The Ministry of Health (MOH) is working to revise the 2008 Law on Health Insurance, focusing on provisions specifying cases in which patients might enjoy full coverage for medical examination and treatment costs without having to follow procedures for treatment-line transfer, cases in which patients are ineligible for health insurance benefits, and persons who are required to participate in health insurance.

 VSS Director General  Director Nguyen The Manh 

Accordingly, the health insurance fund would cover 100 percent of examination and treatment costs for patients in three cases.

Firstly, patients are diagnosed to have rare or serious diseases or those requiring complicated surgeries or advanced medical technology, and seek medical examination and treatment at healthcare facilities with specialized departments or higher technical capabilities.

The MOH also provides a list of 42 rare or serious diseases that would qualify for this expanded coverage, namely cancer, coronary artery surgery, stroke, hearing loss, Parkinson’s disease, paralysis, among others.

Secondly, patients are diagnosed to suffer chronic diseases and transferred back to their primary care providers for management and provision of specialized drugs or drugs used at higher-level healthcare facilities.

Thirdly, health insurance-covered primary care providers have insufficient professional capacity to perform some technical services and medical treatment of some diseases, then patients would be allowed to seek medical examination and treatment at healthcare facilities of higher technical lines in their localities or neighboring areas. Provincial-level Departments of Health would work with provincial-level social security agencies in identifying healthcare facilities unqualified for performing some technical services or medical treatment activities. The list of unqualified healthcare facilities would be publicized on websites of provincial-level Departments of Health and healthcare facilities.

However, according to the MOH, levels of health insurance benefits would be based on the seriousness of sickness, category of the insured within the scope of benefits, and health insurance payment duration as specified in the 2014 Law revising the Law on Health Insurance, which range from 80 to 100 percent on a case-by-case basis.

Accordingly, the 100-percent payment of medical expenses would be applied if (i) patients are officers, career army men, non-commissioned officers and soldiers, persons with meritorious services, war veterans, under-six children, persons entitled to monthly social insurance allowance, members of poor households, ethnic minority people living in areas with difficult socio-economic conditions, and relatives of people with meritorious services; or (ii) the cost of a check-up is below the level specified by the Government and for medical care provided at the commune level, or (iii) patients have paid health insurance premiums for five consecutive years or more and have the costs paid for medical care in the year higher than the basic salaries of six months.

Regarding cases ineligible for health insurance benefits, the MOH proposes revising provisions on the age limit for health insurance coverage of some eye-related diseases, and use of prostheses.

Illustrative image (internet)

Accordingly, the health insurance fund would pay treatment costs of squint, short-sightedness and refractive defects for patients aged under 18 years, not for only under-six children as provided currently.

Use of prostheses including artificial limbs and hearing aids would be eligible for health insurance benefits, meanwhile the use of such prostheses as artificial eyes, false teeth, glasses, movement aids in the medical examination, treatment and function rehabilitation would continue to be ineligible for health insurance coverage.

Another salient point of this draft is the expansion of health insurance target groups to ensure alignment with the 2024 Law on Social Insurance.

Specifically, persons required to participate in health insurance would include employees working under indefinite-term labor contracts or labor contracts of full one-month or longer term; corporate managers, controllers, representatives of state capital, representatives of enterprise capital in companies and their subsidiaries, cooperative and cooperative union managers who receive salaries; business household owners that are required to register their business.

Foreign workers in Vietnam who are subject to compulsory social insurance would also be required to participate in health insurance if they hold a work permit or practice certificate or practice license issued by a Vietnamese competent authority and have a definite-term labor contract of 12 months or more with an employer in Vietnam.

The draft law is scheduled to be passed by the National Assembly in October.