Attending the meeting were representatives of the Standing Committee of the Ethnic Council and a number of the NA's Committees; Deputy Minister of Health Do Xuan Tuyen; Deputy General Director of Vietnam Social Security (VSS) Pham Luong Son; representatives of the Social Security Administration of the Ministry of National Defense, the People's Public Security and a number of related ministries and branches.

Illustrative image (source: VSS)

Health insurance coverage rate exceeds the assigned target

Reporting at the meeting, Mr. Do Xuan Tuyen - Deputy Minister of Health said that although the Law on Health Insurance as well as related legal provisions have been fully promulgated, in practice there is still a lack of specific sanctions for subjects who self-pay or supported to pay health insurance premiums. Due to the impact of the Covid-19 epidemic, some businesses had to suspend their labor contracts, resulting in employees not being able to participate in health insurance.

However, with the participation of the whole political system and the coordination with relevant ministries and sectors, by the end of 2020, the whole country had 87.97 million participants in health insurance, an increase of 2.23 million compared to 2019 and reached a coverage rate of 90.85% of the population - 10.85% higher than the target assigned in Resolution No. 68/2013/QH13. "In which, the state budget pays and supports health insurance premiums for more than 51 million people, accounting for 58% of the total number of subjects and total state budget expenditures paid and supported in 2020, equal to 41% of total health insurance revenues," said Tuyen.

Along with that, the MoH has also prescribed a basic package of health services for the grassroot level, including: Service package for medical care paid by the health insurance fund (76 services, 241 types of drugs); package of medical services for health care, prevention and health promotion paid only by the state budget and other lawful funding sources; stipulates the scope of professional activities for medical practitioners, in which the scope of professional activities is general medical care, creating favorable conditions for the implementation and payment of medical expenses covered by health insurance.

Notably, the regulation on the basic package of health services paid by the health insurance fund is not clear in concept and does not show the nature of the basic health service package that must be placed in the balance of the scope of benefits and the ability to pay of the health insurance fund. Meanwhile, the Law on Health Insurance still has provisions on the scope of benefits and the level of health insurance benefits; and stipulates the Minister of Health to promulgate the list, rates and payment conditions for drugs, medical equipment and medical services within the scope of benefits of the health insurance participants.

On the centralized social and health insurance participation database, the Vietnam's social insurance industry has deployed services to look up the process of participating in social and health insurance and health insurance card information. In particular, the health insurance assessment information system has connected and linked data between the social insurance agency and nearly 13,000 health care facilities with health insurance nationwide; the quality of data communication has been markedly improved and upgraded. In 2020, the data of 167.8 million medical treatment visits was received and the connection rate reached 97.56%; the rate of records discharging on the right day reached 92.6%, etc.

Agreeing with the above report, Mr. Dang Thuan Phong - Vice Chairman of the Committee on Social Affairs affirmed that Vietnam's poverty rate is high, however, it has achieved numerous achievements in implementing health insurance; Health insurance coverage in the past year all met and exceeded the targets assigned by the Government and the NA. However, the number of people not participating in health insurance currently accounts for nearly 9.1% of the population - these are the groups that are difficult to mobilize, have poor economic conditions and are not ready to participate or have joined other types of health insurance. “On the other hand, the current number of participants is mainly supported by the state budget, and the number of employees as well as enterprises that are eligible to participate due to the impact of the Covid-19 epidemic should stop or pay high debts; Student participation has not yet reached 100%, etc. Therefore, the Government needs to find a solution to ensure sustainable health insurance coverage in order to gradually reduce the burden of support from the State and the people to participate and enjoy the policy themselves." - Phong analyzed.

Mrs. Leo Thi Lich - Member of the Committee also said that the implementation of the health insurance policy and moving towards universal health insurance still faced difficulties and obstacles. Therefore, the Government needs to clarify the subjects that have not participated in any focused group, and which local budgets have not been supported according to regulations; What is the percentage of the population participating in health insurance in difficult or especially difficult areas? In particular, whether it is difficult for businesses to avoid paying health insurance premiums for their employees due to the Covid-19 epidemic; the responsibility of competent authorities in handling this debt, etc.

Health insurance participants to enjoy many benefits

Along with the increase in health insurance coverage, health care using health insurance for the people is always ensured in a timely manner. In the past year, the whole country had 167 million medical and health care visits using health insurance (10% decreased compared to 2019 due to social distancing). As a result, the number of medical care expenditures covered by health insurance also decreased by about 2%, of which expenditure at the provincial level accounted for the highest proportion with 46%, while the rate at the commune level was the lowest. Notably, although the proportion of expenditures at the district level is not high, it accounts for the largest proportion of expenses.

