Increase benefits for participants and beneficiaries of health insurance policies

As the agency organizing and implementing the health insurance policy, Vietnam Social Security has been proactive, active, and responsible, together with the Ministry of Health and related ministries and branches, in the process of developing, participating in comments on amendments and completing the content of the draft Decree. With the viewpoint of always creating favorable conditions for health insurance participants and ensuring the balance and safety of the health insurance fund, many inadequacies or issues that need to be amended and supplemented from practice have been focused on by Vietnam Social Security, with suggestions and comments to ensure the effective organization and implementation of health insurance policies.

Proposals of Vietnam Social Security such as: expanding the rights to enjoy health insurance policies for a number of groups of subjects; removing obstacles in payment of medical examination and treatment costs, strengthening management measures, and using health insurance funds... have received consensus and agreement from ministries and branches and have been specified by the Government in Decree No. 75 with many new points.

In particular, Decree No. 75 has added the group of subjects whose state budget contributions are people in safe zone communes, revolutionary safety zones (ATK) and the group whose state budget supports health insurance contributions (at least 70% of the contribution level within 36 months from November 1, 2023) including ethnic minorities living in communes that have just escaped from difficult and especially difficult areas in ethnic minority and mountainous areas in the period of 2021 - 2025 according to the Prime Minister's decision.

According to Vietnam Social Security, Decree No. 75's addition of ethnic minorities living in communes that have just escaped from difficult or extremely difficult areas in ethnic minority and mountainous areas in the 2021-2025 period to the group receiving state budget support for health insurance premiums is extremely important, aiming to create favorable conditions for all people, especially disadvantaged groups, to have the opportunity to participate in and benefit from health insurance policies, thereby contributing to maintaining and developing health insurance coverage. The regulation that the state budget continues to support for a period of time after escaping poverty so that people can accumulate and have sufficient economic conditions to participate in health insurance demonstrates the Government's policy of ensuring social security and sustainable poverty reduction.

The level of health insurance examination and treatment benefits has also been increased. Those who participated in the resistance war and defended the Fatherland are entitled to an increase in the level of benefits from 80% to 100% of the cost of health insurance examination and treatment. Those who serve people with meritorious services to the revolution living in their families are entitled to an increase in the level of benefits from 80% to 95%. The spouses of martyrs who have remarried but are receiving monthly allowances according to the provisions of the Ordinance on preferential treatment for people with meritorious services to the revolution (code TG) are entitled to 95% of the cost of health insurance examination and treatment.

Decree No. 75 abolishes the regulation on the total payment for health insurance examination and treatment costs, and implements payment according to the service price payment method applied from January 1, 2019. At the same time, it stipulates that, based on the budget assigned by the Prime Minister, Vietnam Social Security will assign the budget for health insurance examination and treatment costs to the Social Security of provinces and cities, the Social Security of the Ministry of National Defense, and the Social Security of the People's Public Security (within 90% of the national health insurance revenue budget).

After that, the Social Insurance agency will notify the expected amount of health insurance medical examination and treatment expenses to the medical examination and treatment facilities. The medical examination and treatment facilities will make plans to use the health insurance medical examination and treatment expenses for the year according to the notified amount. The assignment of this expected amount of expenses will not be used as a basis for advance payment or settlement of the medical examination and treatment facility in case of exceeding the expected amount of expenses.

According to the new regulations, the costs of medical examination and treatment under health insurance within the scope of benefits and the level of benefits of health insurance participants that have been assessed by the Social Insurance agency will be covered by the Health Insurance Fund. The payment mechanism is based on the actual technical services, medicines, medical supplies, etc. used for patients and the prices according to current regulations. These regulations create conditions for medical examination and treatment facilities to improve the quality and efficiency of their operations and ensure the rights of health insurance patients, and to manage and use the health insurance fund safely and in accordance with regulations.

In order to effectively implement Decree No. 75 of the Government, Vietnam Social Security has promptly issued documents directing and guiding Social Security of provinces and cities to proactively implement solutions such as: coordinating with relevant departments and branches to advise the Provincial People's Committee to allocate budget support when paying health insurance premiums for groups of subjects supported by the state budget for health insurance premiums; reviewing, making a list and issuing and exchanging health insurance cards of beneficiaries under this Decree... With the efforts of the whole industry, it is expected that by the end of 2023, the health insurance coverage rate will reach 93.35% of the population.