No poverty or destitution after a serious illness
The conference to collect opinions on the draft Law on Health Insurance was held by the Ministry of Health today, August 29, in Hanoi.
At the conference, Ms. Tran Thi Trang, Director of the Department of Health Insurance, Ministry of Health, said that health insurance is about sharing risks, patients have equal access to policies and at the same time also take into account factors to ensure balance in the health insurance fund.
The Ministry of Health proposes to add more benefits for patients when examining with health insurance at the grassroots level, reducing the burden on upper-level health care.
PHOTO: DAU TIEN DAT
According to Ms. Trang, the situation after a serious illness should not become poverty and bankruptcy due to the burden of medical expenses. Therefore, health insurance is also a social security issue. Therefore, along with the principle of preserving funds, it is still necessary to include social security policies and many groups participating in health insurance are due to the state budget buying health insurance cards.
In fact, more than 40% of the health insurance fund's 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.
The draft law on health insurance proposes additional benefits for patients, including basic content such as: patients with health insurance when receiving treatment at the central or provincial level, when returning to the district health center, will still enjoy the same drug benefits as the upper level. If approved, patients will not have to go to the central level for treatment, thus helping to reduce the load on the central level.
Regarding administrative procedures, the draft law on health insurance proposes to cut down on procedures for treatment referral.
Specifically: for technical treatment services that have not been performed locally, patients can go directly to higher-level treatment, still enjoying full benefits, without having to apply for a referral for treatment. The local health department is responsible for issuing a list of medical services that have not been performed locally, based on the actual assessment and practice license, so that people know and proactively go to higher-level when they are sick.
In addition, in reality, drugs and medical supplies paid for by the health insurance fund are in short supply at public hospitals, forcing health insurance patients to buy them themselves. To ensure the rights of patients, the draft law on health insurance proposes that hospitals will pay for patients, and then these costs will be paid by the health insurance fund to the hospital.
The Ministry of Health proposes to expand the benefit level for health insurance patients based on the principle of balancing revenue and expenditure.
"Adjust benefits but balance contribution levels and health care requirements in each period. This time, we propose to adjust some benefits but not abnormally increase costs from the health insurance fund," Ms. Trang affirmed.
Surplus but still consider the risk of negative funds
Commenting on expanding the scope of benefits when examining and treating health insurance, Mr. Nguyen Tat Thao, Deputy Head of the Health Insurance Policy Department (Vietnam Social Insurance), said that social insurance supports expanding benefits for patients, but the Ministry of Health needs to have a comprehensive 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 the basic salary; there were regulations on payment ceiling and co-payment, the health insurance fund balanced revenue and expenditure.
2016 - 2023: medical service prices are adjusted, there is an additional structure for medical staff salaries, the list of drugs is expanded, and the number of medical examinations and treatments has increased after the Covid-19 pandemic. The fund had an imbalance in revenue and expenditure. Only in the 3 years of 2020 - 2022 did there 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 drugs and medical supplies, so payments decreased.
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.
The representative of the Social Insurance said that if the management cost is included in the price of medical services, it will increase spending 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 spending by about 67,000 billion VND . Therefore, the Ministry of Health should consider the balance of revenue and expenditure when expanding the benefits of health insurance patients.
The Ministry of Health proposes to expand the rights to medical examination and treatment and reduce cumbersome administrative procedures. The proposals all include policy impact assessments, including making it more convenient for health insurance patients, and proposing a balance between revenue and expenditure to ensure that health insurance patients have access to medical services. To balance the fund, it is possible to consider adjusting the health insurance premium to suit socio-economic conditions.
( Ms. Tran Thi Trang, Director of Health Insurance Department, Ministry of Health )
Source: https://thanhnien.vn/quy-bhyt-du-40000-ti-dong-bo-y-te-de-nghi-tang-quyen-loi-nguoi-benh-185240829185820803.htm
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