Proposal to remove referral procedures for some rare and serious diseases

Minister of Health Dao Hong Lan - Photo: GIA HAN

On the morning of September 25, the National Assembly Standing Committee gave opinions on the draft Law amending and supplementing a number of articles of the Law on Health Insurance.

Proposal to remove referral procedures for some rare and serious diseases

Presenting the report, Minister of Health Dao Hong Lan clearly stated the draft law amending and supplementing 40 articles on health insurance participants, payment responsibilities, benefits, scope of benefits, health insurance medical examination and treatment organization, fund management and a number of technical regulations...

In particular, the draft law amending regulations on medical examination and treatment at the right and wrong medical facilities (inter-hospital) is updated according to the technical expertise level of the 2023 Law on Medical Examination and Treatment, on the basis of maintaining a stable rate of health insurance benefits according to current law provisions.

Eliminate referral procedures for some rare and serious diseases... that can be transferred directly to higher specialized levels to reduce procedures, create convenience, reduce out-of-pocket expenses for people, and save costs for the fund.

Amend regulations on initial health insurance medical examination and treatment registration and patient transfer between health insurance medical examination and treatment facilities to synchronize with regulations on technical expertise levels.

This is done in the direction of decentralization and delegation of authority to the Department of Health to determine the initial health insurance examination and treatment registration facilities and allocate health insurance cards in accordance with local reality on the basis of regulations of the Minister of Health.

Supplementing regulations on costs of using blood, blood products, medical gases, supplies, tools, and instruments used in medical examination and treatment within the scope of benefits of health insurance participants to synchronize with the Law on Medical Examination and Treatment...

National Assembly Chairman Tran Thanh Man - Photo: GIA HAN

It is necessary to ensure fairness between medical examination services and medical examination under health insurance.

Examining this content, Chairwoman of the Social Committee Nguyen Thuy Anh stated that the bill was amended and supplemented in the direction of expanding the scope and level of health insurance benefits for a number of subjects.

However, in the context of the draft law being submitted to the National Assembly for consideration and approval according to the one-session process, the Standing Committee of the Committee recommends that the Drafting Committee, without carefully assessing the impact on the state budget and health insurance fund, should be cautious about expanding health insurance benefits and coverage levels.

Limit the adjustment of benefits and scope of benefits for some groups of subjects and ensure equality of benefits among subjects participating in health insurance of similar nature.

Regarding the scope and level of benefits for health insurance participants, Ms. Thuy Anh said that some opinions believe that the most pressing issue currently in payment and settlement of health insurance medical examination and treatment costs is the assessment of the reasonableness of medical service provision when assessing health insurance.

The "suspension" of settlement of medical examination and treatment costs under health insurance is due to the difficulty in reaching agreement between the appraisal agency and the medical examination and treatment facility on the reasonableness of service provision.

Some argue that social insurance does not have the capacity to do so. Therefore, it is recommended to study and revise the concept of "health insurance appraisal" in the current law.

Presenting his opinion on the discussion, National Assembly Chairman Tran Thanh Man said that the current pressing issues are related to payment and settlement when examining and treating health insurance, ensuring medicine for people when going for medical examination and treatment under health insurance, etc.

He suggested that there should be no discrimination and that fairness must be ensured between medical examination services and medical examinations covered by health insurance. "It is necessary to thoroughly understand the basics so that those who can afford to go for medical examination services and those who cannot afford to go for medical examinations covered by health insurance are treated equally," Mr. Man noted.

He believes that expanding the number of participants is the right move towards universal health insurance. However, careful review is needed to ensure fairness, no subjects are left out, and no one has their benefits reduced or lost compared to the present...

"After a storm, floods, and landslides in 26 northern provinces and cities, it has been shown that people's lives are very difficult. Currently, many people no longer have homes and have to live in tents, shacks, camps, and temporary shelters in community facilities...

Life is very difficult so taking care of people's health is a regular task, but especially in the most difficult areas today we must pay attention," Mr. Man said.

According to Mr. Man, the proposed law applies when transferring patients between medical examination and treatment facilities, not only from district level to higher level as currently, but also adds subjects entitled to this benefit. This must ensure fairness and specific calculations of financial benefits and feasibility.

"If I buy health insurance, I can go for medical examinations nationwide. I can go to any province or district that has a health insurance card and get medical examinations and payments. The roadmap for moving forward must be simple," Mr. Man stated clearly.

Vice Chairman of the National Assembly Nguyen Khac Dinh reiterated some opinions suggesting that people with health insurance be provided with medicines on the health insurance list, but if they are not provided, people must go buy medicines on the list, and the insurance must pay.

"This is a reasonable issue that needs to be studied to make an appropriate decision," Mr. Dinh said.

Source: https://tuoitre.vn/de-xuat-bo-thu-tuc-chuyen-tuyen-mot-so-benh-hiem-benh-hiem-ngheo-20240925101333151.htm