The draft Law amending and supplementing a number of articles of the Law on Health Insurance (Law on Health Insurance 2024) is being consulted by ministries, branches and localities and is expected to be submitted to the National Assembly for consideration and comments at the session this October. One of the draft's adjustments is to increase benefits for people when participating in health insurance examination and treatment.
Ms. Tran Thi Trang - Director of the Ministry of Health said that the draft will focus on adjusting a number of policies to expand the number of people eligible for health insurance.
Accordingly, adjusting the subjects participating in health insurance in line with relevant legal regulations; 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.
This draft law will update the subjects who are social insurance participants as stipulated in the Social Insurance Law recently passed by the National Assembly.
Accordingly, employees in enterprises only need to work for one month to participate in health insurance (previously, they had to work for three months or more). Full coverage of health insurance participants will increase health insurance revenue from new participants, while at the same time, achieving the target of 95% universal health insurance as assigned by the Government.
The scope of benefits for patients with health insurance examination and treatment is also expanded. Some serious diseases, serious diseases, diseases requiring the use of high technology that people currently have to get referral papers for during the year in order from lower-level to higher-level treatment facilities, will be adjusted in the direction of issuing a list of diseases that must be treated at higher-level facilities without referral papers, which is both convenient for people and saves costs due to not having to examine and treat patients at lower-level and higher-level facilities.
The medical examination and treatment costs of health insurance participants at some medical facilities in the case of being in the right place or people coming to see a doctor themselves are also adjusted. District medical centers with outpatient examination and treatment functions, with outpatient general clinics, when people come to see a doctor, they are also covered by health insurance. At the same time, it is proposed that the health insurance fund pay 100% of the medical examination and treatment costs and have the prescribed benefit levels for patients who have been diagnosed by medical facilities with some rare diseases, serious diseases, diseases requiring surgery or using high technology according to the regulations of the Ministry of Health.
Supplementing a payment mechanism for drug transfer in cases where drugs have been purchased according to the most convenient regulations of the new Bidding Law but there is still a shortage of drugs to overcome the shortage of drugs and ensure the rights of health insurance participants, not allowing patients to buy by themselves and have their rights guaranteed.
Increase the rate of advance payment for health insurance examination and treatment costs for medical examination and treatment facilities every quarter from 80% to 90%. Adjust the rate of expenses for organization and management of health insurance funds (health insurance fund management costs) to reduce by 1% to increase direct expenses for medical examination and treatment from the beginning of the year (medical examination and treatment costs increase from 90% to 91%, maximum management costs decrease from 5% to 4%), save procedures, time for allocating and adjusting funds.
