Ministry of Health responds to proposal to 'open health insurance' for people aged 70 and over

Many people wonder about the expansion of health insurance examination and treatment for the elderly, especially those over 70 years old when their health is declining.

Doctors at the Central Hospital for Tropical Diseases examine patients - Photo: NGUYEN HIEN

Many elderly people want to "clear the way" for health insurance examination

In fact, many people aged 70 and over today suffer from chronic diseases such as high blood pressure, diabetes, cardiovascular disease, bone and joint disease, etc.

Many people are concerned that commune and ward health stations or district hospitals do not have enough capacity and facilities to effectively treat these diseases.

Therefore, many elderly people often have to go to provincial or central hospitals, which have full medical specialties and equipment, for examination.

However, according to current regulations of the Law on Health Insurance, if a patient arbitrarily goes to a hospital that is not in the right line of treatment (ie does not have a referral letter from the initial registration place), they will only be paid a portion of the cost by the health insurance fund, at a much lower level than if they went to the right line.

This causes the elderly, who have low incomes or even no income, to have to pay hundreds of thousands to millions of dong for each medical examination, not to mention the cost of medicine, tests, and treatment. These costs increase psychological pressure, making many people afraid to see a doctor or delay treatment, making the condition worse.

Not only that, for the elderly and those with weak health, traveling long distances, asking for hospital transfer papers, waiting in line... are not small obstacles, even causing many people to give up the need for medical examination and treatment at higher levels.

Therefore, many opinions suggest that there should be a special policy for people aged 70 and over, allowing them to have health insurance examinations at higher levels without needing a referral letter, helping to access medical services more conveniently and effectively.

What diseases do not require a referral?

In response to people's proposals, the Ministry of Health said that currently, the regulation of medical examination and treatment at different levels (currently medical examination and treatment levels) aims to ensure examination and treatment according to the disease condition (regardless of age).

This is also suitable for the technical level, helping to reduce overload at the upper level (technical level). Only when the condition is serious should the patient be transferred to a higher level for appropriate treatment.

However, according to Circular No. 01/2025/TT-BYT dated January 2, 2025 of the Ministry of Health guiding the implementation of health insurance examination and treatment, some groups of serious diseases and chronic diseases commonly found in the elderly are allowed to be treated at higher technical specialized levels without a referral letter.

In Appendix I and Appendix II of this Circular, the Ministry of Health lists diseases and groups of diseases that are considered eligible for direct transfer, including many common diseases in the elderly such as heart failure, coronary artery disease, diabetes with complications, COPD, Parkinson's, cancer in the treatment stage...

If a health insurance card holder is diagnosed with a disease on this list, they can go directly to a basic or specialized hospital for treatment while still enjoying full health insurance benefits.

Proper medical examination and treatment not only helps reduce overload at upper-level hospitals, but also ensures treatment quality appropriate to the capacity of each level, in accordance with professional principles.

Thus, although there is no "completely open" policy for all people aged 70 and over, people with chronic diseases now have a more favorable path when examining and treating patients with health insurance at higher levels.

People can refer to the specific list of diseases in Circular 01/2025/TT-BYT to know whether they are eligible for direct referral or not to comply with regulations.

WILLOW

Source: https://tuoitre.vn/bo-y-te-phan-hoi-ve-de-xuat-thong-tuyen-bao-hiem-y-te-cho-nguoi-tu-70-tuoi-20250719160226854.htm