Sharing this issue, a representative of the Health Insurance Department - Ministry of Health said that the proposed 100% health insurance coverage rate for some specific cases means that patients will be covered for the maximum cost. Medical examination and treatment within the scope of entitlement.
"This does not mean that health insurance covers 100% of medical examination and treatment costs" - said a representative of the Health Insurance Department.
Accordingly, medical examination and treatment costs are within the scope of benefits and benefit levels according to the provisions of the current Health Insurance Law according to payment rates of 80%, 95% and 100% for each specific case.
Regarding the proposal, for some specific cases that are not subject to the order and procedures for medical examination and treatment covered by health insurance, a representative of the Health Insurance Department explained, for example, patients with blood, cardiovascular diseases, …
Diseases that can only be treated by specialized medical facilities at the final level, patients do not need to apply for a referral letter in order. Patients go to a specialized facility and are entitled to 100% of medical examination and treatment costs within the scope of benefit and benefit level according to regulations.
Similarly, patients with rare and dangerous diseases such as cancer , stroke, polio, etc. will also be covered 100% of medical examination and treatment costs within the scope of benefits and benefit levels according to regulations. There is no need for referral according to the medical examination and treatment process covered by health insurance.
In addition, the Ministry of Health also proposed a regulation that when patients with chronic diseases are transferred to the primary medical examination and treatment facility, they will be given specialized drugs and drugs used at a higher professional level. .
At the same time, the health insurance fund pays 100% of the medical examination and treatment costs according to the scope of benefits and the level of benefits of the health insurance participant.
Previously, in the impact assessment report of the draft Law amending and supplementing a number of articles of the 2nd Law on Health Insurance, the Ministry of Health proposed to regulate the health insurance coverage ratio of 100% of medical examination costs. diseases and medical treatment within the scope of benefits and benefit levels for:
- Some special cases are not subject to the order and procedures for medical examination and treatment covered by health insurance, transferring patients between medical examination and treatment facilities covered by health insurance according to regulations of the Ministry of Health.
- In cases where a patient has a confirmed diagnosis of a number of rare diseases, serious diseases, diseases requiring surgery, complex procedures or the use of high technology, they can go directly to a specialized medical examination and treatment facility. Higher professional and technical capacity according to regulations of the Ministry of Health.
According to the assessment of the Ministry of Health, this regulation helps save costs for the health insurance fund because patients do not have to be examined many times at the lower level and re-examined at the upper level. This helps reduce the number of medical examinations and increase the effectiveness of each treatment session.
People save on travel costs and co-payment costs in case they have to go for urgent medical examination or treatment themselves.
According to current regulations, the list of serious diseases includes 42 types of diseases such as cancer, coronary artery surgery, stroke, hearing loss, Parkinson's disease, polio, etc.
