Amended Health Insurance Law: Many new benefits for patients.

Law No. 51/2024/QH15, amending and supplementing several articles of the Health Insurance Law, was passed by the National Assembly on November 27, 2024. From January 1, 2025, several new regulations officially came into effect, aiming to improve the rights of citizens, especially patients with rare and serious illnesses.

Many patients are pleased with the new policies.

Patients are pleased with the new policy.

One of the new features of the amended Health Insurance Law is that patients with rare or life-threatening diseases no longer need a referral letter. Accordingly, patients diagnosed with rare or life-threatening diseases or diseases requiring advanced medical techniques (listed in the 62 groups of rare diseases issued by the Ministry of Health ) can now go directly to specialized hospitals without needing a referral letter. In this case, health insurance will cover 100% of the treatment costs.

In addition, patients who purchase medication outside the hospital will be reimbursed. Specifically, if a doctor prescribes medication or supplies that are covered by insurance but the hospital does not have them in stock at that time, and the patient has to purchase them outside, the social insurance agency will reimburse the patient.

However, to be eligible for direct reimbursement, certain conditions must be met, such as: at the time of prescribing medication, the use of medical equipment was not available; the medical equipment was not tendered or purchased without a qualified contractor; the medical facility did not have alternative medication; and the patient was not transferred to another medical facility when their health condition did not qualify for transfer. The Social Insurance agency will directly reimburse the patient based on the quantity and unit price recorded on the invoice from the pharmaceutical business.

Another significant change is that the regulations regarding the list of drugs covered by health insurance no longer categorize by hospital type. The Ministry of Health has abolished the columns classifying hospitals using drugs, and also removed notes on reimbursement rates and conditions for drugs.

With these changes, patient Nguyen Thi Ly, 64 years old, residing in Quang Thang ward, Thanh Hoa city, currently receiving treatment at Thanh Hoa Provincial Oncology Hospital, happily shared: “Previously, whenever I needed to be transferred to a higher-level hospital for treatment, I had to return to the original hospital to register for examination and treatment according to regulations. After that, I had to go through a series of procedures, from tests to obtaining referral letters, because lower-level hospitals lacked the specialized equipment and facilities for cancer treatment, such as surgery, chemotherapy, radiotherapy, or targeted therapy. These procedures often took a lot of time and caused considerable inconvenience.”

Ms. Ly expressed her excitement about the new policy, effective from January 1, 2025: “Now, I don’t need to go through the referral process; I can go directly to specialized hospitals for treatment. I no longer have to worry about queuing for check-ups, tests, and waiting for referrals at lower-level hospitals, which was tiring, time-consuming, and costly in terms of travel expenses.”

Similarly, Ms. Nguyen Thi Huong, residing in Bac Son ward, Bim Son town, who is currently receiving treatment at the Thanh Hoa Provincial Oncology Hospital, expressed her joy: “The new regulations of the Health Insurance Law help people with serious illnesses like me skip many unnecessary steps and proactively go straight to specialized treatment. Furthermore, when the hospital lacked medication, Ms. Huong had to buy medicine outside, which was costly. Now, with the new policy, if she meets the conditions, she will be reimbursed for the cost of the medication she purchased. This is a very practical policy that helps reduce the economic burden on patients with rare and serious illnesses.”

Discussing the new regulations in the amended Health Insurance Law, Dr. Nguyen Quang Hung, Deputy Director of Thanh Hoa Provincial Oncology Hospital, said: The new regulations allow patients diagnosed with cancer, along with other rare diseases as stipulated, to directly receive treatment at specialized hospitals without needing to go through referral procedures. This policy demonstrates the deep concern of the Party and the State for those suffering from serious illnesses, helping them reduce complex administrative procedures and save on treatment costs.

It is necessary to clearly understand the regulations of the amended Health Insurance Law.

Following the official entry into force of the amended Health Insurance Law, the Prime Minister issued Decree No. 02/2025/ND-CP dated January 1, 2025, amending and supplementing several articles of Decree No. 146/2018/ND-CP dated October 17, 2018, of the Government detailing and guiding the implementation of the Health Insurance Law, which was further amended and supplemented by Decree No. 75/2023/ND-CP dated October 19, 2023, of the Government; the Ministry of Health issued Circular No. 01/2025/TT-BYT dated January 1, 2025, detailing and guiding the implementation of several articles of the Health Insurance Law.

Simultaneously, the Ministry of Health organized online conferences to disseminate decrees and guiding circulars to health departments nationwide. These health departments then held online conferences with all local medical facilities. However, because the new law has only recently been implemented, many patients are not yet familiar with the regulations and eligibility requirements, and have independently sought treatment at specialized facilities that do not meet their eligibility criteria. This has led to overcrowding at higher-level hospitals and unnecessary travel costs.

Mr. Nguyen The Soi, Deputy Director of the Social Insurance Agency of Thanh Hoa province, said: To ensure that health insurance participants receive their entitlements as prescribed, the Social Insurance Agency is actively coordinating closely with medical facilities in the province to promote the dissemination of the new regulations of the amended Health Insurance Law. At the same time, people also need to proactively understand the regulations of the law to avoid cases of exceeding the prescribed level when they are not eligible.

Dinh Giang - Mai Phuong

Source: https://baothanhhoa.vn/luat-bao-hiem-y-te-sua-doi-nbsp-nhieu-quyen-loi-moi-cho-nguoi-benh-238653.htm