In which cases are patients transferred directly to a higher level?

From January 1, 2025, patients with serious or rare diseases will be transferred directly to specialized medical facilities without going through intermediate steps.

This is one of many important new points in the Law amending and supplementing a number of articles of the Law on Health Insurance recently passed by the National Assembly, expanding benefits and reducing burdens for people.

From January 1, 2025, patients with serious or rare diseases will be transferred directly to specialized medical facilities without going through intermediate steps.

After 15 years of implementation, the Law on Health Insurance has come into effect, with 93.35% of the population participating in health insurance. This is a testament to the correctness and appropriateness of the health insurance policy, based on the principle of risk sharing, ensuring financial security for medical examination and treatment needs and social security.

In order to overcome difficulties and obstacles in practice and to be consistent with the Law on Medical Examination and Treatment No. 15/2023/QH15, the Ministry of Health has proposed and developed a Law amending and supplementing a number of articles of the Law on Health Insurance.

Compared with the current Law, the Law amending and supplementing a number of articles of the Law on Health Insurance has 8 basic new groups of points as follows:

Amend and update the participating subjects: Add the subjects that have been prescribed by other Laws, add the subjects of village health workers and village midwives to encourage, motivate and have appropriate policies for the subjects of health care for people in remote areas, while ensuring fairness with other subjects in residential groups; assign the Government to prescribe other arising subjects after reporting to the National Assembly Standing Committee.

Adjusting the responsibility for paying health insurance, payment method and deadline: Regulating the responsibility for making a list of health insurance payments, the validity period of the card to suit the amendment of health insurance participants and in sync with the provisions of the Law on Social Insurance and other relevant laws.

Regulations on medical examination and treatment under health insurance: Initial registration for medical examination and treatment under health insurance.

Transfer patients between health insurance medical examination and treatment facilities according to the technical expertise level of the Law on Medical Examination and Treatment 2023.

Rights of health insurance card holders in registering for initial health insurance examination and treatment at initial and basic level medical examination and treatment facilities.

Principles for allocating health insurance cards to facilities registering for initial medical examination and treatment; assign the Minister of Health, the Minister of Public Security, and the Minister of National Defense to issue detailed regulations and instructions for implementation.

Regulations on health insurance benefits: No distinction between administrative boundaries by province. Maintain stable health insurance benefits according to current law and expand to some cases.

Health insurance participants are entitled to 100% of the benefits when examining and treating at primary health insurance medical examination and treatment facilities nationwide; inpatient examination and treatment at basic facilities nationwide; and examination and treatment at basic and specialized facilities that have been identified as district level before January 1, 2025.

In some cases of rare or serious illnesses, patients are taken directly to a specialized medical facility for examination and treatment.

Extended benefits: Treatment of strabismus and refractive errors of the eyes for people under 18 years old.

Adjust the expenditure ratio from the health insurance fund: Increase the allocation from health insurance revenue to spend on medical examination and treatment activities to 92%, reduce the amount for the reserve fund and organization of health insurance fund activities to 8%, of which at least 4% is for the reserve fund.

Clearly stipulate the deadline for notifying the results of medical examination and treatment cost appraisal to overcome the problem of extending the payment and settlement time.

Supplementing payment mechanism: Payment for drugs and medical equipment transferred between medical examination and treatment facilities.

Payment for paraclinical services is transferred to other facilities in case of shortage of drugs and medical equipment. Application of information technology, digital transformation: Regulations on issuing electronic health insurance cards.

Sharing data in the field of health insurance, connecting and using clinical results between medical examination and treatment facilities. Providing solutions to enhance the capacity of medical examination and treatment under health insurance for grassroots health care.

Issue principles and criteria for developing a list of drugs, medical equipment, and medical services covered by health insurance to ensure standardization, transparency, and publicity.

Strengthening management and handling of violations: Regulations on late payment, evasion of payment of health insurance and handling measures. Regulations on the responsibility of the Ministry of Health in reviewing and regularly updating treatment regimens. Regulations on assessing the reasonableness of providing health insurance examination and treatment services.

With the above new points, the Law amending and supplementing a number of articles of the Law on Health Insurance will fundamentally resolve the urgent problems and difficulties after 15 years of implementing the Law on Health Insurance, ensuring the consistency and synchronization of the legal system, ensuring social security, rights and interests of health insurance participants and medical examination and treatment facilities.

At the same time, the law contributes to gradually reducing the rate of direct out-of-pocket spending from people and strengthening the management and effective use of the health insurance fund.

Source: https://baodautu.vn/truong-hop-nao-nguoi-benh-duoc-chuyen-thang-tuyen-tren-d231233.html