Ms. Tran Thi Trang, Director of the Ministry of Health, said that this draft amendment to the Law on Health Insurance focuses on adjusting 4 policies. These are adjusting the subjects participating in health insurance in line with the provisions of relevant laws; adjusting the scope of health insurance benefits in accordance with the contribution level, balancing the health insurance fund and health care requirements in each period; adjusting relevant health insurance regulations according to the level of technical expertise in medical examination and treatment and effectively allocating and using the health insurance fund.
The Ministry of Health stated that participating in health insurance has contributed to reducing household out-of-pocket spending on health care. However, currently, the out-of-pocket spending rate in Vietnam is still relatively high, accounting for about 45% of medical expenses.
In addition, the fact that medical service prices are not calculated correctly and sufficiently increases out-of-pocket costs. Some hospitals have difficulty purchasing drugs and medical supplies, leading to drug shortages and insufficient necessary drugs for patients. Drug bidding and drug management are not guaranteed, some necessary drugs are not supplied, so patients have to buy them from outside.
According to current regulations on medical examination and treatment for people with health insurance, when patients from communes go to third-class hospitals for examination and treatment, they do not need a referral letter, but when they go to second-class hospitals for examination and treatment, they must have a referral letter.
In fact, some localities do not have district hospitals (grade 3 hospitals) directly under the district health center, but have provincial regional hospitals located in the district (grade 2 hospitals). When patients from the commune come to see a doctor and receive treatment at a grade 2 hospital, they must have a referral letter.
Ms. Trang said that removing the requirement for referral letters for provincial hospitals located in the district is “a proposal that can help reduce inconvenience for patients. However, this also needs to be carefully considered to avoid overloading provincial hospitals, while ensuring feasibility and effectiveness in managing the Health Insurance Fund.
This draft revised Law on Health Insurance also proposes to allow the transfer of patients between health insurance medical examination and treatment facilities if it exceeds the technical expertise when the patient has been diagnosed with a number of chronic diseases. After being prescribed a prescription by a doctor at a higher level, the patient can go to a lower level for treatment and receive the same medicine and medical supplies as at a higher level. On the other hand, it also allows the transfer of medicine and medical equipment between health insurance medical facilities if they are not available and the patient cannot be transferred to another medical examination and treatment facility.
Some serious diseases, serious illnesses, and illnesses that require high technology, for which people currently have to get referral papers within the year in order from lower-level facilities to higher-level treatment facilities, will be adjusted in the direction of issuing a list of illnesses that must be treated at higher-level facilities without needing referral papers.
Medical examination and treatment costs for health insurance participants at some medical facilities in the right place or people who come to see a doctor themselves will also be adjusted.
