On September 25, continuing the 37th session, the National Assembly Standing Committee gave opinions on the Draft Law amending and supplementing a number of articles of the Law on Health Insurance (HI).
Presenting the report, Minister of Health Dao Hong Lan said that the Draft Law amends and supplements 40 articles on subjects participating in health insurance, responsibility for payment, benefits, scope of benefits, organization of health insurance examination and treatment, fund management and some technical regulations.
Minister of Health Dao Hong Lan stated that the Draft Law fully reflects the four policy groups approved by the Government.
Including adjusting the scope of health insurance benefits to suit the contribution level, balancing the health insurance fund and health care requirements in each period; effectively allocating and using the health insurance fund.
The Minister of Health also stated that the new amendments are urgent and have clear information and data to overcome difficulties and shortcomings, ensure the rights of health insurance participants, and improve the efficiency of fund management and use.
After preliminary examination, the Standing Committee of the National Assembly's Social Committee basically agreed with the scope of amendments and supplements and found that the content of the draft Law is basically consistent with the purpose and requirements of law making. The amended provisions basically follow the 4 policies approved in the proposed Law.
However, the draft Law still has some adjustments such as: Some contents have been omitted such as policies on supplementary health insurance; some policies have been expanded such as expanding the subjects participating in compulsory health insurance; regulations on payment of health insurance medical examination and treatment costs.
Regarding payment and settlement of health insurance examination and treatment costs, the preliminary audit report clearly stated that the Standing Committee of the Social Committee found that the most pressing issue currently in payment and settlement of health insurance examination and treatment costs is the assessment of the reasonableness of medical service provision when assessing health insurance.
In reality, medical facilities are specialized agencies with a team of well-trained, qualified, and most specialized doctors and nurses, who are also the ones who directly examine, treat, and understand the patient's condition. Therefore, the regulation that the Social Insurance agency is responsible for checking and evaluating the prescriptions for the use of drugs, medical supplies, technical services, etc. by doctors and nurses is not consistent with the functions and expertise of the Health Insurance assessor.
Not to mention, in many cases, to evaluate treatment indications, it is necessary to have a medical professional council undertake the task; human resources for health insurance appraisal are trained from many different majors such as: medicine, pharmacy, economics and finance... and are currently very lacking.
The shortcomings of this regulation have led to difficulties for the Social Insurance Agency and medical facilities to reach consensus on the appraisal results, leading to delays in payment of health insurance medical examination and treatment costs, affecting the medical examination and treatment activities of medical facilities. Therefore, it is recommended to study and revise the concept of "health insurance appraisal" in the current Law.
Chairman of the Social Committee Nguyen Thuy Anh suggested that the Drafting Committee study and supplement regulations on the competent authority to make the final decision when there is no professional consensus between the health insurance medical examination and treatment facility and the social insurance agency.
The Social Committee also requested the Government to continue to complete the component documents of the dossier, noting: The impact assessment report needs to supplement more thorough and comprehensive assessment content, especially the newly added component policies; supplement the opinions of the Ministry of Finance.
