Amending the Law on Health Insurance: An urgent requirement

Delivering the opening speech, Prof. Dr. Tran Van Thuan - Deputy Minister of Health emphasized: Health insurance is a public financial mechanism in the health care of the people that has achieved numerous positive achievements. Sharing about the proportion of people participating in health insurance estimated at 87.93 million people until now, covering 90.85% of the population (exceeding 0.15% compared to the target assigned by the Prime Minister in Decision No. 1167/QD-TTg and Resolution 01/NQ-CP), Thuan said: in the economic context affected by the COVID-19 epidemic, this rate proves that the health insurance policy is increasingly meeting the needs of life and social, demonstrating increased awareness of the significance of participating in health insurance; the quality of health services and health insurance services has met the satisfaction of participants, and the efforts of the political system, etc.

Emphasizing the request to amend the Law on Health Insurance, the Deputy Minister of Health said that over the past time, the process of implementing the Law on Health Insurance still has some shortcomings due to the internal provisions of the Law and newly arising factors that yet have an adequate legal basis to resolve. The guiding documents are lacking specificity and consistency with other legal documents. The implementation of the Law in many aspects is still facing some limitations, etc.

“The revised contents are placed in the context of other related new laws being issued or revised such as the Law on Medical Examination, Law on Social Insurance, Insurance Business Law, Penal Code, Labor Code, etc.”, said Mr. Thuan.

Analyzing the limitations and problems in the implementation of the current health insurance policy, Mr. Le Van Kham - Director of the Department of Health Insurance (Ministry of Health) pointed out 9 groups of issues that need to be amended and supplemented in the Law on Health Insurance, including: participants of health insurance; health insurance benefits; Management and use of funds and payment of expenses; Service provision; Health insurance assessment; The "inter-agency" mechanism lies potential disadvantages in terms of rational use of the health insurance fund; IT application; Relevant Amended Law on Health Insurance related to the adjustment of other Laws; Increasingly high demand for health care and protection.

Overview image of the Conference

According to Kham, the amendment of the Law on Health Insurance this time will aim to fully and promptly institutionalize the Party's guidelines and policies on health insurance, in line with socio-economic conditions and development trends. Specifically: to increase the rate of participation in health insurance and ensure sustainable coverage of universal health insurance; to adjust benefits to suit the health care needs, the development of the society and the affordability of the health insurance fund; to ensure fairness and convenience for the provision and use of medical services, and improve the efficiency of grassroots health activities; to improve efficiency of management, administration and use of the health insurance fund.

From the policy implementation agency's perspective, Mr. Le Van Phuc - Director of Department of Social Insurance Implementation  (VSS) also pointed out the shortcomings and challenges in implementing health insurance policies. In the "input", the reality is showing "paradox", which means: the more the participants are developed, the more the deficit is; Inverse selection; The ability and target of cross support cannot be guaranteed (high income earners are not participating). As for the "output", equality of interests is not ensured, leading to cases of paying less and enjoying more and vice versa; hospital finance mechanism is not suitable; inequity between the ability to provide health services and allocate resources, etc.

Additional new points about the scope and level of health insurance benefits

Presenting the draft revised Law on Health Insurance, PhD. Nguyen Van Tien - former Vice Chairman of the National Assembly's Committee for Social Affairs, said this draft Law on Health Insurance is expected to have 59 articles and 12 chapters, an increase of 7 articles and 2 chapters compared with the current integrated Law on Health Insurance. In which there are 2 new chapters: Supplementary health insurance; Health insurance assessment.

The draft Law proposes the establishment of the National Council on Health Insurance, which is an advisory body for health insurance policy established by the Government. The Council is responsible for advising the Government and relevant agencies in making policies and laws on health insurance, proposing the premium rate, scope of benefits and coverage of health insurance benefits; medical technical service prices, etc. paid by the health insurance fund; Counseling to solve arising problems or disputes, etc.

The draft Law also adds a number of new points about the scope and level of benefits of health insurance (additional preventive treatment; newborn screening, prenatal screening, screening for diseases transmitted from mother to child, etc.; Screening and early diagnosis of chronic diseases; periodic health examinations; home check-ups for the elderly and the severely disabled; Nutrition products used in inpatient treatment of premature infants under 6 years of age who are malnourished; The participants of health insurance allowed to prepare personal health records managed by the primary health care facility). Proposing the regulation on "Referral" with quite extensive conditions such as: for medical facilities with management activities and health care, they will have the right to transfer patients to any level; for medical facilities with no management activities and health care, referrals will be in order from low to high, etc.

Especially, the completely new content in this Draft Law is Chapter 3: Supplementary health insurance. Accordingly, the principle of this type of health insurance is: Voluntary, and must have participated in social health insurance before. The supplementary health insurance is implemented in a non-profit form. VSS is supplemented by the health insurance organization, but must ensure the principle of independence and management expenditures specified by the Ministry of Finance, the balance must be used to support the difficult and deficit subjects to self-adjust. The draft Law envisages additional health insurance packages as follows: a health insurance package to support payment; payment of expenses outside of health insurance; Cover for some illnesses; other additional health insurance packages, etc.

VSS Deputy General Director Pham Luong Son concluded the Conference

The remaining new chapter is Chapter IX on Health Insurance Assessment. Accordingly, the Draft Law clearly stipulates the rights and responsibilities of the agency implementing the health insurance assessment. Accordingly, the new point is the right to solicit expert opinion when necessary. Besides, the person doing inspection must have a practice certificate. The assessors must have a certificate of training in health insurance. If they are professional experts, they must be a doctor or a university pharmacist, etc. It is scheduled to be applied after 5 years.

Contributing ideas at the Conference, representatives from the Ministry of Finance, some health departments, private medical associations and medical facilities, etc. suggested clarifying some new provisions in the Draft Law such as: Will independent assessment be established? If yes, who will pay for this agency? Is it taken from the health insurance fund? Is the operating principle open and transparent? Does the supplementary health insurance package to help co-pay lose the meaning and effectiveness of supervision from the patient side in the current co-payment mechanism? Should we continue to deliver budget estimates to health facilities?, etc.

Concluding the Conference, Son suggested the compilation team absorb the comments at the Conference, and a similar conference will be held in the South to continue to supplement and complete the Draft Law. Suggesting experts to continue to contribute to the Draft Law, Son expressed his wish to receive effective solutions and proposals to address issues that need attention in implementing the current health insurance policy such as: Object development; increase the health insurance premium; the organization of medical care facilities (both in terms of type and financial mechanism) remains appropriate, encouraging the improvement and development of health services; How to expand benefits to optimize the interests of participants?; How can breakthroughs like supplementary health insurance not accidentally become a barrier to the policy implementation?, etc.