Ensuring rights, interests of the insured is ultimate purpose of health insurance

13/11/2018 04:30 PM


In recent times, public opinions have focused on the accumulated surplus of the health insurance fund worth up to nearly 39 trillion VND, with concerns growing as to whether the rights and interests of health insurance participants have been limited in order to maintain the fund. Dao Viet Anh, Deputy Director General of the Vietnam Social Security (VSS), has granted an interview to the press to clear up the concerns.

Could you clarify the information on the nearly 39 trillion VND surplus of the health insurance fund last year?

Mr Dao Viet Anh – VSS Deputy Director General: Firstly, it can be said that in all cases, the rights and interests of health insurance participants have been fully ensured in line with the Law on Health Insurance, regardless of the deficit or surplus of the health insurance fund. 

Secondly, Article 35 of the Law on Health Insurance stipulates that “at least 5 percent of insurance contributions must be channeled to the reserve fund”. Therefore, the figure you mentioned is exactly the health insurance reserve fund, which has been accumulated for many years since the implementation of the Law on Health Insurance to the end of 2017.

Thirdly, according to the health insurance policies of many countries and Vietnam in particular, the health insurance reserve fund is necessary to ensure the sustainability of the health insurance policies, as well as payment capacity against risks posed by natural disasters and diseases. In Vietnam, the fund has special importance as apart from the risks of natural disasters and epidemics, we also need payment resources when medical fees are adjusted up in line with the set roadmap on calculating full costs and applying technological and scientific advances in medical check-ups and treatment.

Fourthly, in 2017 and over the past few years, we had to use the reserve fund to compensate for overspending of the health insurance fund. If fees for medical check-ups and treatment are not controlled well and the reserve fund is not sufficient for payment, then we must increase insurance premiums, which will affect the income of residents, business capacity, balance of the State budget, and national competitiveness. I think that different aspects should be taken into account when considering the reserve fund, such as the annual rise of medical fees and the current payment on the services (about 90 trillion VND), as well as overspending of the health insurance fund; the current reserve fund will not last long if it is not used in an economical and effective manner.

There have been concerns that the accumulated health insurance fund - a short-term fund, will affect the rights and interests of health insurance participants? Could you offer further details on the subject?

Mr Dao Viet Anh – VSS Deputy General Director: I want to confirm that this story is simple not true, as according to the law and consistent guidelines of the Government; ministries and related agencies; and the VSS, the use and management of the health insurance fund must go in tandem with better ensuring the rights and interests of health insurance participants. In all cases, ensuring the best rights and interests of health insurance participants has been identified as the ultimate purpose of the health insurance fund, and ensuring the rights and interests of health insurance participants is also the sole purpose of the reserve fund. 

In fact, the interests and rights of health insurance participants have been ensured fully in line with legal regulations. Any violations in any cases will be strictly handled. Over the past few years, the number of people having their medical costs covered by health insurance and the total payment for insurance-covered medical examination and treatment have increased year-on-year. In 2017 alone, social security agencies paid over 88 trillion VND (3.79 billion USD) for medical check-ups and treatments of nearly 170 million patients. Thousands of cases had their medical fees mounting to hundreds of millions of VND, some even at billions of VND.

Lastly, I want to repeat that with such a fast growth rate of medical fees covered by health insurance at present (rising 1.8-fold in just two years), without measures to control these costs, the reserve fund will run out and health insurance premiums must be raised. In this case, people, businesses, as well as the whole of society will be greatly influenced.

Additionally, there are some opinions that our health insurance policy is heading towards low-cost healthcare with limited insurance-covered medicines. What do you think about this issue?

Mr. Dao Viet Anh – VSS Deputy Director General: I think we should work towards an advanced, modern, and fair healthcare system on the basis of developing fundamental health insurance (to ensure basic medical care needs and a package of basic medical services covered by health insurance as stipulated by the Law on Health Insurance) along with supplementary health insurance (for those who wish to receive higher benefits and have on-demand services).

According to many international organisations, Vietnam is one of the countries with the best health insurance policies in the world. The premiums of local health insurance cards are just over 30-40 USD per capita on average, while there are more than 1000 types of medicines covered by health insurance in Vietnam – a number much higher than that in many other countries (about 700 on average). Thousands of technical services, many of which are expensive high-tech services, are also covered by health insurance. In 2017, nearly 170 million cases had their medical fees paid by the health insurance fund, with payment in many cases amounting to hundreds of millions of VND, sometimes even reaching over 1 billion VND. So, the opinion that we are working towards cheap healthcare services with a list of limited insurance-covered medicines does not match the reality and lacks an objective and proper understanding of the policy.

Once again, we hope that media agencies will step up the dissemination of information to help the public fully understand their rights, responsibilities, and the humanitarian purpose of the current universal health insurance policy.

Thank you very much!

Vietnam Social Security