Many solutions to reduce the distinction between health insurance medical examination and service medical examination

One of the prominent complaints people have had about medical examination and treatment recently is the discrimination between medical examination and treatment services and health insurance at major hospitals.

One of the prominent complaints people have had about medical examination and treatment recently is the discrimination between medical examination and treatment services and health insurance at major hospitals.

According to many opinions, medical examination services often have quick procedures and high quality, while patients using health insurance have to wait a long time and the quality of service is not guaranteed.

Illustration photo.

Minister of Health Dao Hong Lan affirmed that, according to current regulations, there is no distinction between patients using medical services and patients using health insurance.

However, she also admitted that some hospitals, especially in specialties such as oncology, cardiology, orthopedics, obstetrics and pediatrics in big cities, are facing overload, leading to long waiting times for patients with health insurance cards.

At large hospitals such as Viet Duc Friendship Hospital, Bach Mai Hospital or Cho Ray Hospital, people have to come very early, lining up from 4-5 am to get a number and ticket, even though the medical examination and treatment fee covered by health insurance is about 50,000 VND per visit.

Meanwhile, patients who use services, especially those with specialists, associate professors, and doctors, can save time and receive better quality medical examination and treatment, although the cost is much higher (a specialist visit can cost up to 500,000 VND).

The Ministry of Health has issued regulations to unify the prices of health insurance medical examination and treatment services among hospitals of the same rank nationwide and requires medical examination and treatment facilities to implement solutions to improve processes and procedures to shorten waiting time for patients.

Recently, the Ministry of Health has also proposed to study and make proposals for competent authorities to consider and decide to ensure the rights of health insurance participants, while being suitable to actual conditions.

Another issue that patients are concerned about is that the list of health insurance drugs has not been updated promptly, especially for specific drugs for patients with underlying or incurable diseases.

Minister Dao Hong Lan said that the Ministry of Health issued Circular 37 on November 16, 2024 to stipulate the principles and criteria for developing and updating the list of health insurance drugs. The Ministry is reviewing and adding new drugs to the list, while removing drugs that are no longer suitable.

The addition of new drugs, especially those for the treatment of chronic and rare diseases, must ensure the affordability of the Health Insurance Fund, while carefully considering the requirements for treatment effectiveness and reasonableness within the scope of payment.

Many opinions have proposed expanding the scope of health insurance payments to modern medical services, such as magnetic resonance imaging, testing and new diagnostic and treatment methods.

The Ministry of Health said it issued Circular 39 on November 17, 2024 to expand the scope of health insurance payment for a number of technical services, especially in cancer diagnosis and treatment, including CT scans, tumor marker tests, and emergency blood filtration.

However, the Ministry also emphasized that further expansion of payment scope will have to be based on the payment capacity of the Health Insurance Fund and the health insurance premium level of the people.

Another issue that people have reported is that the health insurance premium based on the basic salary is increasing, making it difficult for low-income earners, workers without contracts, or housekeepers and maids to participate in health insurance.

The Ministry of Health has informed that the current health insurance contribution rate is 4.5% of the basic salary, and the Government has issued many support policies, including reducing the contribution rate for subjects such as meritorious people, the poor, the near-poor, ethnic minorities, as well as households with average living standards.

The Ministry of Health has also implemented policies to help people who do not receive salaries from the state budget to participate in family health insurance with the contribution rate decreasing according to the number of people in the household.

From January 1, 2025, one of the notable regulations in Circular No. 37/2024/TT-Ministry of Health is the payment of 100% of medical examination and treatment costs at primary medical examination and treatment facilities and basic health insurance facilities.

Circular 39 also provides regulations on the "correct, adequate and reasonable" use of drugs, and updates many new drugs to the list covered by health insurance.

In particular, from 2025, patients with rare or serious diseases will be treated directly at specialized medical facilities without having to request a referral.

Diseases such as cancer, stroke, lupus erythematosus, and other serious illnesses will be covered 100% by health insurance when patients are treated at upper-level hospitals.

Another important improvement is that private hospitals will be allowed to participate in the health insurance payment process from 2025. However, the payment level will be regulated according to the health insurance medical examination and treatment price of that technical service as prescribed by the Provincial People's Council.

With these improvements, patients will have more options in medical examination and treatment upon request, while still ensuring benefits from the Health Insurance Fund.

Source: https://baodautu.vn/nhieu-giai-phap-de-giam-phan-biet-giua-kham-benh-bao-hiem-y-te-va-kham-dich-vu-d256314.html