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Tailor health insurance for all

Addressing the meeting, Deputy Minister of Health Tran Van Thuan said, after 15 years of implementation, the Law on Health Insurance has proven effective in providing essential healthcare services and financial security for Vietnamese citizens. However, he  acknowledged that the law requires updates to address certain shortcomings.

Key areas for improvement, he noted, include: Subject coverage: ensuring that individuals are enrolled in health insurance programmes that align with their specific needs and circumstances; Service scope: expanding the range of healthcare services and benefits covered by health insurance; Referral system: streamlining the process for referring patients between different levels of healthcare facilities; Contribution rates: reviewing and adjusting health insurance contribution rates to ensure fairness and affordability; and Contractual agreements: strengthening contracts between health insurance agencies and healthcare providers to improve service quality and efficiency.

Therefore, revising and supplementing the Law on Health Insurance is crucial to promote equitable participation, protect participant rights, enhance service delivery, and improve healthcare performance. This will ensure that individuals can enroll in health insurance programs that align with their specific needs and circumstances, guarantee that health insurance participants have access to necessary healthcare services based on their needs, professional requirements, and the financial capacity of the health insurance fund, facilitate the provision and utilisation of health insurance-based medical examination and treatment services, and strengthen the capabilities of medical facilities and optimize the management and use of the health insurance fund.

The revised draft Law on Health Insurance, as approved by the National Assembly Standing Committee, focuses on four key policy areas: adjusting participant eligibility to align with relevant legal regulations; expanding or limiting health insurance benefits based on contribution levels, the financial health of the health insurance fund, and evolving healthcare needs; updating health insurance regulations to reflect advancements in medical technology and promote the role of primary healthcare in initial care and health insurance-based services; and implementing effective strategies for allocating and utilizing the health insurance fund.

Thorough study to ensure the draft law’s feasibility

Deputy General Director of Vietnam Social Security Nguyen Duc Hoa said as the proposed amendments are quite broad, therefore, thorough study is needed, along with referencing international experiences and a comprehensive, cautious financial impact assessment to ensure the feasibility of the draft law as well as to adjust the scope of benefits to align with contribution levels and the balancing capacity of the health insurance fund.

Regarding health insurance claim reviews, Deputy General Director Nguyen Duc Hoa suggested that the drafting agency conduct a comprehensive review and amendment, changing the content of the assessment work; at the same time, enhance the application of information technology and digital transformation in this work.

Deputy General Director Nguyen Duc Hoa of Vietnam Social Security addresses the meeting

Hoang Lien Phuong, from the Legal Department of the Ministry of Labour, Invalids and Social Affairs, has proposed that near-poor households be included in the group of individuals whose health insurance is either fully or partially funded by the social security organizations or the government. Specifically, he suggests adding this group to the category of beneficiaries receiving monthly social welfare allowances, including those aged 75 and over, and those aged 70-75 who belong to poor or near-poor households. This proposal aims to align with the provisions of the Law on Social Insurance.

Deputy Minister of Justice Tran Tien Dung concluded by emphasizing the complexity of the Law amending and supplementing a number of articles of the Health Insurance Law. He highlighted its significant impact on the population, particularly vulnerable and disadvantaged groups. The Deputy Minister urged the drafting agency to carefully review the challenges and obstacles encountered in the practical implementation of health insurance. This review should inform a systematic amendment of the Health Insurance Law, ensuring its compatibility with the Law on Medical Examination and Treatment.

Regarding its appropriateness with the Party’s guidelines and policies, the Deputy Minister asked the drafting agency to closely follow and institutionalise the Resolution No 20-NQ/TW dated October 25, 2017 of the 12th Party Central Committee on enhancing citizens’ health protection, care, and improvement in the new situation; the Directive No 25-CT/TW dated October 25, 2023 of the Secretariat on reinforcing and improving the performance of grassroots medical facilities in the new situation; the Resolution No 42-NQ/TW dated November 24, 2023 of the 13th Party Central Committee on continuing renewing and enhancing the quality of social policies, satisfying requirements of the national construction and protection in the new period.

Regarding eligibility for health insurance support, the Deputy Minister requested that the drafting agency to clearly define new eligible subjects in the draft Law; and collaborate with relevant ministries and sectors to review and assess specific impacts, particularly on the most vulnerable populations.

Concurrently, the drafting agency should research regulations on allocating the budget to health insurance agencies; establish a unified mechanism defining the responsibilities of state management agencies for healthcare and health insurance in medical claim review; consider stipulating a deadline for annual audit settlement of the health insurance fund before October 1of the following year; and clarify regulations on private clinics and examination facilities./.