Proposal for people with serious illnesses to be transferred directly to higher level hospitals

The draft law amending and supplementing a number of articles of the Law on Health Insurance was submitted by the Government to the National Assembly on the morning of October 24. The draft law outlines cases where health insurance participants are paid when they go to a hospital other than the initial registration location or do not have to go through procedures to transfer to a higher-level hospital.

Accordingly, emergency patients at all hospitals nationwide will be paid 100% of inpatient and outpatient medical examination and treatment costs according to the benefit rate.

Patients are allowed to go to hospitals with basic or specialized technical expertise in case of diagnosis and treatment of certain serious or dangerous diseases, diseases requiring surgery or using advanced techniques.

The Government also proposed to pay health insurance for people who go to primary health care facilities or basic health care facilities that have been decentralized before January 1, 2025.

Health insurance will pay for inpatient treatment costs for patients going to specialized provincial hospitals for examination and treatment; outpatient treatment will not be paid.

From July 1, 2026, outpatients in this case will be paid 50% by health insurance according to the benefit level.

For the Central line, health insurance will pay 40% of inpatient costs according to the benefit level and will not pay for outpatient medical examination and treatment costs.

Ethnic minorities and people from poor households in difficult or extremely difficult areas, island communes and island districts, when going directly to higher-level specialized examinations, will be covered by health insurance.

According to Minister of Health Dao Hong Lan, eliminating referral procedures for some rare and serious cases, so that they can go straight to a higher level of expertise, will reduce procedures, create convenience, reduce out-of-pocket expenses for people, and save costs for the health insurance fund.

Representative of the inspection agency, Chairwoman of the Social Committee Nguyen Thuy Anh assessed that the draft law has expanded the benefits of health insurance participants by one step when "providing universal medical examination and treatment".

However, the Social Committee recommends that the Government carefully assess the impact on the ability to balance the health insurance fund as well as the organization and operation of the medical examination and treatment system, including primary health care.

The Committee also recommends that the drafting agency consider allowing 100% health insurance payment for diseases requiring surgery or high technology, as this scope is relatively wide. The Minister of Health should issue a transparent list to ensure the health insurance fund's ability to pay.

"The drafting agency needs to clarify with hospitals established after January 1, 2025 that are not divided by district or province, what mechanism will be applied to ensure fairness in the rights of people with health insurance cards, especially those who are currently enjoying district-level benefits," said Ms. Thuy Anh.

The Ministry of Health needs to soon rank the technical expertise of hospitals under its management, including private hospitals, before December 31, 2024 to synchronize the settlement of health insurance examination and treatment payments according to technical expertise levels.

This afternoon, the National Assembly discussed the draft law amending and supplementing a number of articles of the Law on Health Insurance.