Proposal to pay 100% of health insurance for some cases even if "going beyond the line"

Ms. Tran Thi Trang, Director of the Department of Health Insurance, Ministry of Health, said that the Ministry of Health is studying to include in the draft supplementary and revised Law on Health Insurance, proposing that in some cases, patients can be examined and treated at higher levels without having to follow the normal examination and treatment procedures.

Specifically, people with rare diseases, serious diseases, diseases requiring surgery or high technology can go to specialized and specialized facilities for examination and treatment without having to follow the referral process and still be covered 100% according to health insurance regulations.

"For example, with some rare diseases (congenital hemolytic anemia, hemophilia, multiple myeloma...), diseases that require the use of high technology or diseases that cannot be treated at basic health care hospitals such as districts and provinces, and have not been approved for the list of techniques, people can go directly to specialized facilities, end-line hospitals, and leading hospitals for diagnosis and treatment.

This is still considered the right level of technical expertise and is entitled to 100% health insurance benefits," Ms. Trang explained.

The representative of the Health Insurance Department added that when hospitals publicly disclose their technical lists, people can rely on these lists to know whether the hospital has diagnosed and treated the disease or not. If there is no technical list, patients can go directly to the next level for treatment and enjoy health insurance like the initial level.

"This proposal helps patients reduce the time required to apply for referral procedures and documents. Hospitals also reduce the pressure on medical examination and treatment. However, there also need to be professional and management solutions to avoid abuse of referrals, in accordance with the expertise and nature of the disease," said Ms. Trang.

In addition to the above proposal, the Ministry of Health also proposes that for some diseases, after initial diagnosis at a higher level, specialized, high-tech, and can be returned to the commune health station or district hospital for care, the patient will be admitted for disease management at a lower level and receive the same medicine as at a higher level.

"Medicines for cardiovascular, diabetes, high blood pressure, etc., patients treated at commune health stations will also be provided the same as those at higher levels. This is a new point that meets people's expectations, ensures the rights of health insurance participants, and increases patients' trust in lower-level health care.

In particular, we are trying to expand the drug list at the lower level, so that patients can feel secure in receiving treatment at the primary or basic medical level. This is a sustainable solution, reducing waiting time and unnecessary referral procedures.

Besides, there should also be a mechanism for serious illnesses that require high technology so that patients can be treated at higher levels," said Ms. Trang.