Amending the Law on Health Insurance in the direction of expanding benefits and convenience for participants

Patients with health insurance see a doctor at a medical facility.

On November 27, 2024, the Law amending and supplementing a number of articles of the Law on Health Insurance was passed by the National Assembly . This is an important milestone, demonstrating the determination to reform administration, facilitate people, reduce paperwork, promote digital transformation and improve the effectiveness of health insurance policy implementation. The Law on Health Insurance (amended) takes effect from July 1, 2025, with a number of important provisions applied from January 1, 2025 to ensure timely implementation of a number of benefits for patients receiving health insurance examination and treatment.

At the conference, Deputy Minister Nguyen Van Thuan presented a number of new and outstanding policies of the Law on Health Insurance (amended). Specifically, the Law amends and updates the subjects of participation, adjusts the responsibility for paying health insurance, the method, payment period, responsibility for making a list of health insurance payments, and the validity period of the card; Supplements regulations on health insurance medical examination and treatment, including initial medical examination and treatment registration, and patient transfer between health insurance medical examination and treatment facilities according to the technical expertise level of the 2023 Law on Medical Examination and Treatment. Patients can choose their initial medical examination and treatment facility as well as transfer medical examination and treatment facilities flexibly, according to professional requirements.

Regarding the regulation on health insurance benefits when implementing the health insurance medical examination and treatment in the direction of not distinguishing administrative boundaries by province. Accordingly, patients are entitled to 100% of the benefits when examining and treating at the initial level nationwide, 100% of the benefits when examining and treating at the basic level nationwide, 100% of the benefits when examining and treating at any basic or specialized medical facility that before January 1, 2025 is determined to be a district level. In particular, in some cases of rare diseases, serious diseases... patients are sent directly to specialized medical examination and treatment facilities.

The amended law also adjusts the ratio of expenditures for health insurance examination and treatment, reserve expenditures and health insurance activities from health insurance premiums; Supplements the mechanism for payment of drugs and medical equipment transferred between medical examination and treatment facilities and payment of paraclinical service costs transferred to other facilities in case of shortage of drugs and medical equipment; Supplements specific regulations on late payment, evasion of health insurance payment and measures to handle these cases and many other important regulations.

The draft Decree detailing and guiding the implementation of a number of articles of the Law on Health Insurance consists of 12 chapters with 78 articles. Commenting on the draft, Mr. Duong Duc Tuan, Head of the Department of Health Insurance Policy Implementation, Vietnam Social Security proposed to improve the efficiency of resource use and the role of fund supervision by using controlled payment methods, applying information technology, authenticating electronic data, using paraclinical results, and connecting diagnostic images between health facilities.

Ms. Vu Nu Anh, Deputy Director of the Department of Health Insurance, Ministry of Health, said that the draft new decree proposes to increase the health insurance contribution support level to at least 50% (up from 30%) for high school students from grade 1 to grade 12. It is expected that the state budget will increase by 3,700 billion VND to increase the support level from 30% to 50%. For the group of students, currently about 2.8 million people, the support level remains at 30%. This content has been specifically added to the proposal, expected to be submitted to the government in the near future.

The newly added groups of subjects include: Village and hamlet health workers; village and hamlet midwives; non-professional workers in villages and residential groups as prescribed by law; people participating in the force to protect security and order at the grassroots level; victims of bombs, mines and explosives after the war; people awarded the title of People's Artisan, Meritorious Artisan according to the provisions of the Law on Cultural Heritage... are entitled to 50% support from the state budget when participating in social insurance.

According to the new regulations, payment of transportation costs is made at a fixed rate (0.2 liters of RON92 gasoline per 1 km), so payment documents do not require a red invoice for gasoline and are divided into 2 cases: Medical facilities provide the service themselves or patients provide their own means of transportation (paid once, one way, not paid two ways).

At the conference, delegates exchanged, discussed, and raised practical difficulties and problems from localities and establishments regarding payment of medical examination and treatment costs between social insurance agencies and medical examination and treatment establishments, between social insurance agencies and health insurance participants; application of information technology, digital transformation in health insurance implementation. The Ministry of Health will continue to receive comments and suggestions on the draft to contribute to perfecting the policy and ensuring effective implementation of the Law on Health Insurance in the coming time.

According to baotintuc.vn

Source: https://baolaocai.vn/sua-doi-luat-bao-hiem-y-te-theo-huong-mo-rong-quyen-loi-thuan-tien-cho-nguoi-tham-gia-post399387.html