Health insurance participation rate is not sustainable
By the end of 2024, the whole country will have more than 95.5 million people participating in health insurance, with a coverage rate of 94.29%.
Mr. Duong Tuan Duc, Head of the Department of Health Insurance Policy Implementation, Vietnam Social Security ( Ministry of Finance ) said that thanks to policy changes and the addition of more health insurance participants through each revision, Vietnam has become one of the countries with universal health insurance coverage.
In terms of structure, the proportion of households participating in health insurance accounts for 28% - this is the self-paying group. In addition, the subjects participating in health insurance are paid by the state budget and supported with a contribution level of 50%.
Looking at this structure, it shows that the groups of subjects participating in health insurance are not uniform. The group of subjects whose contributions are paid or supported by the state budget still accounts for a high proportion.
“Although we have covered health insurance on a large scale, it is still not sustainable. Because the structural shift between subjects is still large, it can be from poor households to near-poor households, escaping poverty... When there is such a change, the level of support for health insurance contributions also changes. For example, a group of people who are currently covered by the state budget for health insurance will have difficulty participating in sustainable health insurance if they switch to the self-paying group,” Mr. Duong Tuan Duc analyzed.
Among the places registering for health insurance examination and treatment, health stations have registered the most with more than 9.8 thousand stations. Along with that, Vietnam has had many policies to develop primary health care. It even set a target to strive for 95% of people using primary health care services at primary health care facilities to be covered by health insurance by 2030. At the same time, it sets out the requirement to innovate the financial mechanism and payment mechanism of the Health Insurance Fund towards increasing spending on primary health care.
However, Mr. Duong Tuan Duc is concerned that the number of medical examinations and treatments at commune health stations will continuously decrease from 14.69% in 2022 to 12.72% in 2024. If there are no policies to develop grassroots health care, in 2025, the rate of medical examinations and treatments at health stations will drop below single digits.
In addition, spending on health insurance examination and treatment at the commune level has also decreased from 1.74% in 2022 to 1.5% in 2024. "Therefore, we need to increase spending on primary health care to expand service provision, especially for primary health care of the people," Mr. Duong Tuan Duc proposed.
Medical examination and treatment, expanded coverage
Speaking at the conference, Deputy Minister of Health Tran Van Thuan emphasized that the revised Law on Health Insurance has a number of major policies on health insurance examination and treatment, in the direction of expanding benefits and making it more convenient for health insurance participants as well as increasing responsibility for those who pay health insurance premiums and transparency in payment settlement.
According to Deputy Minister of Health Tran Van Thuan, the revised Law on Health Insurance has a number of provisions that will take effect from July 1, 2025, including the provision of health insurance examination and treatment regardless of administrative geography. The Law also stipulates the level of health insurance benefits when implementing the provision of health insurance examination and treatment regardless of administrative boundaries by province.
Accordingly, patients are entitled to 100% of the benefits when examining and treating at the primary level nationwide, 100% of the benefits when examining and treating at the basic level nationwide, 100% of the benefits when examining and treating at any basic or specialized medical facility that is identified as a district level before January 1, 2025. In particular, in some cases of rare diseases, serious diseases..., patients are sent directly to specialized medical facilities.
Referring to the expansion of medical examination and treatment forms covered by health insurance, Mr. Doan Quoc Dan, senior expert of the Department of Health Insurance (Ministry of Health) said that health insurance participants will have additional benefits to be paid by health insurance when performing remote medical examination and treatment or remote medical examination and treatment support, family medical examination and treatment, medical examination and treatment at home, rehabilitation, periodic pregnancy examination, childbirth, etc.; at the same time, the cost of transporting patients between medical facilities (previously, it was transport between lower and upper levels). Children under 18 years old treated for strabismus and myopia will also be paid by health insurance, etc.
In addition, people who register for initial health insurance examination and treatment at specialized and basic facilities, when arriving at a different place of initial registration due to a change in temporary residence or place of stay, will be examined and treated at a basic facility appropriate to the new place of residence and will be paid according to regulations.
Source: https://hanoimoi.vn/thao-go-ton-tai-them-quyen-loi-cho-nguoi-tham-gia-bao-hiem-y-te-697105.html
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