Flexible health insurance examination and treatment mechanism, ensuring patient rights

Deputy Prime Minister Tran Hong Ha said that it is necessary to pay more attention to grassroots healthcare in allocating the health insurance expenditure budget to effectively carry out tasks of primary healthcare, management of some chronic diseases, and preventive medicine , so that people do not flock to upper-level healthcare - Photo: VGP/Minh Khoi

The Deputy Prime Minister requested ministries and branches to discuss frankly and clarify the contents with different opinions. The goal after the meeting is to complete and immediately issue the Decree amending and supplementing a number of articles of Decree 146/2018/ND-CP; and at the same time, it will take effect immediately to ensure the rights of patients.

Deputy Minister of Health Tran Van Thuan reported on important contents of the Decree amending and supplementing Decree 146/2018/ND-CP

At the meeting, Deputy Minister of Health Tran Van Thuan reported specifically on the plan to amend and supplement a number of articles of Decree 146/2018/ND-CP, focusing on a number of groups of issues: Principles of payment and settlement of health insurance examination and treatment costs; groups of subjects supported with health insurance contribution levels; co-payment rates for health insurance examination and treatment costs for a number of groups of subjects;...

Accordingly, representatives of ministries, branches and associations agreed to replace the regulation that the health insurance fund's payment does not exceed the total payment of health insurance medical examination and treatment costs at medical facilities with a plan to assign a budget estimate, with a flexible adjustment mechanism based on the actual medical examination and treatment of the medical facility.

Deputy General Director of Vietnam Social Security Nguyen Duc Hoa gives comments on the payment mechanism and settlement of health insurance medical expenses - Photo: VGP/Minh Khoi

The leaders of Vietnam Social Security and the representative of the Ministry of Finance proposed to complete the regulations on the basis of building, approving, allocating, and adjusting the health insurance expenditure estimates for medical facilities based on the principle of assigning the annual state budget estimates, ensuring that the total annual payment does not exceed the regulations but can be flexibly adjusted, overcoming the situation where some places have excess, some places have shortage but the Health Insurance Fund still has surplus.

Agreeing with this opinion, Vice Chairman of the Ho Chi Minh City People's Committee Duong Anh Duc said that the Decree needs to specify the policy of applying a flexible and flexible payment and settlement mechanism for health insurance examination and treatment costs, so as not to affect the rights of patients; at the same time, control and prevent abuse and profiteering in the use of drugs and equipment that are not suitable for the treatment regimen.

Deputy Prime Minister Tran Hong Ha emphasized that the draft Decree must thoroughly grasp the principle of health insurance, which is to share risks and focus treatment resources on the unfortunate and disadvantaged - Photo: VGP/Minh Khoi

Concluding the meeting, Deputy Prime Minister Tran Hong Ha requested the Ministry of Health to absorb opinions and complete regulations on payment and settlement of health insurance medical examination and treatment costs regarding procedures, authority to develop, approve, allocate, and adjust health insurance medical examination and treatment expenditure estimates for medical facilities; the total health expenditure for the following year must increase compared to the previous year; ensuring the implementation of the health insurance policy objectives according to the law.

"The draft Decree must thoroughly grasp the principle of health insurance, which is to share risks and focus treatment resources on the unfortunate and disadvantaged. In case of necessity, when the total health insurance expenditure exceeds the total revenue, it is necessary to consider the state budget to compensate", the Deputy Prime Minister noted and said that "it is necessary to pay more attention to grassroots health care in allocating the estimated health insurance expenditure to effectively perform the tasks of primary health care, management of some chronic diseases, and preventive medicine, so that people do not rush to upper-level health care".

The Ministry of Health is responsible for guiding medical facilities to prepare annual expenditure estimates based on the volume of work and assigned tasks; not rigidly applying the principle of preparing estimates based on the total expenditure of the previous year.

Along with that, the Deputy Prime Minister assigned the Ministry of Health to issue a complete treatment regimen to optimize treatment effectiveness and an effective monitoring mechanism to limit the arbitrary and abusive use of drugs and treatment equipment in health insurance-covered medical examination and treatment.

"In case of necessity, when the total health insurance expenditure exceeds the total revenue, it is necessary to consider the state budget's compensation plan," the Deputy Prime Minister noted.

The Ministry of Health, Vietnam Social Security and relevant ministries and branches shall review, study and propose plans to amend and supplement the Law on Health Insurance and the Law on Social Insurance in the direction of diversifying health insurance packages to meet different payment capacities of the people; a mechanism for payment of differential costs for health insurance patients who need to use treatment regimens and health care service packages with higher payment levels than the basic health insurance service package; build, update and share health care database between the Health Insurance Fund and medical facilities to both control the quality of patient treatment, but not abuse treatment techniques with high costs...

Source: https://dttg.baotainguyenmoitruong.vn/co-che-kham-chua-benh-bhyt-linh-hoat-bao-dam-quyen-loi-nguoi-benh-357363.html