Minister of Health Dao Hong Lan informed about the proposal that serious illnesses be transferred directly to higher levels.

On the morning of September 25, the National Assembly Standing Committee gave opinions on the draft Law amending and supplementing a number of articles of the Law on Health Insurance.

Eliminate transfer procedures in many cases

Minister of Health Dao Hong Lan said that this draft law stipulates a number of solutions that clearly demonstrate the spirit of administrative reform, medical examination and treatment procedures, reducing paperwork, increasing the application of information technology, decentralization, and maximum delegation of power, creating convenience for people, agencies, and organizations.

In particular, the draft law amending regulations on medical examination and treatment in the right and wrong line (inter-line) is updated according to the technical expertise level of the 2023 Law on Medical Examination and Treatment, on the basis of maintaining a stable rate of health insurance benefits according to current law.

One of the notable contents is the draft law that eliminates referral procedures for some rare and serious diseases that are sent directly to higher specialized levels to reduce procedures, create convenience, reduce out-of-pocket expenses for people, and save costs for the Health Insurance Fund.

The draft law also amends regulations on initial health insurance medical examination and treatment registration and patient transfer between health insurance medical examination and treatment facilities to synchronize with regulations on technical expertise levels.

This regulation aims to synchronize with the regulations on technical expertise levels in the direction of decentralization and delegation of authority to the Department of Health to determine the initial health insurance examination and treatment registration facilities and allocate health insurance cards in accordance with local realities on the basis of regulations of the Minister of Health.

Preliminary examination of this content, Chairwoman of the Social Committee Nguyen Thuy Anh proposed to maintain the spirit of the current law on initial medical examination and treatment registration, only in some cases can initial medical examination and treatment registration be organized at the basic and advanced levels.

According to the Chairman of the Social Committee, the drafting agency needs to clearly stipulate the principles, criteria, specific conditions, and special cases that are eligible for initial health insurance examination and treatment, to eliminate the risk of policy abuse, create a request-grant mechanism, and strengthen the activities of grassroots health care.

Convert health insurance numbers to avoid profiteering from medical examinations and taking medicine to sell

To improve the efficiency of fund management and use, the draft law supplements regulations on the costs of using blood, blood products, medical gases, supplies, tools, and instruments used in medical examination and treatment within the scope of benefits for health insurance participants.

In case of chronic disease transferred to lower level, the medicine is used as in higher level and the health insurance benefit rate is adjusted in some cases to promote the role of primary health care.

Regarding this content, some opinions in the Standing Committee of the Social Committee said that the most pressing issue currently in payment and settlement of medical examination and treatment costs under health insurance is the assessment of the reasonableness of medical service provision when assessing health insurance.

The “suspension” of the settlement of medical examination and treatment costs under health insurance is due to the difficulty in reaching agreement between the appraisal agency and the medical examination and treatment facility on the reasonableness of the service provision. In addition, there are opinions that social insurance does not have the capacity to perform appraisal. Therefore, it is proposed to study and revise the concept of “health insurance appraisal” in the current law.

Presenting the current pressing issues related to payment and settlement of health insurance-covered medical examinations and treatments, and ensuring medicine for people when receiving health insurance-covered medical examinations and treatments, National Assembly Chairman Tran Thanh Man suggested that there should be no discrimination and that fairness must be ensured between service medical examinations and insurance-covered medical examinations.

"We must thoroughly understand the fundamentals so that people who have money to go to medical examination services and people who do not have money to go to medical examination health insurance are treated fairly. We need to solve the root cause instead of just solving it when there is public opinion here or there," the National Assembly Chairman noted.

In addition, the National Assembly Chairman also proposed a careful review to ensure fairness and not to miss out on health insurance participants, paying special attention to people with meritorious services and ethnic minorities...

“After the recent storms, floods and landslides in 26 northern provinces and cities, people's lives have been very difficult. Many people are homeless and have to live in tents and camps. Medical examination and treatment for people is a regular task, but special attention is needed in difficult areas,” said the National Assembly Chairman.

Vice Chairman of the National Assembly Nguyen Khac Dinh pointed out the fact that people go to the hospital and find out that their health insurance cards have expired and have to make a new one, which is very time-consuming and requires a lot of travel. Therefore, he noted that the procedure for making a new card must be very quick, done right at the hospital, and done electronically. Now, if people have to go back to their hometowns and make a declaration, it will be very time-consuming.

The Vice Chairman of the National Assembly also noted that some opinions reflect that people with health insurance cards are treated fairly and provided with medicines on the health insurance list, but if they cannot be provided, people have to buy medicines on the list, and the insurance has to pay.

To avoid health insurance fraud, Mr. Dinh said that it is necessary to promote digital transformation and put everything online to monitor and avoid exploitation and abuse, and to avoid the situation where people go to the doctor many times and then take medicine home and do not take it but sell it.