Can you explain in details the major new points in the health insurance policy which became effective on December 1, 2018, especially those regarding levels of benefits and payment for medical cost?

Mr. Nguyen Ta Tinh: Decree No. 146/2018/ND-CP took effect on December 1, 2018, replacing the Government’s Decree No. 105/2014/ND-CP dated November 15, 2014 and joint-ministerial Circular No. 41/2014/TTLT-BYT-BTC dated November 24, 2014. Noteworthy new points in the decree include the addition of some groups covered by health insurance, participation of households, and the abolition of regulations on the handover of health care fund to medical facilities (including communal health stations) and replace those with the total global payment . It also amends and supplements a number of specific regulations on the payment by health insurance  fund to health care facilities and on the contracts between payer and providers on medical checkup and treatment covered by health insurance. 

The new points on levels of benefits and health insurance payment for medical costs are as follows:

Firstly, the levels of adjusted benefits coverage   for some groups.

People who participated in the resistance war and lose 81 percent or more of working ability as a consequence of exposure to toxic chemicals previously had all their medical costs covered by health insurance but with limits on medicines, chemicals, medical materials and technical services. Under the new decree, the limits have been removed.

People who are 80 years old and above and receiving survivor benefits will entitle to 100 percent of medical costs covered by health insurance instead of the previous 80 percent.

Secondly, there are new rules for health insurance payment for medical costs in the following cases:

Patients who are diagnosed and treated by upper-level medical establishments and then are transferred to communal health stations for monitoring and receiving medicine, are eligible to insurance benefits as regulated (following the Health Ministry’s guidance).

The new regulation will allow patients with chronic diseases, elderly patients and those facing difficulties in travelling to get medical check-ups and treatment at places near their houses, thus helping save time and costs.

In addition, the Health Insurance Fund will pay for costs occurring in cases when a medical establishment sends samples or refer patients to other facilities for testing and diagnostic imaging (following principles and a list stipulated by the Health Ministry). This means that patients will still be covered by health insurance when they and their samples are sent to other health care providers  for testing.

Moreover, in-patients whose health insurance cards expire during the course of treatment still have their medical costs paid for by health insurance until they are discharged from hospital, but only for a duration not exceeding 15 days since the expiry date of the card. The social insurance agency is responsible for granting or extending the validity of the cards for patients while they are treated at the medical facilities.

In case people with health insurance cards themselves get checkup and treatment at healthcare facilities which are not designated in their health insurance cards, and then are transferred to other healthcare facilities, the health insurance fund will cover in the same manner as for patients getting treatment at facilities not designated in their health insurance cards, except for emergency cases or inpatients diagnosed of new diseases which are beyond the professional capacity of the medical facility, or whose diseases going beyond the facility’s capacity.

Regarding regulations on direct payment: if health insurance card holders get medical check-ups and treatment at district-level healthcare facilities which are not contracted in the health insurance system; or get inpatient treatment at provincial and central facilities which are not part of the health insurance system; or get treatment at healthcare facilities designated in the health insurance card without showing their health insurance cards (or ID with photos), the health insurance fund will pay for the card holders’ medical costs in accordance with the ratio calculated based on the base salary applied to the levels of the hospitals where they go for medical check-ups and treatment.

Decree 146/2018/ND-CP adds several new groups of health insurance beneficiaries for whom the State budget will pay for their insurance contributions. Who are they?

Mr. Nguyen Ta Tinh: The decree supplements several new groups of health insurance beneficiaries whose contributions  will be paid by the state budget. They are (1) Frontline conscripted labourers who served in the resistance wars against France and the US, national defence war or internationAt the same time, the State budget paid part of health insurance contributions for close to 16,6 million people across the country in 2017, with the support rates ranging from 30 to 70 percent of the required contributions. A total 4.095 trillion VND was allocated from the State budget to cover the support.al missions; (2) Young volunteers based in the south who served in the resistance war from 1965 – 1975; (3) Persons awarded the title of People’s Artisans or Emeritus Artisans by the State who have monthly income per capita lower than the basic salary regulated by the Government. Another group is persons of poor households lacking access to basic social services.

According to VSS statistics, more than 34.2 million health insurance beneficiaries had their contributions paid by the State budget last year, accounting for 42 percent of the total insurance  enrollees, with the total amount coming to about 25,19 trillion VND, representing some 31 percent of the nation’s total health insurance revenue.

At the same time, the State budget paid part of health insurance contributions for close to 16,6 million people across the country in 2017, with the support rates ranging from 30 to 70 percent of the required contributions. A total 4.095 trillion VND was allocated from the State budget to cover the support.

Can you explain the more flexible rules on the extension of health insurance duration as stipulated in the decree?

Mr. Nguyen Ta Tinh: The new decree allows a patient whose health insurance card expires while he/she is receiving inpatient treatment in hospital to continue having his/her medical costs covered by the health insurance fund, but for not more than 15 days from the day the card expires to the day the patient is discharged from hospital.

The social insurance agency is responsible for guiding the issuance of a new card or extending the validity of the patient’s health insurance card during the time he/she is receiving medical treatment services at hospital.

