At the meeting, Deputy General Director of VSS Pham Luong Son emphasized: “The assessment process is an important document with great influence, affecting all units and agencies involved in the assessment. organization and implementation of health insurance policies. VSS has at least 4 times issued the assessment process. Practice shows that the assessment process in each period is quite appropriate, brings positive effects, and helps us to accomplish significant political goals. First of all, it contributes to ensuring the maximum legal and reasonable interests of the participants of health insurance when going for medical treatment; it also ensures benefits for medical facilities; assists the VSS control costs”.

According to the Deputy General Director, in the context that the Law on Health Insurance is actively being revised with many breakthroughs, this requires the assessment process to be updated to match the legal and practical basis. In particular, it is necessary to solve difficulties and problems, even controversial issues between medical treatment facilities and the social security agency.

The General Director requested to speed up the completion of the new health insurance assessment process in an efficient and strict manner.

Reporting on the implementation of the new health insurance assessment process, Director of the Department of Health Insurance Implementation Le Van Phuc said that, in order to ensure convenience and consistency in the application of the law and improve objectivity, publicity, and transparency in the implementation of health insurance assessment activities, it is of great importance and competent for the VSS to develop and issue the health insurance assessment process. Based on the above-mentioned grounds, the VSS has the discretion to issue the health insurance assessment process to carry out the assessment of health insurance and take responsibility before the law for the assessment results. In the draft assessment process, in addition to the regulations applied internally by the social security agency, there are also contents applicable to medical treatment facilities.

Regarding the procedure, the process of developing the draft revised and supplemented health insurance assessment process has been widely consulted in writing by the Center for Medical Claim Review in collaboration with the Department of Health Insurance Implementation with regard to relevant units of the VSS; opinions and comments of the Ministry of Health (3 times), Ministry of Justice, Ministry of Finance; opinions and comments of the Departments of Health of the provinces, cities, medical facilities; opinions and comments from social security agencies of provinces and cities (3 times). Also, the VSS held a workshop to collect public opinions on the assessment process with the participation of departments and agencies of the Ministry of Health, social security agencies, Departments of Health of provinces, cities, Vietnam Private Hospital Associations and many health insurance based medical care facilities.

Director of the Department of Health Insurance Implementation Le Van Phuc reported on the implementation of the health insurance assessment process.

The VSS revised the process of assessment of health insurance promulgated together with Decision No. 1456/QD-BHXH, amending the principle of selecting assessment samples suitable to human resources. In addition, many assessment operations have been performed on the health insurance assessment information system and linked with other professional software of the sector, which has set the necessary requirements to appropriately amend and supplement the health insurance assessment process.

Regarding the publicity of the assessment rules, according to the opinion of the Center for Medical Claim Review, the assessment rules are developed based on the provisions of the Law on Health Insurance and relevant legal documents. The regulations are promulgated by the competent authority and the relevant units responsible for the implementation.

At the meeting, Mr. Duong Tuan Duc - Director of the Center for Medical Claim Review said: The VSS has 3 times consulted in writing, and organized 2 consultation online workshops to receive comments on the development of the health insurance assessment process. The process of assessment of health insurance includes 6 chapters, 41 articles including: General provisions; Assessing conditions for signing contracts for medical treatment covered by health insurance; Assessment of payment conditions for drugs, medical supplies and treatment services; Professional assessment of medical treatment expenses covered by health insurance; Managing and exploiting the information system of assessment of health insurance and management of medical expenses with health insurance on professional software; Implementation and organization.

Overview image of the meeting.

The Director of the Center for Medical Claim Review presented details of the health insurance assessment process; highlighted new points, ideas received and explained related to regulations on responsibility; payment vouchers; assessment of the list of drugs and medical supplies; service list assessment; reviewing payment requests.

Concluding the meeting, General Director Nguyen The Manh emphasized: “With the common goal of ensuring the interests of all parties when participating in the implementation of the health insurance policy, especially the interests of the people when participating in health insurance, amending and supplementing the health insurance assessment process is a necessary issue, reaching the high consensus of the leaders of the Ministry of Health, the VSS and medical facilities", emphasized Manh.

The General Director requested to accelerate the completion of the legal basis; changing basis of legal documents, human resource practice, digital transformation trend, IT application; supplement the concept of health insurance assessment as the assessment process is a specialized professional activity of the Vietnamese social insurance industry; evaluate the feasibility of implementation./.