Recently, the Ministry of Health has received recommendations from voters in Dong Nai province, including opinions from voters in Binh Phuoc province before, requesting that the authorities study and expand the list of medical examination and treatment services covered by 100% health insurance, and at the same time consider increasing the payment level of the health insurance fund for other medical examination and treatment services. Along with that, it is necessary to review, update and adjust the list of medicines to ensure the rights of the people.
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Minister of Health Dao Hong Lan affirmed that the list of technical services covered by the health insurance fund is currently relatively complete, meeting the basic treatment needs of the people with more than 9,000 technical services.
The technical services currently applied at medical facilities are all included in the insurance payment list. These lists are also regularly revised, supplemented and updated to ensure better benefits for patients, in accordance with the payment capacity of both the insured and the health insurance fund.
According to the provisions of the Law on Health Insurance, the insured person can have the fund pay 80%, 95% or up to 100% of the medical examination and treatment costs, depending on the target group and the benefit level. The adjustment of benefits and benefit levels is based on the contribution level and financial capacity of the fund.
Minister Dao Hong Lan emphasized that Vietnam is one of the few countries with a fairly comprehensive drug list, built commensurate with the health insurance premiums of its people.
Regarding the list of modern medicines, Circular No. 20/2022 issued by the Ministry of Health on December 31, 2022 clearly stipulates the list, payment rates and conditions for pharmaceutical drugs, biological products, radioactive drugs and tracers.
Accordingly, the list of covered drugs includes 1,037 active ingredients or pharmaceuticals and biological products divided into 27 main groups, along with 59 radioactive drugs and markers. Of these, 76 active ingredients belong to the cancer treatment and immunomodulation groups.
The list of health insurance drugs in Vietnam is published by the name of the active ingredient or main ingredient, without specifying the content, dosage form or trade name.
Therefore, medical facilities can choose from a variety of finished drugs that are still covered by the health insurance fund, without being limited by specialty, acute or chronic.
In fact, the number of commercial drugs covered at medical facilities is much larger than the published list of active ingredients.
Regarding the list of traditional medicines and medicinal herbs, the Ministry of Health's consolidated document No. 13 issued on October 15, 2021 announced the list of oriental medicines, herbal medicines and traditional medicinal herbs covered by the insurance fund. Specifically, there are 229 medicines divided into 11 groups of effects and 349 traditional medicines belonging to 30 groups of effects according to oriental medicine theory.
Minister Dao Hong Lan also noted that these lists of traditional medicines are not differentiated by hospital class, so all primary health care facilities, including district hospitals, can use the entire list of medicines. Except for a few medicines with specific regulations that can only be paid for at traditional medicine hospitals or hospitals of second class or higher.
The Ministry of Health is currently reviewing and amending the Circular related to the list of drugs covered by the insurance fund, in order to better meet treatment needs and ensure the rights of people participating in health insurance.
Under the new regulations, people who have participated in health insurance for 5 consecutive years are allowed to interrupt for up to 3 months and will enjoy a number of outstanding benefits that have never been available before.
The first and most notable benefit is that the health insurance fund will cover 100% of medical examination and treatment costs in many cases, including out-of-network medical examination and treatment.
Specifically, according to Clause 17 of the amended Law on Health Insurance, patients will be paid the entire cost of medical examination and treatment if they simultaneously meet three conditions: Having participated in health insurance for 5 consecutive years or more; the amount of co-payment in the year exceeds 6 times the reference level (the amount prescribed by the Government in place of the previous minimum wage); and falling into valid cases of medical examination and treatment, including medical examination and treatment not at the original registered place in some specific situations.
Cases considered eligible for 100% benefits even if examined outside the designated area include: medical examination at basic or specialized facilities when treating serious illnesses, rare illnesses, illnesses requiring surgery or high technology according to regulations of the Ministry of Health; being an ethnic minority, a person from a poor household living in a difficult area or in an island commune or island district; inpatient treatment at district-level facilities or equivalent facilities before January 1, 2025; emergency care at any medical facility; examination at the place of initial registration; and transfer to the hospital in accordance with regulations.
Another important new point of the 2024 revised Law on Health Insurance is the abolition of the 180-day waiting period to enjoy high-tech services for new or intermittent health insurance participants. Under current regulations, first-time or intermittent health insurance participants must wait 180 days to enjoy high-tech services.
However, from July 1, 2025, according to the new regulations in Clause 3, Article 16, people participating in health insurance for the first time or having an interruption of more than 90 days only need to wait 30 days from the date of full payment for the card to be valid and enjoy all benefits, including high technology.
This change helps people access modern medical services sooner without worrying about time barriers.
In addition, the Law also changes the way benefits and contributions are calculated by introducing the concept of "reference level" instead of the previous "minimum wage".
This is a new basis for calculating health insurance benefits, while ensuring flexibility and being more suitable to current socio-economic conditions.
Accordingly, when the total amount of money that the patient pays exceeds 6 times the reference level in the year, the health insurance fund will pay all medical examination and treatment costs within the scope of benefits, regardless of whether the patient is on-line or off-line, if they fall under permitted cases.
With important and beneficial adjustments for the people, the revised Law on Health Insurance 2024 is a big step forward in expanding health insurance coverage, encouraging people to participate long-term and continuously, and reducing the burden of medical costs for vulnerable groups.
People need to proactively check their health insurance participation information to clearly understand the benefits they will receive from July 1, 2025.
Source: https://baodautu.vn/de-xuat-mo-rong-danh-muc-thuoc-dich-vu-y-te-duoc-bao-hiem-y-te-chi-tra-100-d343253.html
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