On September 16, Vietnam Social Security informed about the proposed amendments to the draft Law on Health Insurance. According to Vietnam Social Security, amending and supplementing the concept and content of health insurance appraisal is an urgent and necessary issue to overcome the limitations, difficulties and inadequacies of the current Law on Health Insurance.
At the same time, responsibilities between parties are clearly and transparently defined, tasks are assigned in accordance with the functions and duties of the parties and ensure feasibility in implementation.
This amendment brings positive impacts not only to the social insurance agency, health insurance medical examination and treatment facilities, and state health management agencies, but also ensures the rights and interests of health insurance patients.
For health insurance patients, the amendment of the concept of health insurance assessment does not reduce the rights of health insurance participants nor does it affect the health insurance treatment process of health insurance participants because the inspection, review, and comparison are carried out after the patient has completed the treatment process. In terms of expertise, health insurance patients are still assessed and prescribed according to their medical condition.
For the Social Insurance agency, the task of the Social Insurance agency's health insurance appraiser is still to check, review, and compare the payment requests of the health insurance medical facility with the provisions of the law on health insurance and other relevant legal provisions as a basis for determining the health insurance costs within the scope of payment of the health insurance fund and ensuring the rights of health insurance participants when receiving health insurance medical care.
In fact, in recent years, the number of health insurance-covered medical examinations has increased rapidly, the number of records and costs requested for health insurance payment has also increased, while the number of officials doing health insurance appraisal work has not increased because Vietnam Social Security has strictly implemented the policy of streamlining the payroll according to the regulations of the Party and the State.
In the coming time, the Social Insurance Agency will continue to strengthen the implementation of health insurance appraisal to effectively manage and use the health insurance fund, in accordance with the provisions of law, contributing significantly to the basis for unifying appraisal results between the Social Insurance Agency and health insurance medical facilities, overcoming the current situation of slow payment and settlement of health insurance medical expenses. At the same time, it will protect the rights of health insurance participants.
For health insurance medical facilities, after the concept of health insurance appraisal is revised, it will overcome the maximum lack of consensus on medical expertise between health insurance medical facilities and social insurance agencies and limit the arising of problems in implementing health insurance policies and laws.
Contribute significantly to the implementation of payment and settlement of health insurance medical examination and treatment costs with health insurance medical examination and treatment facilities ensuring the time according to the provisions of the Health Insurance Law.
Ensuring the rights and responsibilities of medical practitioners and medical facilities in providing medical examination and treatment to patients as stipulated in the Law on Medical Examination and Treatment.
According to Vietnam Social Security, for the State health management agency, there will be no additional work for other agencies because the inspection, examination, and evaluation of treatment prescriptions, drugs, technical services, and quality control of medical examination and treatment... as stipulated in the Law on Medical Examination and Treatment are the responsibility of the State health management agency.
The responsibilities between the parties are clearly and transparently defined, and the assigned tasks are in accordance with the functions and duties of the parties as stipulated in the Law on Health Insurance.
In addition to the proposal to amend the concept and content of health insurance appraisal, Vietnam Social Security also proposed many solutions to ensure health insurance benefits for participants and have been basically incorporated into the draft revised Law on Health Insurance, such as cases of serious and fatal diseases treated in the wrong hospital, without needing a referral letter (instead of having to have a referral letter as at present); health insurance payment for cases of treatment of strabismus, myopia and refractive errors of the eyes for people under 18 years old (instead of only for people under 6 years old as at present)...
Currently, the draft amended and supplemented Law on Health Insurance is continuing to collect opinions from ministries, branches and experts; it is expected to be submitted to the National Assembly in October 2024.
