Dr. Nguyen Duc Hoa - Deputy General Director of Vietnam Social Insurance delivered the opening speech of the Workshop

Towards building a comprehensive health insurance policy that ensures absolute rights for participants

In his opening remarks at the workshop, Dr. Nguyen Duc Hoa, VSS Deputy General Director, expressed his gratitude to the international partners and organizations that have contributed and supported the VSS in building policies, innovating payment methods, and evaluating the impact of health insurance policies. He particularly acknowledged the crucial support and contributions of USAID.

In accordance with the Memorandum of Understanding on Health Insurance Support in 2020, the USAID has collaborated and supported the VSS in building software for managing the supply and payment of drugs from the health insurance fund. They also provided training for data exploitation on the software for managing drug supply and payment from the health insurance fund. Furthermore, the USAID has improved the effectiveness of using the health insurance fund for medical expenses through activities such as sharing experiences in monitoring and supervising healthcare contracts when applying the DRG payment method, providing recommendations that are suitable for the Vietnamese context, and providing technical support to propose amendments to the Referral Policy to enhance the effectiveness of using the health insurance fund.

Contributions, lessons learned from some countries are shared from experts from WHO and WB organizations

Dr. Nguyen Duc Hoa stated that the Law on Health Insurance has regulated three payment methods for medical expenses between the social security agency and health facilities providing health insurance services since 2009, which are the prospective payment method, the payment method based on DRG, and the payment method based on service prices. However, after more than 30 years of implementing health insurance policies, Vietnam still mainly applies the payment method based on service prices.

Dr. Nguyen Duc Hoa expressed his confidence that with the contributions, lessons learned, and experiences shared by experts from WHO and WB, the VSS and related agencies will be able to build increasingly comprehensive health insurance policies, towards ensuring absolute rights for health insurance participants.

USAID will support Vietnam in enhancing technical capacity and effectiveness in using the health insurance fund

Sharing the same viewpoint with Dr. Nguyen Duc Hoa, Mr. Randolph Augustin - Director of the Health Program at USAID assessed that Vietnam is striving for efficiency in implementing health insurance policies, including payment reform. The ambitious targets of the Vietnamese government come with significant challenges. As a principal partner with the Vietnamese government in achieving universal health insurance coverage, the USAID through the LHSS project will not only share research findings but also provide recommendations that are suitable for the Vietnamese context, and technical support to enhance the effectiveness of using the health insurance fund.

The workshop also recorded many discussions to remove difficulties and obstacles in controlling health insurance costs

According to assessments, implementing the fee-for-service payment method as regulated in the Government's Decree No. 146/2018/NĐ-CP dated October 17, 2018, reveals weaknesses that require changes to ensure a high level of agreement among all parties involved in implementing the health insurance policy. This includes ensuring the rights of health insurance participants, balancing the interests of health facilities providing health insurance services to insured patients, and effectively using the health insurance fund.

Regarding the overall situation of implementing the health insurance policy in Vietnam from 2015 to 2022, representatives of the Department of Health Insurance Implementation (VSS) stated that with the goal of prioritizing the rights and benefits of health insurance participants, grasping and closely monitoring the practical situation, the VSS has always been proactive and supportive in creating conditions and maximizing support for health insurance participants. As a result, health insurance coverage has increased sharply over the years, with 92.04% of the population having health insurance cards.

In addition, Vietnam is still lacking "tools" to control healthcare costs. At the same time, the policy mechanism still does not have strong enough sanctions for cases where the supply of essential drugs and medical supplies is not ensured for health insurance participants. Sanctions for unreasonable medical services or wasting medical resources are not strong enough. Medical service prices have not been fully calculated, leading to patients having to pay price differentials with out-of-pocket expenses still accounting for 43% of Vietnam's total healthcare spending in 2016.

Therefore, how to increase financial resources from health insurance, improve the efficiency of using the health insurance fund, maintain and sustainably develop universal health insurance coverage, and cope with population aging is a problem that needs to be solved as soon as possible.

Addressing difficulties and obstacles in providing people with access to the best healthcare services, anytime, anywhere

At the seminar, delegates shared international experiences on "Applying DRG classification to hospital budget allocation" and "Contracts in the DRG payment system." They emphasized that "determining and managing healthcare service prices" is the top priority and the policy tool to achieve health policy objectives. Dr. Annie Chu - Health System Coordinator (World Health Organization - WHO) also shared some international experiences and suggestions for Vietnam.

Overview of the workshop

Dr. Sarah Bales, an independent expert from the Sustainable Health Systems Development project (USAID), shared international experiences on building monitoring and evaluation systems for the implementation of DRG. She noted that in the process of reforming the health insurance payment system, when Vietnam transitioned from fee-for-service payment to DRG payment for provincial-level inpatient treatment, the monitoring and evaluation framework needs to meet the diverse needs of various stakeholders. Therefore, building a DRG payment system includes factors such as appropriate indicators to guide DRG policy design, monitoring and reporting on DRG implementation, tracking hospital performance, and reducing potentially harmful provider behavior.

Delegates are taking souvenir photos

In the closing speech of the seminar, Dr. Nguyen Duc Hoa - VSS Deputy General Director acknowledged the valuable contributions of the experts, stating that "these are valuable lessons on health insurance payment based on DRG and the impact evaluation of the referral policy in health insurance." The Deputy General Director expressed hope that in the near future, the Ministry of Health will work with the VSS to boldly pilot some specific services and continue to receive the support of domestic and international experts in this field./.