Reporter: Recent surveys and studies such as the PAPI 2020 and the World Bank’s report "What Will Be the New Normal for Vietnam?” point out that people’s concerns about the economy and health have sharply increased as a result of COVID-19. Health insurance is seen as one of the main public financial institutions for healthcare. Could you elaborate on the noticeable achievements in the implementation of health insurance policy so far?

Deputy Director General Pham Luong Son: Generally speaking, the first and foremost success is that a legal corridor for the implementation of health insurance policies has been basically completed. Vietnam’s Law on Health Insurance was approved by the 12th National Assembly in 2008 and revised and amended by the 13th National Assembly in 2014. This is a significant legal foundation to develop health insurance policy.

Besides, the Party and State have introduced numerous instruction documents including the National Assembly’s Resolution No 68/2013/QH13 dated November 29, 2013 on accelerating the implementation of health insurance law, towards universal health insurance; the Prime Minister’s Decision No 1167/QĐ-TTg dated June 28, 2016 on adjusting targets for health insurance implementation in the 2016-2020 period, and Resolution No 20-NQ/TW dated October 25, 2017 on better protection of, care for and improvement of people’s health.

Regarding “coverage”, the three elements contributing to the success of health insurance policy (the number of participants, reduced medical costs for patients, and benefit packages of health insurance participants) have been realised with positive results. Vietnam Social Security (VSS), which is responsible for social security implementation, has made non-stop efforts to effectively execute the health insurance policies and laws.

Health insurance policy has made considerable contributions to changing people’s understanding of financial solutions to better care for their health. Health insurance participants are increasingly aware of benefits and obligations in the implementation of health insurance policies and law.

Health insurance premiums have markedly increased over the past years whilst outstanding debts have also decreased. The figures partly show the higher abidance by legal regulations on health insurance implementation.

Reporter: Health insurance policy is changing to increase benefits for participants, could you provide some more details?

Deputy Director General Pham Luong Son: Amid COVID-19, VSS has actively worked with ministries and sectors to guide and create the best conditions for participants in health insurance, such as providing medicines for long-term use, providing medicines for patients with chronic illnesses for use between 2-3 months to help them avoid making frequent visits to healthcare facilities, and so on. VSS and social security bodies in localities have proactively and actively reformed administrative procedures related to health insurance through the application of Information Technology in declaring, signing up for health insurance, organising agencies, directly paying medical costs, providing feedback and information, and recently enabling participants to use health insurance cards through the mobile platform VssID, which satisfies patients. 

Vietnam Social Security’s Deputy Director General Pham Luong Son.

According to VSS, by December 31, 2020 there were 87.93 million participants in the health insurance system nationwide, equivalent to 90.85 per cent of the population, an impressive increase since 2015 when the revised Law on Health Insurance took effect, which saw 69.97 million participants or 76.5 per cent of the population.

The figures rose to 75.92 million participants and 81.9 per cent of the population in 2016; 81.19 million and 86.9 per cent in 2017; 88.5 per cent in 2018; and 89.3 per cent in 2019.

In 2021 alone, the first five months witnessed an increase of health insurance participants compared to the end of 2020. This shows the success in the implementation of health insurance policy, which showcases efforts and flexibility of the social security sector amid prolonged difficulties since early 2020, which caused many enterprises to cease operation or dissolve, making numerous labourers who are participating in the social and health insurance system unemployed and unable to pay their premiums, etc.

Health insurance has helped households reduce expenditures for medical services. According to the Ministry of Health, household medical services expenditure dropped to 43 per cent currently from 49 per cent in 2012. Although the figure remains high, it is likely to decrease, which is expected to bring about justice in healthcare for all, especially the disadvantaged, the near poor and children under 6 years old.

The present Law on Health Insurance also stipulates a large benefit package for health insurance participants, which covers almost all medical services the Vietnamese health sector can supply, including high and costly technical services. Vietnam is among a few countries where the health insurance fund covers the treatment of rare diseases. Apart from treatment services, the health insurance fund also covers services such as rehabilitation, periodical prenatal checkup, and birth-giving. Lists of medicines, medical supplies and technical services are regularly adjusted (names of categories, hospitals that can be applicable, payment rates) to satisfy medical checkup and treatment needs, the development of science and technology, and efficient use of the health insurance fund. Payments for medical checkup and treatment at facilities different from registered ones are also adjusted in line with the 2014 Law on Health Insurance to better benefit participants.

