Proposal for health insurance to pay for screening for some cancers, diabetes, blood pressure

Currently, health insurance only covers medical treatment, not screening costs.

Proposal to pay health insurance for disease screening

According to the draft revised Law on Health Insurance, the Ministry of Health proposes to prioritize expanding health insurance coverage to include cervical cancer, breast cancer, hypertension, diabetes, and hepatitis C and B.

The Ministry of Health evaluates the expansion of screening coverage to assess risks and prevent the occurrence and progression of certain diseases. Early detection and timely treatment of diseases help reduce future treatment costs.

According to statistics in 2023, the cost of treatment for 6 common cancer groups (breast, lung, liver, colon, stomach, prostate cancer) from the health insurance fund is 6,186 billion VND.

Regarding type 2 diabetes, in 2021, it is estimated that the number of diabetic patients in Vietnam will be nearly 4 million, of which 50% have not been diagnosed. In 2023, there will be more than 15,500,000 medical examinations and treatments with costs of up to VND 6,766 billion/year, accounting for 5.6% of total fund expenditure.

For hypertension, in 2023 there will be nearly 23 million medical examinations and treatments with a cost of VND 6,015 billion/year, accounting for 4.9% of total fund expenditure.

According to the Ministry of Health, if detected early and treated promptly, it will help reduce the cost of treating complications and late-stage treatment of the disease, saving money for the health insurance fund.

Specifically, with type 2 diabetes screening, the average cost to be paid is 141 billion VND/year in the first 10 years of implementation. At the same time, the budget to be paid for the treatment of cases detected from screening is 2,089 billion VND/year. After 10 years of implementation, an average of 162 billion VND/year will be saved.

With hypertension screening, the average cost to be paid is 88 billion VND/year in the first 10 years of screening for people aged 18 and over. When cases are detected, it is estimated that 27,940 billion VND/year will be needed for treatment costs. After 10 years of implementation, an average of 1,216 billion VND/year will be saved.

Cervical cancer screening, with an average cost of 3,000 billion/year, will bring economic benefits 19-21 times greater than the investment cost in the first 10 years of implementation.

Breast cancer screening costs an average of $2.1 trillion to $5 trillion per year, depending on the screening method. However, this cost would be significantly reduced if the age group of women screened were limited.

Follow the appropriate roadmap and stages

According to the Ministry of Health, the health insurance fund has increased spending on additional benefits in the first 3 years of implementation, but it can be offset by saving costs for treating serious, high-tech, and expensive illnesses. In particular, treatment costs are often many times higher than the cost of early diagnosis (in severe cases, the current cost is up to billions of VND per treatment session).

The Ministry of Health believes that expanding early diagnosis and treatment of some diseases will help increase people's financial security. In particular, people will be covered by the health insurance fund, contributing to the goal of reducing the current out-of-pocket spending rate of 43% to about 23% by 2025.

When comparing positive and negative economic impacts, the positive impacts of the solution bring more sustainable values, the negative impacts are necessary costs and can be offset by positive values.

Therefore, the Ministry of Health proposes that this solution is feasible and stable in balancing the fund, and is also consistent with the health insurance laws of countries around the world such as Thailand, Japan, Korea, many European countries, etc.

In addition, the Ministry of Health also proposed paying health insurance for special nutritional products for children under 6 years old with severe acute malnutrition; donated pasteurized breast milk for premature and low birth weight babies; treatment of strabismus for people under 18 years old; payment for medical supplies such as prosthetic limbs and hearing aids; and additional newborn screening and diagnostic services (prenatal screening for thalassemia and hypothyroidism).

Accordingly, the expansion of benefits will be implemented according to a roadmap suitable to the balancing capacity of the health insurance fund and prioritize diseases with high risk and current high disease burden.