According to the Ministry of Health, with the new points in the Law amending and supplementing a number of articles of the Law on Health Insurance, which has just been passed by the National Assembly, it will fundamentally resolve the urgent problems and difficulties after 15 years of implementing the Law on Health Insurance, ensuring the consistency and synchronization of the legal system, ensuring social security, rights and interests of health insurance participants, medical examination and treatment facilities, contributing to gradually reducing the rate of direct out-of-pocket expenditure of health insurance participants and strengthening the management and effective use of the health insurance fund.
Compared with the current Law, the Law amending and supplementing a number of articles of the Law on Health Insurance has 8 basic new groups of points as follows:
Firstly, amend and update the participating subjects, thereby adding subjects already prescribed by other Laws, adding subjects of village health workers and village midwives to encourage, motivate and have appropriate policies for subjects of health care for people in remote areas and be fair to other subjects in residential groups; assign the Government to stipulate other arising subjects after reporting to the National Assembly Standing Committee.
Adjust the responsibility for paying health insurance, payment method, payment period, responsibility for making the list of health insurance payments, and the validity period of the card to be consistent with the amendment of health insurance participants and in sync with the provisions of the Law on Social Insurance and other relevant laws.
Second, regulations on health examination and treatment under health insurance, including initial registration for health examination and treatment under health insurance, and transfer of patients between health examination and treatment facilities under health insurance according to the technical expertise level of the Law on Health Examination and Treatment 2023.
The Law stipulates the rights of health insurance card holders to register for initial health insurance examination and treatment at primary and basic health examination and treatment facilities...
At the same time, regulations on transferring medical examination and treatment facilities are implemented according to professional requirements and the ability of the medical examination and treatment facility to respond, and transferring patients to the initial medical examination and treatment facility covered by health insurance for treatment and management of chronic diseases.
Third, regulate the level of health insurance benefits when implementing universal health insurance examination and treatment in the direction of not distinguishing administrative boundaries by province, maintaining the stable rate of health insurance benefits according to the provisions of the current Law and expanding it to some cases.
Accordingly, health insurance participants are entitled to 100% of the benefits when examining and treating at initial health insurance medical examination and treatment facilities nationwide; 100% of the benefits when going for inpatient examination and treatment at basic health insurance medical examination and treatment facilities nationwide;
100% of the benefit level when examining and treating at any basic or specialized health insurance medical examination and treatment facility that before January 1, 2025 has been determined by a competent authority to be at the district level.
In particular, in some cases of rare diseases, serious illnesses... patients are taken directly to specialized medical examination and treatment facilities.
At the same time, the Law has expanded some scope of benefits for people with health insurance cards, including treatment of strabismus and refractive errors of the eyes for people under 18 years old;
Fourth, adjust the ratio of expenditures for health insurance examination and treatment, reserve expenditures and organization of health insurance activities from the health insurance premiums...
Clearly stipulate the deadline for notifying the results of medical examination and treatment cost appraisal to overcome the problem of extending the payment and settlement time.
Fifth, supplement 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 and stipulate the mechanism for the health insurance fund to pay for these cases.
Sixth, add specific regulations on late payment and evasion of health insurance payment and measures to handle these cases.
Seventh, 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 health insurance medical examination and treatment services;
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...
Eighth, supplement regulations on electronic health insurance issuance, regulations on state audit to audit the annual report on settlement of health insurance organization and operation expenditures of social insurance agencies to synchronize with the Law on Social Insurance.