In 2020, there were over 167.220 million inpatients and outpatients nationwide using medical checkup and treatment services. Though the users of medical checkup and treatment services decreased, to about 16.89 million (9.18 per cent), compared to 2019 due to social distancing and people reducing hospital visits, payment for health insurance-based medical checkup and treatment was estimated at more than VND102,940 billion, an increase of over VND2,740 billion (2.7 per cent) compared to 2019 since the average treatment fees at medical facilities kept rising. In the first five months of 2021, more than 65.3 million people used health insurance-based health checkup and treatment services nationwide, with payment up to more than VND42,000 billion (an increase of 12 per cent against the same period of 2020).

Reporter: Financial resources of health insurance funds are of overriding importance at the moment. Could you tell us about the current use of the fund?

Deputy Director General Pham Luong Son: Positively speaking, increased payment for health insurance-based medical checkup and treatment demonstrates people’s growing interest in health insurance policies, as well as the guarantee of participants’ benefits. Nevertheless, the increased payment reveals matters of concern regarding the safety of the health insurance fund. The payment for health insurance-based medical checkup and treatment has increased 46 per cent from 2009 to 2016, and for the first time the health insurance fund for medical checkup and treatment became unbalanced.

Since 2017, payment from the health insurance fund has always surpassed collection. Specifically, collection stood at VND71,301 billion but payment was VND88,660 billion in 2017; VND83,335 billion against VND91,405 billion in 2018; and VND90,839 billion against VND108,060 billion in 2019. The number of people claiming health insurance at medical facilities different from registered ones and the number of inpatients tends to increase, and so on.

Additionally, we haven’t completely settled the relationship between benefits and levels of premium payments after the health insurance fund increases its coverage and benefits, affecting the safety of the health insurance fund.

Reporter: In your opinion, what should we do to reach the target of healthcare for all through health insurance?

Deputy Director General Pham Luong Son: Covering healthcare for the whole people is an aspiration to show the preeminence and fairness in people’s healthcare. Experiences from countries worldwide indicate that, to reach such a target there must be sustainable development of health insurance, ensuring two fundamental requirements. First, health insurance must be accessible to all. Concurrently, there must be financial sustainability which is a matter of overriding importance to Vietnam at the moment as the overspending of the health insurance fund continues.

A local receives a health check using health insurance.

To ensure safe and efficient use of the health insurance fund, VSS has required medical facilities and social securities bodies in localities to monitor inpatient treatment to stop the situation in which medical facilities intentionally “force” patients to use inpatient treatment to increase revenue.

Concurrently, VSS worked with the health ministry to partake in the revised Law on Health Insurance project; focusing on solving problems in the payment of drug costs within the scope of the insured person’s benefits. Currently, the service price-based payment reveals shortcomings as it “encourages” medical facilities to increase indications and medical services for patients using health insurance, hiking checkup and treatment costs and abusing the health insurance fund from medical facilities and health insurance participants, which results in overspending of the health insurance fund for medical examination and treatment.

Thus, VSS and the health ministry are pushing for the renewal of payment methods for health insurance-based medical costs. The circular issued by the health ministry guiding the capitation payment for outpatient medical expenses takes effect from July 1, 2021. A circular guiding the health insurance-based capitation payment for Diagnosis Related Group (DRG) medical examination and treatment expenses is expected to be completed and introduced in 2021. These changes are projected to bring about positive outcomes in the implementation of health insurance policies and the supervision of the use of the health insurance fund.

With existing weaknesses in the implementation of the 2014 Law on Health Insurance, the Ministry of Health has introduced a plan to build a revised Law on Health Insurance which is more suitable to the new situation.

However, the reality shows that in order for everyone to soon enjoy the right to social security, the most important condition is that the attention of the whole political system must be commensurate with the important role of this policy, as well as the awareness of the people and medical facilities about the significance of participation in the health insurance system, supervision and effective use of the health insurance fund.

In the future, it is necessary to increase the leadership, and direction of all-level Party committees and administrations, as well as to uphold the role of the Fatherland Front and socio-political organisations in ensuring healthcare for all. It is also essential to continue implementing the Party’s and State’s policies and laws on health insurance.

Reporter: Thank you for your time!