Urgent issues in health insurance payment

ANH HUY |

According to the Social Committee, the most pressing issue currently in the settlement of health insurance treatment costs is the assessment of the reasonableness of medical service provision.

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.

Bo truong Bo y te Dao Hong Lan. Anh: Quochoi.vn
Minister of Health Dao Hong Lan. Photo: Quochoi.vn

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 addition, the "suspension" of settlement of health insurance examination and treatment costs is due to the difficulty in reaching agreement between the appraisal agency and the medical examination and treatment facility on the reasonableness of service provision.

There are opinions that social insurance does not have enough capacity to implement, therefore, it is proposed 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.

ANH HUY
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