Having left extremely disadvantaged areas, many people no longer enjoy the State’s support policy to participate in health insurance. The lives of many people are already difficult, and not having health insurance makes the risk of falling back into poverty even more present every time they fall ill.
When near-poor households say no to health insurance
In a small house along Provincial Road 519, the lunch of Mr. Le Dinh Binh, Mrs. Trinh Thi Thu (both born in 1955), daughter-in-law Cam Thi Phuong and 2 grandchildren is just a bowl of soup and a pot of rice on a torn mat. In Cong Thuong village, Van Xuan commune (Thuong Xuan), Mr. Binh's family is one of the few households with agricultural land with 3 sao of rice fields, but they are not much better off. His children have to work far away to earn a living, sending money back to their parents to raise their young children. Even the grandparents, nearly 70 years old, have to work hard, sometimes working in the fields, sometimes working for hire. It was not until 2022 that his family escaped poverty and became a near-poor household. If they participate in health insurance, Mr. Binh, his wife and family members only have to pay 30% of the health insurance premium (because the State supports 70% according to the Health Insurance Law), which is 241,38 thousand VND/year/person. For a family of 7 adults, the total payment will be nearly 1.7 million VND/year.
With a miserable face, Mr. Binh said: "Indeed, I want to join health insurance to prevent illness, but my family is too poor. There are 10 people in the family, 4 of whom work far away and send money back, but sometimes they don't. At home, we have 3 sao of rice fields to feed 6 mouths, so we can't be better off."
Not far from Mr. Binh's house, Ms. Truong Thi Binh's family is also a near-poor household but has not yet participated in health insurance. Her family has no land for production, her husband died early, she had to travel on an old motorbike selling vegetables, tubers, fruits, meat and fish to people in the village and outside the commune to earn money to raise her two children. Now that the children are grown, she has less hardship, but the family is still a near-poor household. She said: "I have been propagandized and mobilized by village and commune officials, and I also want to participate in health insurance, but due to difficult conditions, I have had to give up."
Among the 74 communes that have just escaped from extreme difficulty according to Decision No. 861/QD-TTg, dated June 4, 2021 of the Prime Minister on approving the list of communes in regions III, II, I in ethnic minority and mountainous areas for the period 2021-2025 (referred to as Decision 861 - PV), Van Xuan commune has better conditions, because it is a new rural commune in 2020. And the households we visited are also considered better off than the near-poor households in the commune, because they are next to the provincial road and are Kinh people who moved up to live, but they are still struggling, the boundary compared to poor households is very fragile. In fact, according to the review results in 2022, Van Xuan commune still has 15.74% poor households and 40.6% near-poor households. So up to now, the commune has only achieved a rate of 69.5% of people participating in health insurance.
Vice Chairman of the Commune People's Committee Le Minh Tuan said: Although the commune has organized many conferences in the villages to propagate and visit each household to mobilize, many households that are eligible for partial support from the State still do not participate in health insurance. This has many reasons, including the reason that economic life is still facing many difficulties.
Similarly, although it has escaped from the extremely difficult village according to Decision No. 612/QD-UBDT, dated September 16, 2021 of the Ethnic Committee on approving the list of extremely difficult villages in ethnic minority and mountainous areas for the period 2021-2025 (referred to as Decision 612 - PV), Khu 1 village, Giao Thien commune (Lang Chanh) still has 86 poor households and 134 near-poor households out of a total of 287 households with 1,181 people. Village head Pham Thi Ly said: "Up to now, the rate of people in the village participating in health insurance is less than 60%. Meanwhile, the village has organized many propaganda and mobilization campaigns for them. Many near-poor households without health insurance cards unfortunately get sick and have to go to the hospital for treatment, which is very expensive, so the risk of falling back into poverty is very high".
The rate of people participating in health insurance is decreasing.
According to the provincial Social Insurance, after Decision 861 and Decision 612 took effect, Thanh Hoa province had 345,182 people affected, no longer receiving full support from the State for the cost of participating in health insurance. After that, the Provincial People's Council issued a resolution to support from the local budget for people in communes, villages, and hamlets that have just left extremely difficult areas to buy health insurance cards until the end of 2021, so during the year, the rate of people participating in health insurance in the province has not been affected. In 2022, the Provincial People's Committee continued to support part of the local budget to buy health insurance cards for near-poor households (20% of the local budget in addition to the 70% of the State budget already supported). Along with that, the provincial Social Insurance has organized and implemented synchronously effective solutions to increase the number of people participating in health insurance, especially promoting propaganda and mobilizing people. However, by December 31, 2022, many mountainous districts still had a decrease in the rate of people participating in health insurance compared to December 31, 2021, such as Ngoc Lac (down 10,689 people), Cam Thuy (down 8,120 people), Thach Thanh (down 5,598 people), Quan Son (down 2,543 people)...
In order to complete the target of the rate of people participating in health insurance this year and the following years, the Social Insurance of mountainous districts has actively and proactively implemented practical solutions. For example, in Thuong Xuan district, in addition to expanding health insurance agents, the district Social Insurance agency has advised the district People's Committee to strengthen the steering committee, assign targets for developing the rate of people participating in health insurance to each commune and promote the responsibility of the head in implementing this goal. In addition, the district Social Insurance has assigned staff to go directly to the grassroots level with local Party committees and authorities to propagate and mobilize Party cell secretaries, heads of villages, hamlets, village elders, and prestigious people in ethnic minority areas to participate in mobilizing people. At the same time, update, monitor, and evaluate daily results as a basis for direction and management. Many district Social Insurance staff even worked on holidays to go with local Party committees and authorities to propagate and mobilize people. However, as of May 12, Thuong Xuan district only achieved 75% of the population participating in health insurance. The district's target for this rate in 2023 is 93.5%. Vice Chairman of Thuong Xuan District People's Committee Cam Ba Dung said: To complete the target of the rate of people participating in health insurance in the year, the district has no other solution than to actively promote propaganda and mobilization work.
It must be said that people have not participated in health insurance, especially those who are partially or mostly supported by the State (near-poor households, agricultural, forestry and salt production households with average living standards) not entirely due to difficult economic conditions, but also due to not being fully aware of the benefits when participating in health insurance, or because of the mentality of waiting and relying on others... Because, there are near-poor households with few members that we visited, the amount of health insurance for the whole family is only about 700 thousand VND/year, but they are not interested, the reason is not because of economics but because of ideology and awareness. And then, when many people do not participate in health insurance, do not have a "talisman" for health, not only are their rights in medical examination and treatment affected, but it also greatly affects the implementation of social security and economic development goals of the locality.
Then, in the condition that there is no longer partial support from the local budget such as in the last 6 months of 2021 and the fourth quarter of 2022, the Party committees, authorities and the Social Insurance sector will have to strengthen the mobilization of the people. Meanwhile, according to Resolution No. 69/QH15, dated November 11, 2022 of the National Assembly on the State budget estimate for 2023, from July 1, 2023, the basic salary will increase from 1.49 million VND/month to 1.8 million VND/month. This means that the health insurance contribution rate of 4.5% of the basic salary for people will also increase accordingly. For near-poor households, the health insurance contribution rate will increase from 241.38 thousand VND/year to 291.6 thousand VND/year for each person. The contribution rate for people in agricultural, forestry, fishery and salt production households with average living standards, students (supported by the State with 30% of the contribution rate) will increase from 563.22 thousand VND/year to 680.4 thousand VND/year. This pressure may make the work of mobilizing people to participate in health insurance in communes, villages and hamlets that have just emerged from extremely difficult areas even more difficult.
Article and photos: Do Duc
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