People register for medical examination and treatment at Dong Anh General Hospital ( Hanoi ). (Photo: LAN VU)

Accordingly, this amendment to the Law on Health Insurance is necessary to address the identified shortcomings and limitations, aiming to create the most favorable conditions and ensure the highest benefits for health insurance participants, on the basis of harmonizing the interests between health insurance participants and primary medical examination and treatment facilities...

According to the Government 's Submission, this Draft Law on Health Insurance amends and supplements 40 articles on health insurance participants, payment responsibilities, benefits, scope of benefits, organization of health insurance examination and treatment, fund management and some technical regulations.

According to delegate Tran Quoc Tuan (Tra Vinh delegation), based on reality and through meetings with voters, there are currently groups of students and people from households working in agriculture, forestry, fishery and salt production with average living standards that need attention. Therefore, the Draft Law considers and stipulates increasing the level of support from the state budget for these two groups from 30% to a minimum of 50% of the contribution level to reduce difficulties.

This group of subjects is currently supported by the State with at least 30% of the health insurance premium and the annual premium is set at 4.5% of the basic salary. However, recently when the basic salary increased by 30%, the value of the health insurance card also increased by 30%, which means that health insurance participants have to pay 30% more out of their own pocket than before, equivalent to 884,000 VND/card/year instead of only 680,000 VND/card/year before. “Therefore, I propose that the National Assembly consider raising the support level from 30% to at least 50% of the health insurance premium for the two groups mentioned above. Then, we will both achieve the target of covering the proportion of people participating in health insurance, but also reduce difficulties for students and people in households working in agriculture, forestry, fishery, and salt production with an average living standard,” delegate Tran Quoc Tuan suggested.

Regarding the content of adding some groups of subjects participating in health insurance, giving comments on adding regulations on subjects participating in health insurance in Clause 9, Article 1 of the draft amending and supplementing Article 12 of the Law on Health Insurance, delegate Nguyen Thi Viet Nga (Hai Duong delegation) said that expanding the subjects participating as in the draft Law on Basic Health Insurance is in line with the thoughts and aspirations of voters, and is one of the basic social security policies with profound humanity. Therefore, the State needs to support the people at the highest possible level. However, there needs to be a balance of budget resources and insurance funds.

Commenting on the Draft Law, some delegates proposed amending the concept of health insurance appraisal; adding regulations to resolve difficulties in settlement of health insurance examination and treatment costs between social insurance agencies and medical examination and treatment facilities.

The assessment report on the implementation of the Law on Health Insurance by the Ministry of Health, the Ministry of Justice and the Social Affairs Committee of the National Assembly all show that the difficulties in health insurance appraisal mainly stem from the provisions of the law on "medical expertise assessment" assigned to the social insurance agency, in which the Ministry of Health believes that the concept of appraisal in the current Law on Health Insurance is still broad compared to the nature of appraisal work, which focuses on cost control, payment control, etc.; health insurance appraisal is a professional activity of the social insurance agency to check, review, and compare requests for payment of health insurance medical examination and treatment costs of health insurance medical examination and treatment facilities, health insurance participants with the provisions of the law on health insurance and medical examination and treatment, as a basis for determining the costs of medical examination and treatment within the scope of payment of the health insurance fund.

Regarding this issue, delegate Tran Quang Minh (Quang Binh delegation) said: In fact, assessing the reasonableness of providing medical services to health insurance participants, assessing the treatment prescription, use of drugs, chemicals, medical supplies, equipment, and medical technical services for patients is the function and task of professional agencies and professional councils of the health sector, but is assigned to the social insurance agency. This is one of the reasons leading to many difficulties and problems that have lasted for many years between the social insurance agency and medical examination and treatment facilities, slowing down the progress of payment of medical examination and treatment costs under health insurance.

According to nhandan.vn