The recently-launched regulation is expected to offer health insurance cardholders better access to healthcare services and benefits including:

- Increase the benefit levels during out-of-referral inpatient treatment at provincial healthcare providers: A health insurance holder who goes to out-of-referral provincial healthcare providers, i.e. different from the originally registered healthcare provider in their health insurance card, without referral permit will be entitled to 100% health insurance inpatient treatment costs covered by the health insurance fund. This is not applicable for outpatient treatment.

- The health insurance cardholder who works far from home, resides out of their home province, or has no referral permit is still entitled to health insurance coverage: When in need of health care from provincial healthcare providers or while work far from home, on a business trip, there’s no need for the insured to travel back to his/her registered hospital to acquire a referral permit as he/she used to. This helps saving time and effort for the beneficiaries while guaranteeing their benefits.

- Able to choose higher quality of medical examination and treatment at provincial healthcare providers: The health insurance beneficiary can choose to take their inpatient treatment at better review provincial healthcare provider.

- Promoting the improvement of service quality at the healthcare providers: The provincial healthcare providers will have to improve their service quality to attract the patients to have medical examination and treatment at their hospital instead of their counterparts in other big cities or provinces. As a result, the improved healthcare quality secures better service quality for the patients.

Illustrative image (source: internet)

However, this regulation will also pose several difficulties and challenges for the healthcare system and health insurance fund specifically as follows:

- The provincial healthcare providers of high quality will attract a higher volume of patients, which means the possibility of being overloaded, especially those in charge of treating chronic and severe diseases. This prolonged overload might degrade their healthcare service quality.

- Currently, the global trend is strengthening outpatient treatment or primary healthcare rather than inpatient treatment. It contrasts with the healthcare reality in Vietnam. When the regulation becomes effective, there might be a possibility that the provincial healthcare providers will request more cases of inpatient treatment even when it is not necessary just to generate more revenues. This might increase the cost of society.

- To meet the healthcare demand of the increasing patient population, the provincial healthcare providers might adopt relevant measures to recruit medical talents from district and commune facilities. This might lead to the shortage of medical staff at healthcare facilities of lower levels.

- Once no inpatient referral requirements at provincial healthcare providers has become effective, the surge of expenses to cover out-of-referral inpatient healthcare entitled to health insurance will pose a huge pressure on the health insurance fund. Thus it is a challenge for VSS to provide an accurate estimation of number of out-of-referral patients for 2021 to allocate the annual quota of health care expenditures to localities.

Shortly, to bring the new referral regulation into practice with actual benefits for the citizens and society, it is crucial that VSS, Ministry of Health and localities cooperate in promoting public education on health insurance policies and laws; improving healthcare quality covered by health insurance at lower levels; preventing abuse via monitoring of inpatient treatment indications; step-by-step adjusting the health insurance premium in line with the global trend and the legal regulations, etc.