Proposal to remove referral procedures for some rare and serious diseases

The draft Law on Health Insurance, as amended and supplemented, proposes eliminating the referral procedure for certain rare and critical illnesses, allowing patients to go directly to higher-level specialized hospitals. This aims to streamline procedures, facilitate treatment, reduce out-of-pocket expenses for citizens, and save costs for the fund.

Minister of Health Dao Hong Lan presents a summary of the draft Law amending and supplementing a number of articles of the Health Insurance Law. (Photo: THUY NGUYEN)

Continue At the 8th session of the 15th National Assembly , on the morning of October 24th, the National Assembly heard Minister of Health Dao Hong Lan, authorized by the Prime Minister, present the draft Law amending and supplementing a number of articles of the Health Insurance Law.

Supplementing the mechanism for payment of drug transfers.

The Minister stated that the draft Law amends and supplements 40 articles, focusing on revising and supplementing regulations that need to be consistent and synchronized with related laws, addressing shortcomings of the current law that are urgent, have complete information and data, and have achieved consensus.

This includes regulations on transitioning from four levels of medical examination and treatment to three levels of technical specialization, to take effect promptly from January 1, 2025, in line with the Law on Medical Examination and Treatment.

Some notable specific points mentioned by the Minister include the amendment of regulations on medical examination and treatment within and outside the designated network (inter-network), updated according to the technical professional levels of the 2023 Law on Medical Examination and Treatment.

Accordingly, the referral procedure will be eliminated for certain rare and life-threatening diseases, allowing patients to go directly to higher-level specialized hospitals. This will reduce bureaucracy, facilitate treatment, minimize out-of-pocket expenses for patients, and save funds for the healthcare system.

The draft also amends regulations on registration for medical examinations and treatment. health insurance Initially, the process involves transferring patients between health insurance-covered medical examination and treatment facilities to align with regulations on technical expertise levels, aiming to further facilitate access for the public and decentralize authority to the Department of Health regarding initial registration for health insurance-covered medical examination and treatment and the allocation of health insurance cards.

Delegates attending the morning session on October 24. (Photo: THUY NGUYEN)

This amendment also adds a mechanism for reimbursing drug transfers in cases where drugs have been purchased according to the most convenient regulations of the new Bidding Law but there is still a shortage, in order to overcome drug shortages and ensure the rights of health insurance participants, preventing patients from having to buy drugs themselves and ensuring their rights are protected.

At the same time, the mechanism for paying for paraclinical services transferred to other qualified facilities is being updated in accordance with the Government 's decree.

Amend the regulation stipulating that social insurance agencies inspect the quality of medical examinations and treatments to inspect the implementation of medical examination and treatment contracts, in order to align functions and avoid overlapping with state management agencies in the field of health.

Supplementing the payment methods for medical examination and treatment costs specifically for the armed forces and people in border areas, particularly disadvantaged communes, and islands.

In addition, the draft also adjusts the health insurance fund management cost rate down by 1% from 5% to 4% to increase direct spending on medical examination and treatment from 90% to 91% from the beginning of the year, saving procedures and time in allocating and adjusting funds.

The fundamental issues in the payment of medical examination and treatment costs under health insurance need to be resolved.

In its review, the Social Affairs Committee of the National Assembly basically agreed with the scope of amendments and additions to the draft Law. According to the reviewing body, the draft Law has taken a further step, better ensuring the rights of health insurance participants through "unified medical examination and treatment."

Accordingly, the health insurance fund will cover medical examinations and treatments as prescribed in cases where patients are able to independently go to basic or specialized medical facilities in certain cases of serious or life-threatening illnesses; receive medical examinations and treatments at primary healthcare facilities and some basic healthcare facilities nationwide; and receive medical examinations and treatments at specialized healthcare facilities with appropriate schedules.

Chairwoman of the National Assembly's Social Affairs Committee, Nguyen Thuy Anh, presents the report on the review of the draft law. (Photo: THUY NGUYEN)

However, the Social Committee believes that a thorough assessment is needed of the impact on the balance of the health insurance fund as well as the organization and operation of the medical examination and treatment system, including primary healthcare.

Regarding the payment of costs for medicines and medical equipment transferred between medical examination and treatment facilities, and the settlement of medical examination and treatment costs under health insurance, the Social Committee highly appreciates the Government's proposal to add regulations on the payment of costs for medicines and medical equipment transferred between medical examination and treatment facilities, and the costs of paraclinical services for patients that have been prescribed but must be performed elsewhere, in order to ensure the rights of health insurance participants as well as to ensure the quality and timeliness of medical examination and treatment.

However, to fundamentally address the rights of health insurance patients, the Drafting Committee is requested to continue researching the provisions in Clause 4, Article 31 regarding the payment mechanism through hospitals or directly to patients when they have to purchase medicines, supplies, and medical equipment themselves, similar to the payment for paraclinical service costs stipulated in Clause 5, Article 31.

The Social Affairs Committee also generally agrees with the regulations on advance payments, settlements, and final accounts of medical examination and treatment costs under health insurance in Article 32, but requests the Government to establish a mechanism to fundamentally resolve the difficulties in payment and settlement of medical examination and treatment costs between Vietnam Social Insurance and medical facilities in the past.

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