Regarding the near-poor group, could you please detail the state’s support for them to buy health insurance?
Mr. Nguyen Ta Tinh: According to Decree 146, for persons in households in near-poor group in the poor districts as stipulated in the Government’s Decree No 30a/2008/NQ-CP dated December 27, 2018 on the programme to support fast and sustainable poverty reduction, their health insurance contribution will be fully paid for by the State budget.

Meanwhile, persons in near-poor households according to standards stipulated by the Government and the Prime Minister (except for those in the above-mentioned group) will receive support by the State budget at at least 70 percent of the contribution.

Based on local fiscal capacity, the People’s Committee and the People’s Council of provinces and centrally-run will decide whether to provide further support for the near-poor households besides the minimum level regulated in the Decree No.146. At present, many localities have arranged its budget to pay the remaining 30 percent of the health insurance premiums for this group.

Does Decree 146 contain any changes related to benefits of health insurance holders when they receive health care service at medical facilities not contracted in the health insurance system, or at the first registered facilities?
Mr Nguyen Ta Tinh: When a health insurance card holder go to a medical establishment not designated in his/her insurance card for checkups and treatment, and thereafter is transferred to another establishment, he/she will be entitled to health insurance coverage as applied to medical treatment at undesignated medical facilities, except for cases of emergency or when an inpatient is diagnosed with other diseases beyond the professional capacity of the medical facility where he/she is receiving treatment; or when the patient’s  disease progresses beyond the professional capacity of the medical station.

Thus, in order to fully enjoy the benefits of health insurance, health insurance holders should get medical service at  his/ her first registered facilities.

In cases where health insurance participants get treatment at medical facilities not contracted in the health insurance system, or at designated facilities but fail to show necessary papers, the health insurance fund will pay for their medical costs based on the ratio of payment to the basic salary stipulated for the levels of the hospitals, instead of a specific amount as under current rules. 

The specific ratios of payment are as follows:

First, for medical establishments not contracted in the health insurance system:

        + Outpatient treatment at district-level medical facilities: not more than 0.15 times of the basic salary.

        + Inpatient treatment at district-level medical facilities: not more than 0.5 times of the basic salary .

        + Inpatient treatment at province-level medical facilities: not more than 1.0 time of the basic salary.

        + Inpatient treatment at central-level medical facilities: not more than 2.5 times of the basic salary.

Second, for medical facilities contracted in the health insurance system: the health insurance fund will only pay for those who fail to complete procedures at the designated medical stations at the following ratios:

        + Outpatient treatment: not more than 0.15 times of the basic salary.

        + Inpatient treatment: not exceed 0.5 times of the basic salary.

Could you give more details on the new content included in Decree No.146/2018 that could help to realise the goal set by the Government on health insurance coverage nationwide?

Mr. Nguyen Ta Tinh: To increase the health insurance coverage, Decree No.146 has added more groups subject to health insurance; and stipulate support from the State budget and other legal sources for health insurance participants. Meanwhile, some payment regulations have been adjusted to facilitate health insurance participants’ access to medical services, for instance a patient who is transferred from a medical establishment of a higher level to a commune-level medical facility for monitoring and treatment will be entitled to insurance benefits as regulated. Or the health insurance will cover the costs occurred when a medical facility send  patient’s substance for laboratory test or patients to other facilities for testing and diagnostic imaging services. The decree also amends regulations on assigning the payment quota for and enhancing the responsibility of health facilities in effectively using the assigned financial resource. It amends and supplements some specific regulations on paying for medical costs; and adds more specific details to regulations on insurance-covered medical checkups and treatment contracts. The amendments and supplements are aimed at increasing the responsibilities of parties involved towards sustainable development of the health insurance.

Recently, there were reports on the record health insurance payment for some patients. According to statistics of the VSS’s medical review system, in the first 10 months of 2018, the health insurance fund paid medical costs for 50 patients ranging from nearly 830 million VND to over 4.7 billion VND. Are these cases exceptional, and do they affect the benefits of other patients, who are also paying for health insurance?

Mr. Nguyen Ta Tinh: It is true that some patients suffer severe health problems that require treatment over a long period of time. Thanks to health insurance, they can afford the high cost of treatment. Those patients often suffer from blood diseases, particularly hemophilia. The payment reflects the basic principles of social health insurance policy – risk poolling. However, we guarantee that other health insurance holders’ benefits are not affected. To ensure the balance of the health insurance fund, the Vietnam Social Security is working to reform methods used for medical claim review and insurance payments, while asking health facilities and patients to join hands in using the health insurance fund in an effectively manner, thus ensuring the fund’s payment capacity, which also means ensuring the benefits of health insurance holders and of medical establishments.

Decree 146 clarifies that from 2020, electronic health insurance card will be launched. What are advantages for users when using this service?

Mr. Nguyen Ta Tinh: Under Decree 146/2018/ND-CP, by 2020, the VSS will complete the issuance of electronic health insurance cards for  enrolleesThe VSS will fully enforce regulations related to electronic heath insurance card on January 1, 2020, and will provide the cards to enrollees  as schedule.

Electronic health insurance cards will integrate data of health insurance cards and social insurance record books with basic information on card holders’ contributions and benefits.

The cards are expected to make getting medical check-ups and treatment more convenient and faster, contributing to reforming administrative procedures and cutting waiting times.

Thank you for the interview./.