Along with that, expanding the list of drugs for national-level centralized bidding focused on drugs with a large amount of use and great value; the number of drugs for centralized bidding at the local level is 129, an increase of 23 compared to the old list; put 681 brand-name drugs, 15 monoclonal antibodies and 5 HIV drugs with 1 or 2 manufacturers on the list of price negotiations to reduce drug prices and reduce costs of health insurance funds. “The quality of medical care services has been improved, but it has not yet met the increasing and diverse needs of the people; there is a large disparity between lines and regions, especially at lower levels. People do not really believe in grassroots health care, and most of them only focus on curing diseases, but do not have enough conditions to take care of patients comprehensively. The situation of bypassing levels leading to overcrowding in some central hospitals and big cities has not been completely solved," Tuyen admitted.

At the meeting, the Standing Committee on Social Affairs and delegates also highly appreciated that the MoH, the VSS and relevant ministries and branches have made great efforts in implementing Resolution No. 68/ 2013/QH13, in which a number of targets were well met compared to the requirements set forth by the NA. However, besides that, there are still some unfulfilled targets; The grassroots health system has not been invested in terms of facilities, equipment, human resources or professional quality of medical care, leading to limited quality of medical care at lower levels. In addition, some delegates also suggested a solution to the situation of evasion of payment and late payment of health insurance premiums in 2020 - which continues to increase in many localities; as well as handle the non-compliance with the law on health insurance by many employers.

Along with that, some delegates were also concerned about the risk of imbalance in the health insurance fund. Specifically, the proportion of people participating in health insurance is increasing day by day - one of the main reasons leading to an increase in the number of health care visits using health insurance and an increase in the cost. According to the delegates, while the number of visits to health care services under health insurance increased, the source of health insurance fund increased disproportionately, despite an increase in the number of participants, leading to a lack of funding for medical care using health insurance, as health insurance premiums do not increase in proportion to the increase in the price of technical services and the demand for medical care, leading to the risk of fund imbalance.

In particular, currently 59% of participants in health insurance are paid by the state budget and supported to pay according to the base salary, so the revenue to the fund is low, affecting the balance of revenue and expenditure of the health insurance fund. On the other hand, the benefits of health insurance participants are always adjusted in the direction of expansion (reducing the co-payment level, adjusting the list within the coverage of the health insurance fund), the increasing demand for medical care of the people leads to to the health insurance fund to pay more. When the price of medical services is fully calculated (including management and depreciation costs), it will lead to the risk of fund imbalance. “There are shortcomings in the implementation of health care services with health insurance due to the lack of guiding documents and the MoH needs to pay more attention to solve difficulties and obstacles in the implementation of health care and health insurance, such as promulgating the price bracket for medical services towards correct and sufficient calculation in order to reduce the burden on the health insurance fund," suggested Nguyen Kim Thuy, Vice Chairman of the Committee on Social Affairs.

Illustrative image (source: VSS)

Clarifying a number of issues raised by the delegates, VSS Deputy General Director Pham Luong Son said that the VSS basically agreed with the reports of the Government; also, he emphasized, according to Resolution No. 68, there are currently 3 targets to be adjusted to create conditions for the VSS to implement the policy. According to Deputy General Director Pham Luong Son, from 2021, the VSS will face challenges in developing sustainable health insurance, not in health insurance coverage; therefore requires specific sanctions to attract the participation of the people, not from the support of the budget.

“The NA amends the Law on Health Insurance to meet the goals of health insurance coverage as well as health care benefits; control of medical expenses (mechanism for procurement of drugs, medical supplies, conditions for adjusting the scope of benefits, co-payment mechanism); shortening the appraisal time to exceed the annual medical and health insurance fund of the localities accordingly, etc.” - proposed Son.

Speaking at the conclusion of the meeting, Mrs. Nguyen Thuy Anh - Chairman of the Committee on Social Affairs said that all opinions at the meeting were basically explained and clarified by the VSS and the MoH. However, there are some issues that will need further reporting, especially since we have not yet had an official report from the Government. As a result, the discussions can be included in the explanatory report and the upcoming report of the Government, in order to have a resolution to replace Resolution No. 68.

"This is the first time the NA has discussed and listened to this content. However, we need to prepare the "shape" of a draft Resolution on the target of health insurance coverage. If there is no alternative Resolution, we will also have a Resolution related to health insurance in the Resolution on Socio-Economic Development in 2022. In the immediate future, there will be a plenary meeting of the Committee in October, after which the Commission will finalize the verification report and send it to the NA's Standing Committee for comments." - Anh added.