Rare and serious diseases, high-tech surgeries are transferred directly to the final line, with 100% health insurance coverage

Immediately after the Law amending and supplementing a number of articles of the Law on Health Insurance (HI) was recently passed by the National Assembly, the Vietnam Social Security (VSS) held an online meeting with the Social Security of provinces, cities and district-level Social Security nationwide to inform about this content, and at the same time direct the work and tasks in the whole industry to promptly and promptly implement and ensure the rights of health insurance participants according to the new regulations.

Deputy General Director of Vietnam Social Security Nguyen Duc Hoa said that the Law amending and supplementing a number of articles of the Law on Health Insurance addresses institutional bottlenecks and is consistent with other laws in the implementation process. Simplify procedures, creating the greatest convenience for people using health insurance. Assign the Government and ministries to regulate the contents under their authority to flexibly and promptly amend when necessary; minimize overlapping regulations with the contents already stipulated in other laws.

The Law amending and supplementing a number of articles of the Law on Health Insurance has many outstanding new points that bring benefits and convenience to health insurance participants. In particular, the Law has completely amended Article 12 of the old Law on subjects, payment methods, and payment levels, in sync with the Law on Social Insurance (amended) that was just passed by the National Assembly in June 2024. Many new groups of subjects have been added as well as the support level has been increased.

Regarding the expansion of benefits, the Law expands the scope of health insurance benefits with the form of remote medical examination and treatment, supporting remote medical examination and treatment, family medicine medical examination and treatment, and home medical examination and treatment to synchronize with the Law on Medical Examination and Treatment in 2023 and the trend of digital transformation in the health sector.

A highlight is that in the Law amending and supplementing a number of articles of the Law on Health Insurance, the regulations are designed to "eliminate administrative boundaries" in medical examination and treatment. The Law stipulates in line with the Law on Medical Examination and Treatment on the decentralization of expertise into 3 levels: Intensive, basic and initial. In which, the transfer of medical examination and treatment facilities does not depend on the level (commune, district, province, central as before); creating maximum conditions for patients, reducing administrative procedures when transferring medical examination and treatment facilities.

Regarding initial medical examination and treatment registration, there are very clear regulations and criteria. In particular, people who register for initial medical examination and treatment at a higher level will receive medical examination and treatment at a lower level. In particular, health insurance participants are entitled to 100% of the benefits when receiving medical examination and treatment at a basic or specialized medical facility in cases of confirmed diagnosis and treatment of certain rare diseases, serious diseases, diseases requiring surgery or using advanced techniques according to regulations of the Minister of Health. Thus, in some cases of rare and serious diseases, requiring surgery or using advanced techniques... patients do not need to be transferred according to regulations but still enjoy 100% of the benefits. The Law also stipulates overcoming the shortage of drugs and medical supplies, ensuring the rights of patients when having to buy medicine outside...

In addition, the Law also stipulates the responsibility of the Ministry of Health in reviewing and regularly updating treatment regimens to ensure convenience in medical examination and treatment and payment of health insurance; regulations on assessing the reasonableness of providing health insurance medical examination and treatment services; regulations on the application of information technology, digital transformation, data sharing in the field of health insurance, the connection and use of paraclinical results between medical examination and treatment facilities in accordance with professional requirements and providing solutions to enhance the capacity of health insurance medical examination and treatment for grassroots health care; additional regulations on issuing electronic health insurance cards, etc.

In order to implement the amended and supplemented Law on Health Insurance in a timely and effective manner, Deputy General Director Nguyen Duc Hoa directed the Health Insurance Policy Implementation Board, the Health Insurance Assessment Center and Multi-level Payment to proactively and closely follow relevant ministries and branches in developing Decrees and Circulars guiding implementation; at the same time, prepare content for communication, training and guidance for local Social Insurance. Social Insurance agencies of provinces and cities proactively plan and implement the Law from the first days of its effectiveness; promptly ensuring the rights of health insurance participants.

The Law amending and supplementing a number of articles of the Law on Health Insurance will take effect from July 1, 2025.