote propaganda and dissemination of new regulations of the revised Law on Health Insurance. At the same time, people also need to proactively learn the provisions of the law to avoid cases of bypassing the right level when not the right subject.
Dinh Giang - Mai Phuong
Source: https://baothanhhoa.vn/luat-bao-hiem-y-te-sua-doi-nbsp-nhieu-quyen-loi-moi-cho-nguoi-benh-238653.htm
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