Surplus insurance fund: Opportunity to expand people's rights
Prof. Dr. Tran Van Thuan, Chairman of the National Medical Council, said that by the end of 2023, the Health Insurance Fund (HI) has accumulated an outstanding VND 40,000 billion and is expected to continue to increase.
According to Mr. Thuan, the Ministry of Health is orienting a comprehensive amendment to the Law on Health Insurance to concretize the direction of General Secretary To Lam on gradually moving towards free medical examination and treatment for all people.
In the draft amendment, many important contents are proposed, especially expanding the scope of payment for screening and early detection services - a key factor in improving the quality of life and reducing the burden of long-term medical costs.
By the end of 2024, the health insurance coverage rate in Vietnam reached 94.2% of the population - an impressive figure, demonstrating the persistent efforts of the entire policy system and locality in popularizing social security. Notably, the health insurance fund is still maintaining a balance of revenue and expenditure, with a stable balance.
According to Article 35 of the amended Law on Health Insurance 2024, this fund is allocating 92% for medical examination and treatment, the remaining 8% is for reserve and management activities. In theory, the surplus can be used to increase benefits, especially for vulnerable groups such as children, the elderly, the poor, etc.
In an interview with reporters, lawyer Hoang Van Ha - ARC Hanoi Law Firm, Hanoi Bar Association commented: "The policy of moving towards free medical examination and treatment for people is the right orientation, in accordance with Article 38 of the 2013 Constitution - which recognizes the right to health care as a basic right of all citizens. However, there needs to be a careful assessment of feasibility, especially in finance and management".
A reality that has been pointed out is that the rate of increase in health insurance spending in recent years has always been higher than the rate of increase in revenue. Without a reasonable spending control strategy, the current surplus could quickly run out. The problem is how to both expand benefits and ensure long-term fund safety.
From humane policies to a solid legal corridor
According to lawyer Hoang Van Ha, to move towards the goal of free medical examination and treatment for all people, Vietnam needs a strict legal corridor and a strategic reform roadmap. In particular, the amendment of the Law on Health Insurance does not stop at changing the legal wording, but is also a change in approach to public health management.
First of all, it is necessary to improve the contribution mechanism to ensure fairness. Currently, the health insurance contribution rate is mainly based on the basic salary - a formula that does not accurately reflect actual income, especially for freelance and seasonal workers. Adjusting based on actual income, as a model applied by many countries, will help allocate financial responsibility more appropriately among population groups, while increasing the sustainability of the fund.
"Vietnam needs to learn from international experience from countries such as Canada, the UK, and Sweden - which have implemented the free medical examination and treatment model for many years. However, the common point of these countries is that they have a developed economy, a high tax system and especially a transparent and effective management mechanism. Vietnam wants to apply a similar model, need to set a roadmap suitable to current socio-economic conditions, avoid being hasty and leading to overloading the health system or financial imbalance" - lawyer Ha emphasized.
A weakness that experts point out is that the process of updating the list of drugs, techniques and treatment regimens covered by health insurance is still slow. Many advanced techniques and modern machines have not been widely used due to the lack of a flexible update mechanism. The solution is to regulate the frequency of specific updates (quarterly or annually), establish an independent Technical Council, allowing large hospitals to pilot new techniques before expanding nationwide.
Along with that, there needs to be a multi-layered health insurance model: Ensuring basic free medical examination and treatment for all people, combined with voluntary supplementary insurance packages for people with higher needs. This is a feasible direction, both ensuring humanity and helping people proactively choose a level of protection suitable for their personal financial capacity.
Another problem is the situation of taking advantage of health insurance - from incorrectly declaring medical records to creating fake payment records. The amendment of the law needs to increase sanctions to strictly handle fraudulent acts, while promoting the application of digital technology in monitoring medical examination and treatment costs. Medical data needs to be synchronized between the insurance, tax, and banking sectors to control income and avoid fund losses.
