End the need for cancer and rare disease patients to go through the trouble of getting referral papers
Ms. Tran Thi Trang, Director of the Department of Health Insurance, said that Circular 01 stipulates that some rare, serious diseases, diseases requiring surgery or high technology will be covered by 100% health insurance when going directly to specialized medical facilities without a referral form. The Circular also issued a list of 62 diseases that can be examined at specialized facilities, 167 diseases at basic facilities and 141 diseases that can be referred within 1 year.
Ms. Trang emphasized that this regulation is important in improving the quality of medical examination and treatment, helping patients access and promptly treat diseases requiring specialized expertise that lower-level medical facilities are not qualified for. It also reduces referral procedures, costs of moving and transporting patients, and other costs, helping to save costs for patients and their families, while effectively using the health insurance fund.
As soon as this Circular takes effect on January 1, 2025, at K Hospital alone - the final line of cancer treatment in the country, more than 20,000 cancer patients will not have to apply for a referral for the new year.
"We are so happy, because every time we ask for a referral from a provincial medical facility to the K Hospital, we have to spend a whole day returning to our hometown to complete the referral procedures. Sometimes we have to ask for a long time to get it" - patient Nguyen Van Kien (56 years old, Ninh Binh - the character's name has been changed), has colon cancer, and is being treated at Tan Trieu K Hospital shared.
In the bed next to him, patient Pham Tien Long (46 years old, Thanh Hoa - name has been changed) also said: "Ask for a referral letter is really a nightmare for cancer patients like us, it takes time and money. From now on, we can rest assured to receive treatment at the final level."
Deputy Minister of Health Tran Van Thuan assessed this as "immediately effective", helping patients benefit from the new regulations on health insurance payments. This is an important document guiding the initial registration for health insurance examination and treatment and transferring health insurance examination and treatment facilities to over 13,000 health examination and treatment facilities nationwide, creating a synchronous legal corridor for effective implementation of health insurance policies in the new period.
Worry about overload at end-line hospitals
When implementing Circular 01, many problems still arise at medical facilities. A representative of Bach Mai Hospital said that in the 62 disease categories, there are categories of status and conditions, many diseases do not have conditions and status listed, so how will it be implemented?
Sharing about the difficulties that may arise when implementing the Circular, a representative of Viet Duc Friendship Hospital said: "We are worried about the problem of overload when implementing the Circular. The issue of health insurance ceiling also needs to be specifically regulated to avoid causing difficulties for medical facilities. Moreover, currently, the diagnostic capacity at lower-level medical facilities in many places is not enough, and the disease has not been detected for the people, but when they reach the final level, after being diagnosed in depth, the patient is found to have other common diseases, then they should also be accepted for health insurance payment when treating those diseases. If it is transferred back to the lower level, it will be very troublesome for the patient."
Regarding the concerns of hospitals, Director of the Health Insurance Department Tran Thi Trang said that the entire group of cancer diseases, with more than 1,000 disease codes, will be initially diagnosed at provincial hospitals. If all 1,000 disease codes are put on the list, it will definitely be overloaded.
"Through reviewing provincial medical facilities, we classify specific cancers that lower-level hospitals nationwide are almost incapable of diagnosing, and will be sent directly to higher-level hospitals such as malignant tumors in the pancreas, malignant tumors in the lungs, meninges, etc. The rest will be left for the provincial level to diagnose, this is a professional classification" - Ms. Trang analyzed.
