Draft amended law on health insurance is well studied

02/09/2024 09:30 AM


Under WHO, Social Health Insurance (SHI) is a form of financing and managing health care based on risk pooling. SHI pools both the health risks of the people on one hand, and the contributions of individuals, households, enterprises, and the government on the other. Thus, it protects people against financial and health burden and is a relatively fair method of financing health care. Desirable though it is, not many least-developed and low-middle-income countries have succeeded in adequately expanding coverage of SHI. Most countries rely primarily on tax-funded finance, which is also relatively fair.

According to Deputy Minister of Health, 93.3 million people, or 93.35 percent of the population, have joined health insurance, proving that the law had truly come into life after 15 years of implementation.

Presenting the Government’s proposal on the draft revised health insurance law, Thuan said after 15 years of implementation, 93.3 million people, accounting for 93.35 percent of the population, have joined health insurance, proving that the law had truly come into life.

It affirms the benefits and relevance of the health insurance policy with the principle of risk sharing, which is a mechanism to ensure financial resources for citizens’ medical examination and treatment needs, as well as social security and international integration.

But when being put into practice, it has problems, obstacles and shortcomings that need to be adjusted. The shortcomings have been pointed out in the summary report covering the first 15 years of the law's implementation, he said.

The shortcomings are related to health insurance beneficiaries; scope of benefits; diversification of health insurance packages and regulations on linkage with commercial health insurance; registration for initial medical examination and treatment, connecting and transferring levels; health insurance medical examination and treatment contracts; health insurance assessment, management and use of health insurance funds.

Reality shows there are still many shortcomings in the provisions related to the responsibilities of relevant parties in implementing health insurance policies, application of information technology in health insurance management.

While punishments are either absent or insufficiently serious to guarantee law compliance and enforcement, there has been no mechanism in place to settle disputes and issues pertaining to health insurance. Some concepts and terms mentioned in the law do not exist or stay unclear.

It affirms the benefits and relevance of the health insurance policy with the principle of risk sharing, which is a mechanism to ensure financial resources for citizens’ medical examination and treatment needs, as well as social security and international integration.

But when being put into practice, it has problems, obstacles and shortcomings that need to be adjusted. The shortcomings have been pointed out in the summary report covering the first 15 years of the law implementation, he said. The shortcomings are related to health insurance beneficiaries; scope of benefits; diversification of health insurance packages and regulations on linkage with commercial health insurance; registration for initial medical examination and treatment, connecting and transferring levels; health insurance medical examination and treatment contracts; health insurance assessment, management and use of health insurance funds.Reality shows there are still many shortcomings in the provisions related to the responsibilities of relevant parties in implementing health insurance policies, application of information technology in health insurance management.

While punishments are either absent or insufficiently serious to guarantee law compliance and enforcement, there has been no mechanism in place to settle disputes and issues pertaining to health insurance. Some concepts and terms mentioned in the law do not exist or stay unclear.

A representative of the draft law’s compiling agency emphasised the need to change a number of articles of the Law on Health Insurance with an aim to resolve urgent problems and inadequacies. This also helps collect sufficient information and data, and achieve high consensus to effectively implement health insurance policies and laws, strengthen management and makes efficient use of the health insurance fund.

In order to make the draft amended law formally come into effect on January 1, 2025, the modifications also seek to guarantee conformity with the Law on Medical Examination and Treatment No 15/2023/QH15 and other relevant laws and regulations.

The purpose of the revisions is to guarantee that individuals can enroll in health insurance within the relevant groups. It also looks to ensure the rights of health insurance participants in accordance with health care needs, professional requirements, technical expertise levels in medical examination and treatment, and the payment capacity of the health insurance fund.

It aims to facilitate the provision and use of health insurance examination and treatment services; improve the efficiency of grassroots healthcare, pay attention to primary health care, contribute to comprehensive management of public health; improve the efficiency of management and use of health insurance funds.

Participants at the meeting reached consensus on the Government's proposal, adding that some of the adjustments would directly affect individuals, businesses, medical examination and treatment facilities, and the balance between the State budget and health insurance funds.

They recommended that the drafting agency consider including a mechanism to protect workers; rights when employers fail to pay for health insurance or postpone doing so.

The NA deputies also proposed carefully weighing and analysing a number of factors before extending the list of beneficiaries to balance the health insurance fund and ensure the social and risk-sharing nature of health insurance.

NA deputy Nguyen Anh Tri from Ha Noi proposed the medical team is responsible for assessing and prescribing treatment while the health insurance agency is in charge of controlling expenditures to ensure that it is consistent with practical capacity. He claimed that while the expenditure control stage amply illustrates the function of health insurance, the process of evaluating treatment and prescribing is one that frequently takes place during the examination and treatment phases. Reasonable regulations on these roles will solve one of the biggest problems of the current Law on Health Insurance.

Deputy Pham Khanh Phong Lan from HCM City agreed with the purpose of the law

amendments. She proposed it is necessary to conduct more thorough research to amend the law in a substantive manner and address shortcomings in the contribution level, health insurance benefits, fund balance, initial medical examination and treatment, health insurance payment service mechanism to better protect the rights of health insurance participants.

Other participants shared their thoughts on the following topics: health insurance beneficiaries; the extent of benefits and the person responsible for paying for them; health insurance payment methods; the transfer of patients between health insurance medical examination and treatment facilities; and the payment and settlement of medical examination and treatment costs covered by health insurance.

Also at the meeting, the NA’s Social Affairs Committee reviewed the Government’s report on themanagement and use of the health insurance fund in 2023 and gave opinions on the assessment of the socio-economic development plan’s implementation, the State Budget estimate for 2024. They also gave feedback on the socio-economic development plan, and the State Budget estimate for 2025 under the Ministry of Health responsibility.

 

 

PV