Speaking at the workshop, VSS Deputy General Director Pham Luong Son emphasised that the health insurance (HI) assessment was an important document with great influence, affecting all participating units and agencies in organising and implementing health insurance policies.

VSS has issued a health insurance assessment process at least four times, he said, adding that the practice shows that the assessment process in each period was appropriate, generating positive effects.

“First of all, it contributes to ensuring the maximum legal and reasonable interests of the HI participants when they go for medical treatment. At the same time, it ensures benefits for medical facilities and helps social security agencies control medical costs,” he said.

However, Son said that the current health insurance assessment process approved under Decision No. 1456/QD-BHXH had revealed some inappropriate contents, both in practice and in legal regulations.

As the Law on Health Insurance has been revised with many breakthrough contents, the HI assessment process also needs to be updated to match the legal and practical basis, he said.

Particularly, it was necessary to solve difficulties and problems, as well as controversial issues between medical treatment facilities and the social insurance agency, he said.

Deputy General Director of Vietnam Social Security Pham Luong Son.

“With the common goal of ensuring the interests of all parties during the implementation of the health insurance policy, especially the interests of HI participants, the amendment and supplementation of the HI assessment process is necessary, reaching the high consensus of the leaders of the Ministry of Health, Vietnam Social Security and from medical facilities,” Son said.

The draft of the HI assessment process has been developed for more than a year. Leaders of VSS and the Health Ministry have been carefully listening to and absorbing opinions to develop the draft.

At the workshop, Duong Tuan Duc, Director of the Centre for HI Assessment and Multidisciplinary Payments, said that VSS  sent written documents and organised two seminars seeking opinions to complete the HI assessment process proposal.

The proposed assessment process now consists of six chapters, including general provisions; assessing conditions for signing contracts for medical examination and treatment covered by health insurance; assessment of payment conditions for drugs, medical supplies and medical examination and treatment services; professional assessment of medical examination and treatment expenses covered by health insurance; managing and exploiting the health insurance assessment information system and managing medical expenses with health insurance on professional software; as well as the organisation and implementation.

Representatives from localities and agencies attend the online workshop.

Dang Hong Nam, Deputy Director of the Health Insurance Department under the Ministry of Health said that the Departments of Health and health facilities need to pay close attention to the revision and comment on the draft amendments to the health insurance assessment process.

“The assessment process has direct impacts on medical facilities. The revision work is very urgent, the Departments of Health and hospitals need to study and give recommendations responsibly.  The VSS and Health Ministry have accompanied and agreed at the highest level to try to develop a complete draft and process, contributing to the implementation of IT application in the 4.0 era, according to the direction of the Government, as well as the need to remove cumbersome procedures,” he said

Assessment process needs to be changed

At the workshop, representatives of social insurance agencies of provinces and cities, leaders of the Department of Health and representatives of hospitals shared concerns, recommendations and suggestions.

Le Van Phuc, Head of Secondary School Health Insurance under the VSS, said that insurance activities were always related to assessment and payment activities. Regarding health insurance activities, the assessment work is not only associated with the social insurance agency but also healthcare facilities.

“2022 is the 30th anniversary of the implementation of the health insurance policy in Vietnam. The assessment process in recent years has been continuously renewed and perfected, associated with legal documents and the innovation of IT,” he said.

Overview of the workshop

Speaking at the conclusion of the workshop, VSS Deputy General Director Pham Luong Son said that VSS and the Health Ministry determined to improve and complete the HI assessment process so that the legal framework would further meet practical demands.

Son requested social insurance agencies of provinces and cities to send written comments to VSS this month. After receiving documents from provinces and medical facilities, VSS will urgently complete the draft before March 8.

The Health Insurance Policy Implementation Board is the focal point to organise a meeting with the Health Insurance Department and the Medical Services Administration (Ministry of Health) to finalise opinions and submit a report on the appraisal of the assessment process so that the agency could issue a new HI assessment process this month.