Providing medical examination and treatment under health insurance regardless of administrative geography

Health insurance fund surplus of about 40,000 billion VND

"The annual health insurance fund is almost balanced from 5% of the reserve fund, this fund is increasing day by day, some years it has a surplus of 58,000 billion VND. Currently, the fund has a surplus of about 40,000 billion VND". This information was announced by a representative of the Department of Health Insurance (Ministry of Health) at a conference on implementing the revised Law on Health Insurance, organized by the Ministry of Health today, March 27.

From 1.7 people participating in health insurance have more benefits

PHOTO: NGOC THANG

At the conference, Professor Tran Van Thuan, Deputy Minister of Health, said that the revised Law on Health Insurance has a number of major policies on health insurance medical examination and treatment, in the direction of expanding benefits and making it more convenient for health insurance participants, as well as increasing responsibility for those who pay health insurance premiums and transparency in payment settlement.

Accordingly, the Law on Health Insurance has amended and updated the participants; adjusted the responsibility for paying health insurance, the method, payment period, the responsibility for making a list of health insurance payments, the validity period of the card; regulations on health insurance examination and treatment, including initial medical examination and treatment registration, transferring patients between health insurance examination and treatment facilities according to the technical expertise level of the 2023 Law on Medical Examination and Treatment. Patients can choose the initial medical examination and treatment facility as well as transfer medical examination and treatment facilities flexibly, according to professional requirements.

Medical examination and treatment information, increase payment level

Notably, the law also stipulates the level of health insurance benefits when implementing health insurance medical examination and treatment without distinguishing between administrative boundaries by province.

Accordingly, patients are entitled to 100% of the benefits when examining and treating at the primary 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 is identified as a district level before January 1, 2025. In particular, in some cases of rare diseases, serious diseases..., patients are sent directly to specialized medical facilities.

In addition, the law also adjusts the ratio of expenditures for health insurance examination and treatment, reserve expenditures and organization of 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.

The Law also adds specific provisions on late payment and evasion of health insurance payment and measures to handle these cases, along with many other important provisions.

Mr. Thuan also said that the Law on Health Insurance will take effect from July 1, 2025, in which some important provisions have been applied from January 1, 2025, to ensure timely implementation of some benefits for patients receiving medical examination and treatment under health insurance.

Source: https://thanhnien.vn/thong-cap-kham-chua-benh-bao-hiem-y-te-khong-phan-biet-dia-ly-hanh-chinh-185250327093544846.htm