Eliminate "administrative boundaries" in health insurance examination and treatment from the beginning of 2025

On the afternoon of November 27, with 446/455 delegates in favor, the National Assembly passed the Law amending and supplementing a number of articles of the Law on Health Insurance, effective from July 1, 2025.

On the afternoon of November 27, the majority of delegates voted to pass the Law amending and supplementing a number of articles of the Law on Health Insurance. (PHOTO: DUY LINH)

On the afternoon of November 27, the majority of delegates voted to pass the Law amending and supplementing a number of articles of the Law. Law on Health Insurance. In which, the National Assembly decided that health insurance participants will be paid for medical examination and treatment at home; "administrative boundaries" in health insurance examination and treatment will be removed from the beginning of 2025.

Home medical examination and treatment is covered by health insurance.

At the meeting, Chairwoman of the National Assembly's Social Committee Nguyen Thuy Anh presented a report explaining, accepting and revising the draft law.

Chairwoman of the Social Committee Nguyen Thuy Anh said that, taking into account the opinions of National Assembly deputies, the draft law submitted for approval has stipulated in the direction of expanding the scope of health insurance benefits with the form of remote medical examination and treatment, support for remote medical examination and treatment, family medical examination and treatment, and medical examination and treatment at home. This is to synchronize with the Law on Medical Examination and Treatment in 2023.

Specifically, Article 21 stipulates that health insurance participants are paid by the health insurance fund for medical examination and treatment costs, including remote medical examination and treatment, support for remote medical examination and treatment, family medical examination and treatment, medical examination and treatment at home, rehabilitation, periodic pregnancy examinations, and childbirth.

In addition, the National Assembly Standing Committee has directed the design of the draft law regulating the level of health insurance benefits on the basis of eliminating "administrative boundaries" in medical examination and treatment, maintaining the stability of the level of health insurance benefits according to the provisions of current law.

The new health insurance law also expands to include some cases, such as rare diseases, serious illnesses... that can be taken directly to specialized medical examination and treatment facilities.

Registration for initial health insurance examination and treatment is stipulated in Article 26. Accordingly, health insurance participants have the right to register for initial health insurance examination and treatment at initial or basic level medical examination and treatment facilities; have the right to change initial health insurance examination and treatment facilities within the first 15 days of each quarter.

The allocation of the number of health insurance cards to the initial health insurance examination and treatment registration facilities must ensure balance and suitability with the initial health insurance examination and treatment needs of the people, the response capacity of the medical examination and treatment facilities and the actual capacity of the locality.

The Minister of Health shall specify in detail the registration for initial health insurance examination and treatment; cases of registration for initial health insurance examination and treatment at specialized medical examination and treatment facilities.

8 basic new points compared to current law

Notably, compared to the current law, the law has 8 basic new groups of points, including:

The first, modify, update participants, responsibilities Health insurance payment, payment method, payment period, responsibility for making health insurance payment list, card validity period to be more consistent and synchronized with the provisions of the Law on Social Insurance and other relevant laws.

Monday, Regulations on medical examination and treatment under health insurance, including initial registration for medical examination and treatment under health insurance, transferring patients between medical examination and treatment facilities under health insurance according to the technical expertise level of the Law on Medical Examination and Treatment 2023.

Tuesday, Regulate the level of health insurance benefits when implementing universal health insurance examination and treatment regardless of administrative boundaries, maintain the stability of the health insurance benefit rate according to current law and expand it to some cases.

Some cases of rare diseases, serious diseases... are taken directly to specialized medical examination and treatment facilities; some scope of benefits for people with health insurance cards is expanded, including treatment of strabismus and refractive errors of the eyes for people under 18 years old.

Regulations on transferring chronic disease cases to primary health care facilities for management in some cases to promote the role of primary health care facilities.

The new law passed by the National Assembly regulates health insurance benefits based on the elimination of “administrative boundaries” in medical examination and treatment. This regulation takes effect from January 1, 2025.

Wednesday, Adjust the ratio of expenditures for medical examination and treatment under health insurance, reserve expenditures and organization of health insurance activities from health insurance premiums; clearly stipulate the deadline for notification of the results of medical examination and treatment cost appraisal to overcome problems related to prolonging payment and settlement time.

Thursday, Supplementing 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.

Friday, Supplement specific regulations on late payment, evasion of health insurance payment and measures to handle these cases.

Saturday, Regulations on the responsibility of the Ministry of Health in reviewing and regularly updating treatment regimens to ensure convenience in medical examination, treatment and health insurance payment.

Regulations on assessing the reasonableness of providing medical examination and treatment services under health insurance; regulations on the application of information technology, digital transformation, data sharing in the field of health insurance, the connection and use of paraclinical results between medical examination and treatment facilities in accordance with professional requirements and 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.

Eighth, Supplementing regulations on issuing electronic health insurance cards, regulations on state audit to audit the annual report on settlement of health insurance organization and activities of social insurance agencies to synchronize with the Law on Social Insurance.

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