NA deputy Tran Khanh Thu from the National Assembly delegation of Thai Binh Province delivered a statement

Contributing to the draft Law on amending and supplementing certain provisions of the Law on Health Insurance on the afternoon of October 31, NA Deputy Tran Khanh Thu from the NA delegation of Thai Binh Province expressed agreement on the necessity of amending the Law to promptly address existing issues, resolve obstacles, and ensure alignment with newly effective related laws, such as the Law on Medical Examination and Treatment, the Law on Social Insurance, the Law on Pricing, as well as the Law on Identification and the Law on Residence...

To finalize the draft Law, Ms. Tran Khanh Thu contributed recommendations on regulations regarding health insurance benefit enjoyment in cases patients may have medical examination and treatment without primary medical examination and treatment facilities, including specialized hospitals, without requiring referral documents. At the same time, NA Deputy Khanh Thu emphasized that such regulations should be approached with caution, particularly in the context of the growing deficit in the Health Insurance Fund for medical examination and treatment.

Further analyzing the issue, Deputy Tran Khanh Thu pointed out that the Law on Medical Examination and Treatment has defined three levels of specialization, with each level performing distinct functions and tasks. The current model of health insurance medical care plays a crucial role in ensuring the sustainable development of the healthcare system. Patients will initially visit primary healthcare facilities or family doctors for early detection and preliminary health assessments. Depending on the severity and type of illness, if the condition exceeds the capacity of the initial facility, the patient will be referred to a higher-level facility. In case of emergency, however, can directly go to the nearest healthcare facility, regardless of the level and enjoy HI benefits as regulated.

"If the provisions in the draft Law are adopted, the trend will be for patients to bypass lower-level facilities and go directly to higher-level hospitals, which will lead to increased hospital overcrowding, longer waiting times, and higher out-of-pocket expenses. Furthermore, healthcare facilities at all levels will be unable to anticipate medical care demand, which poses a risk of shortages in medications, medical equipment, and necessary resources to serve patients. This will undoubtedly increase healthcare costs covered by the Health Insurance Fund," Deputy Tran Khanh Thu analyzed.

It is proposed that patients with rare or serious diseases be allowed to use referral documents for the entire duration of their treatment (Illustrative image)

The female National Assembly Deputy from Thai Binh Province stated that the mechanism allowing patients to receive medical care at other facilities without referral documents might result in missed opportunities for early detection of certain symptoms, as patients may bypass primary healthcare to directly seek care at higher-level facilities, even when unnecessary, leading to reduced efficiency and potentially disrupting the specialized structure of the healthcare system. Deputy Thu cited data to illustrate the trend of patients transffering to district and provincial level hospital immediately after the implementation of "free referral" (starting with district-level referral in 2016). The proportion of medical visits at the district level increased from 43.3% in 2015 to over 60% in 2023. Meanwhile, visits at the commune level decreased from 27.6% in 2015 to approximately 13.7% in 2023. In 2021, when provincial referral was introduced for inpatient services, the proportion of inpatient visits at the provincial level increased from 30.5% in 2021 to 47.28% in 2023, with a corresponding 54% rise in costs. According to Deputy Tran Khanh Thu, the frustration of patients using health insurance stems from difficulties in obtaining referral documents, particularly among patients with chronic or serious illnesses or the limited and inadequate list of medications at primary healthcare facilities compared to higher-level facilities, even when the same disease is treated.

For the reasons mentioned above, Deputy Tran Khanh Thu proposed maintaining the scope of health insurance medical care referral as it is under the current roadmap. Therefore, she suggested adjusting the regulations to empower the Minister of Health to issue definitions for rare diseases and the list of serious and rare diseases, allowing patients with these conditions to use a referral document once for the entire duration of their treatment, rather than limiting for a specific fiscal year as it is currently.

At the same time, she emphasized it is necessary to continue strengthening the capacity of the primary healthcare system so that it can provide outpatient medication treatment for certain chronic diseases consistently across different levels of healthcare facilities.