Expanding benefits for health insurance patients

According to the revised Health Insurance Law project being developed by the Ministry of Health, the rights of health insurance patients are greatly expanded.

More benefits for health insurance patients

The 2024 Law on Health Insurance allows the transfer of patients between health insurance medical examination and treatment facilities if it exceeds the technical expertise, or a medical examination and treatment facility with a higher technical expertise level transfers a patient who has been treated stably to a lower technical expertise level, or at the same level, or in cases requiring long-term treatment, the patient is transferred to the initial health insurance medical examination and treatment facility for management and monitoring.

According to the revised Health Insurance Law project being developed by the Ministry of Health, the rights of health insurance patients are greatly expanded.

That is, patients who have been diagnosed with certain chronic diseases and prescribed a prescription at a higher level can go to a lower level for treatment and receive the same medicine and medical supplies as at a higher level, so that people can receive the best medicine wherever they are treated.

Currently, health insurance only pays for ambulances transporting patients from the district to the province, but this draft Law on Health Insurance proposes to pay for health insurance to also transport patients between medical facilities, in case of emergency or inpatient treatment, they must be transferred to a medical facility according to professional requirements and need to be transported by a specialized patient transport vehicle.

The draft Law on Health Insurance also allows the transfer of drugs and medical equipment between health insurance facilities if they are not available and the patient cannot be transferred to another medical facility - something that the current Law does not cover.

An important content of the Law project under development is to pay health insurance for early diagnosis and treatment of some diseases with high incidence, high disease burden and effective early intervention treatment such as breast cancer, cervical cancer; treatment of some serious and dangerous diseases with indications for the use of specific therapeutic nutrition.

This helps reduce long-term expenditure for the Health Insurance Fund, reducing morbidity, severity, and mortality. However, there are opinions suggesting that it should be considered and piloted before official implementation.

In addition, the 2024 Health Insurance Law Project proposes direct payment to patients when hospitals do not have enough medicine and medical supplies. This is a solution to overcome difficulties in bidding, which is a hot issue in society.

In particular, according to the new proposal, patients can register for initial medical examination and treatment at general clinics and district health centers and still enjoy 100% health insurance, in order to attract patients to lower-level facilities to reduce the load on upper-level facilities.

Balance fund, why still worry about negative?

Ms. Tran Thi Trang, Director of the Department of Health Insurance, Ministry of Health, provided more information about the new point of the revised Law on Health Insurance, which is the effective allocation and use of health insurance funds with the proposal to adjust the current maximum health insurance fund management cost of 5% down to a maximum of 4%, the remaining 1% added to the health insurance medical examination and treatment fund.

Thus, 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.

According to Ms. Trang, along with the principle of preserving funds, it is still necessary to include social security policies and many groups participating in health insurance are covered by the state budget to buy health insurance cards.

In fact, more than 40% of health insurance fund revenue comes from the state budget, purchasing and issuing health insurance cards for the poor, children under 6 years old, near-poor people, policy families, etc.

Ms. Trang said that the health insurance fund's revenue will reach 126,000 billion VND/year (in 2023) and this revenue will increase from July this year, due to the increase in basic salary.

Commenting on expanding the scope of benefits when examining and treating health insurance, Mr. Nguyen Tat Thao, Deputy Head of Health Insurance Policy Department, Vietnam Social Insurance said that Social Insurance supports expanding benefits for patients, but the Ministry of Health needs to have an overall assessment, each expanded policy, how much more the health insurance fund will pay, and whether the balance of revenue and expenditure of the health insurance fund is ensured.

Regarding revenue and expenditure from the health insurance fund over the years, Mr. Thao said that in the years 2005 - 2009, health insurance payment for medical examination and treatment was based on service fees, without a payment ceiling, and without co-payment, the health insurance fund had a deficit of over 2,000 billion VND.

2009 - 2015: Adjusted the contribution rate from 3% to 4.5% of basic salary; had regulations on payment ceiling and co-payment, the health insurance fund has balanced revenue and expenditure.

2016 - 2023: Medical service prices are adjusted, there is an additional salary structure for medical staff, the drug list is expanded, and the number of medical examinations and treatments increases after the Covid-19 pandemic. The fund had an imbalance in revenue and expenditure. Only in the 3 years 2020 - 2022 did there appear to be a large surplus due to the Covid-19 pandemic.

In the 3 years of the Covid-19 pandemic alone, the health insurance fund had a surplus of over 33,000 billion VND due to a sharp decrease in the number of medical examinations and a lack of medicine and medical supplies, resulting in reduced payments.

By the end of 2023, the total surplus of the health insurance fund to date is 40,000 billion VND, of which 33,000 billion VND was surplus during the Covid-19 pandemic. Thus, the surplus of the health insurance fund is mainly due to reduced spending in the 3 years of the Covid-19 pandemic, the remaining years are almost all negative.

A representative of Vietnam Social Security said that if management costs are included in medical service prices, spending will increase by about 2,500 billion VND/year.

If the depreciation costs of medical equipment and fixed assets are included in the price of medical services, the health insurance fund will increase its expenditure by about VND67,000 billion. Therefore, the Ministry of Health should consider the balance of revenue and expenditure when expanding the benefits of health insurance patients.

Source: https://baodautu.vn/mo-rong-quyen-loi-cho-nguoi-benh-bao-hiem-y-te-d223797.html