Vietnam Social Security and the Ministry of Health hold a meeting to discuss the implementation of health insurance policies in the first quarter of 2023

Insurance coverage and benefits for participants are constantly expanding

In 2022, the development of health insurance participants faced numerous difficulties and challenges due to the impact of the Covid-19 pandemic and changes in policies, resulting in around 4.9 million people not continuing to participate in health insurance compared to the end of 2021. This includes 1.7 million family members of health insurance participants who faced difficulties after the Covid-19 pandemic and could not continue to participate, over 1.13 million people who were removed from special difficulty areas, coastal areas, and islands according to Decision No. 353/QD-TTg dated March 15, 2022 of the Prime Minister, and therefore were not covered by the state budget for health insurance, and more than 2.1 million ethnic minorities who were not covered by the state budget for health insurance according to Decision No. 861/QD-TTg dated June 4, 2021 of the Prime Minister.

With the goal of prioritizing the rights and benefits of health insurance participants and ensuring the sustainability of policies, the VSS has implemented a comprehensive and determined approach with many solutions.

The VSS has collaborated on researching proposals to amend the Law on Health Insurance to expand the scope of participants and add groups not currently covered by the existing law. They have also coordinated with local governments to allocate targets for health insurance coverage in each locality. Local People's Committees in provinces and centrally-run cities have established steering committees to implement social and health insurance policies, develop plans and solutions to achieve targets, and submit proposals to the People's Council for budget allocation and mobilizing all resources to support health insurance participants.

Collaborative efforts have engaged the entire political system in rapidly and sustainably increasing health insurance coverage. By the end of 2022, there were 91.074 million people participating in health insurance nationwide, achieving a coverage rate of 92.04% of the population (exceeding the target of 0.04% in Resolution 01/NQ-CP). This was an increase of 2.237 million people compared to 2021, and one of the 7 economic-social targets exceeded by the National Assembly and the Government in 2022.

In recent years, health insurance benefits and coverage have been increasingly ensured and expanded, providing people with access to modern medical services and effective new drugs, thus helping many overcome illnesses and diseases. From 2016 to 2022, an average of about 160 million people received health insurance-based medical treatment each year, equivalent to nearly 50 million health insurance participants.

Expanding healthcare coverage and benefits for health insurance participants (Illustrated image)

Following the pandemic in 2022, the number of people receiving medical treatment returned to relatively normal levels, with 150.6 million health insurance medical treatments (an increase of over 25 million treatments or 19% compared to 2021) and 36.8 million people using their health insurance card for medical treatments. The amount of money spent on health insurance medical treatment also increased by over 20,000 billion VND compared to 2021.

Vietnam Social Security is also coordinating with the Ministry of Health to pilot health insurance medical treatments using chip-embedded citizen identification cards, which not only facilitates the procedure for people but also helps health insurance agencies manage the participation of health insurance participants more effectively and efficiently. This ensures that health insurance participants receive their rightful and legitimate benefits and helps control the costs of medical treatments, the health insurance fund, and timely monitoring of the proper use of health insurance cards.

Overcoming difficulties and challenges

Over the past two years, due to the impact of the Covid-19 pandemic and some changes in the socio-economic situation, there have been many difficulties and challenges in health insurance medical treatment. During this time, the VSS has been working closely with the healthcare sector and healthcare facilities to actively find solutions and gradually resolve these issues.

Based on consensus and agreement, the two sectors have been actively proposing and implementing solutions to timely overcome difficulties and ensure the source of healthcare funding for facilities to provide maximum benefits to health insurance participants as required by regulations.

Regarding the issue of advance payment and settlement, to ensure funding for healthcare facilities' operations, the VSS has directed provincial social security agencies to urgently carry out quarterly settlements to transfer payment and advance funds for the following quarter's operations. During the Covid-19 period, many healthcare facilities faced financial difficulties, and the VSS directed localities to provide sufficient advance payments. If difficulties arise, they are to report to Vietnam Social Security for resolution.

Difficulties and challenges in medical treatment covered by health insurance have been timely resolved (Illustrated image)

Since 2020, the VSS has issued many guidelines for provincial social security agencies to collaborate with healthcare facilities to implement coding, standardize shared categories and data. These guidelines have helped to significantly improve data quality, and most provinces have been able to overcome the issue of sending back or replacing data.

Recently, shortages of medicines and medical supplies have been reported in many hospitals and localities. The main reason for this is the slow and problematic bidding process. In 2022, the VSS and the Ministry of Health have closely cooperated to implement Resolution No. 144/NQ-CP issued on November 5, 2022, on ensuring medicine, medical equipment, and payment for medical treatment costs covered by health insurance. They have also developed and issued guidelines for effectively implementing health insurance policies, minimizing difficulties and challenges during the implementation process in localities.

Continuing to improve health insurance policies and laws in Vietnam

To ensure that health insurance policies are increasingly improved and prioritized for the benefit of health insurance participants, the VSS and the Ministry of Health have closely and effectively cooperated in building, amending, and supplementing health insurance policies and related policies; evaluated the impact and proposed amendments to improve policies, achieving many positive results.

Continue to improve the legal policy on health insurance, and improve the interests of participants (Illustration image)

As the agency responsible for organizing the implementation of health insurance policies, the VSS is proactive in building and improving specialized reports to evaluate and summarize the implementation of policies and regulations. They assess limitations, difficulties, and shortcomings in the practical organization of policy and legal implementation from the central to local levels, and evaluate the impact of proposed amendments to policies and regulations. They have submitted proposals to amend several important bills in recent times, including the Law on Medical Examination and Treatment, two Resolutions of the National Assembly and the Standing Committee of the National Assembly, three Resolutions and Decrees of the Government, two Circulars of the Ministry of Health, and many other guidelines.

In 2023, the two Ministries have identified their biggest task as assessing the implementation of the Health Insurance Law and related documents to make appropriate revisions, striving for a coherent system of legal documents to ensure that the Law on Health Insurance and the Law on Medical Examination and Treatment are implemented smoothly and consistently.

Building and amending bills, especially the Law on Health Insurance, require close consensus between the two Ministries regarding policy building and implementation. The two Ministries will further coordinate to ensure the best benefits for health insurance participants and the sustainable development of the health insurance fund./.