NA Deputy Nguyen Lan Hieu – Bình Định Delegation

During the debate, NA Deputy Nguyen Lan Hieu from the Bình Định delegation observed that current issues and disputes in health insurance examination and treatment premiums payment  mainly on lack of legal provisions, particularly in Clause 6, Article 2 of the current Law on health insurance assessment. Thus, in his comments on the amended draft, he suggested that Article 6 be revised to require the Ministry of Health to establish criteria and guidelines for assessing the appropriateness of medical examination and treatment provided to health insurance participants as a basis for assessment and payment by the social security office.

Hieu noted that both practical and international experience indicate that social security offices only implement financial assessment based on medical regulations. Health industry is responsible for the professional quality of medical examination and treatment services, as clearly outlined in the Law on Medical Examination and Treatment.

According to Hieu, improving the review process would not only reduce unnecessary disputes between VSS and healthcare facilities on health examination and treatment but also enhance treatment quality, limit the overuse and unnecessary treatment prescriptions—an increasing common issue. He emphasized it is neccesary to issue treatment guidelines integrated into electronic medical records to flag potential medical errors. For disputed cases, he suggested that the Ministry of Health delegate local health departments to work with local social security offices to form independent medical councils to adjudicate. For regulations violation, penalties should be applied multiple times aiming to deter and prevent recurrence.

NA Deputy Thach Phuoc Binh – Tra Vinh Delegation

Sharing a similar perspective, NA Deputy Thach Phuoc Binh from the Tra Vinh NA delegation stressed it is necessary to strengthen the Ministry of Health’s role in managing health insurance review. Currently, Clause 6, Article 2 of the Law on Health Insurance stipulates that health insurance review is a proffesional activity aimed to evaluate the appropriateness of health insurance services conducted by health insurance organizations.

However, Representative Binh pointed out the absence of specific guidelines on assessment processes and criteria, leading to challenges and delays in reimbursement, which have become quite common. According to 2023 statistics from Vietnam Social Insurance, 30% of healthcare facilities experienced delayed payments due to ambiguities in health insurance assessment regulations.

To address this issue, Binh proposed to supplement requiring the Ministry of Health to issue detailed criteria and guidelines on health review in amended Law on Health Insurance to unify the assessment process and improve collaboration between Social Security office and the health industry. This regulation shallnot only ensure transparency and consistency but also prevent delays in paying premiums for healthcare facilities and patients.