More benefits for health insurance patients

This is very necessary in the context of rapidly changing disease patterns and increasing demand for modern and highly effective drugs. This is an important step forward, in line with modern treatment needs, but also a major economic problem. Will adding this category to health insurance payments increase the health insurance premium?

Proposal to add 76 new drugs to the list

Deputy Minister of Health Vu Manh Ha said that drugs are always an important component, accounting for a large proportion of the total cost of medical examination and treatment (KCB) covered by health insurance. In 2022, the cost of drugs from the health insurance fund will be VND 40,010 billion, accounting for 33.41% of total expenditure; in 2024, it will increase to VND 50,784 billion, equivalent to 31.22%. Although this rate tends to decrease, the cost of drugs still ranks first among the payment categories. Therefore, the selection, use and adjustment of the list of drugs covered by health insurance is a decisive factor to ensure the sustainability of the fund, while reducing people's out-of-pocket spending on health care, ensuring fairness in drug access for patients at all levels of technical expertise.

Doctors at the Hepatobiliary and Digestive Surgery Center – Central Hospital for Tropical Diseases successfully operated on a case of late-stage liver cancer. Photo: BVCC

The current drug list is basically inherited from 2018 and only adds a few drugs to treat Covid-19 during the epidemic. This update is to meet new treatment needs, based on reviewing the proposal documents of medical facilities, clinical experts and health economic experts, ensuring scientific and practicality. Pursuant to Circular No. 37 issued on November 16, 2024, stipulating the principles and criteria for developing the health insurance drug list, the Ministry of Health has reviewed to add new drugs, amend payment conditions or rates, and remove drugs that are no longer in circulation or do not meet safety and effectiveness requirements.

An important new point is to expand the drug list for grassroots health care, especially commune health stations, to implement the policies in Resolution No. 72-NQ/TW of the Politburo on a number of breakthrough solutions to strengthen the protection, care and improvement of people's health and Directive 52-CT/TW of the Secretariat on implementing universal health insurance in the new period.

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The drugs included in the list of drugs covered by health insurance this time include many new drugs, invented drugs with high prices, and the benefits for patients will be greatly enhanced. This affects the budget of the health insurance fund, but is really necessary for patients. The health sector has carefully considered and reviewed to include drugs in the list, including invented drugs and drugs with high costs, so that the list of drugs of the health insurance fund must be truly advanced, effective, of high quality and meet the expectations of the people.

Head of Health Insurance Department, Ministry of Health Tran Thi Trang

Director of the Health Insurance Department, Ministry of Health Tran Thi Trang said that based on the current list, the Ministry of Health has reviewed 1,037 active ingredients specified in Circular 20 on the list of health insurance drugs. Through initial assessment, the Ministry of Health proposed adding 76 new active ingredients and drugs to the list of health insurance payments, including 28 cancer treatment and immune regulation drugs. Of the 28 added cancer drugs, there are 22 targeted treatment drugs. This addition is expected to increase the health insurance fund's expenditure by an average of VND 2,449 billion per year. Regarding the group of cancer drugs, the representative of the Health Insurance Department said that this is the group with the most additions and has high costs. The adjustment is assessed to have a major impact on the health insurance fund budget, but the Ministry will mobilize resources from enterprises, health insurance and related organizations to ensure the rights of patients.

For expensive drugs, especially new drugs with high costs, the Ministry of Health will carefully review the payment rate to ensure fund balance; 14 pharmaceutical companies have pledged to reduce the price of high-cost drugs, in order to help put drugs on the health insurance list with a more reasonable payment rate, reducing the burden of co-payment for patients. Adding new drugs is necessary in the context of rapidly changing disease patterns and increasing demand for modern and highly effective drugs. Along with adding new drugs, the Ministry of Health also proposed adjusting the rate and payment conditions for 47 drugs already on the list; at the same time, eliminating 130 drugs with active ingredients that no longer have circulation registration numbers, are not rare drugs or do not have import licenses.

Will the people's health insurance premiums increase?

It can be seen that after 8 years, the list of drugs covered by health insurance will be updated in both quantity and quality; including drugs for cancer treatment, immunomodulators, and innovative drugs - a group of expensive drugs. The list of drugs brought to commune health stations has also doubled (about 457 drugs). This is necessary in the context of rapidly changing disease patterns and increasing demand for modern and highly effective drugs. This is also particularly consistent with the policy on 2-level local government when commune health stations are invested in, infrastructure is developed, functions are supplemented and capacity is enhanced to become an important nucleus in performing the task of taking care of people's health at the gateway of the health system. However, many opinions are concerned about the addition of these drugs to the list of health insurance payments. Has the Ministry of Health considered the issue of balance and impact on the health insurance fund as well as whether it is necessary to increase the health insurance contribution level?

Referring to this issue, Director of the Health Insurance Department Tran Thi Trang said that it is true that in order to include many drugs in the list of health insurance payments, the issue of financial resources for payment is very important. The health insurance contribution rate is still low, so currently it is enough to balance revenue and expenditure and the reserve fund. However, according to the Ministry of Health's assessment, updating the list of health insurance payments this time, it is estimated that each year, we will have to increase spending by more than 2,700 billion VND to add new drugs to the list as well as increase the payment rate for some drugs. Thus, it is clear that we must use the reserve fund from the fund. Currently, although the reserve fund from the health insurance fund still exists, this source is only enough for about the next 2 years. Therefore, the health sector will have to have solutions to expand the source of the health insurance fund. This time, the Ministry of Health will very carefully assess the budget impact of the health insurance fund. From 2027 onwards, our country will have to consider increasing the health insurance contribution rate according to the roadmap. In the process of increasing the health insurance contribution according to the roadmap, it is necessary to calculate to supplement other funding sources. For example, supplementary health insurance, commercial insurance or also consider support from the budget for the poor, near-poor, low-income people, and other social policy subjects.

The health sector also plans to propose a program to support patients with income but still facing many difficulties, to reduce the co-payment for patients; at the same time, gradually expand the revenue of the health insurance fund from other activities such as tax revenue on cigarettes. Currently, we are proposing to the National Assembly to have a disease prevention fund from this revenue source.

In addition, many solutions to effectively use and save funds from the health insurance fund such as reviewing projects to connect paraclinical data, reviewing professional processes, inpatient treatment for patients to increase outpatient treatment, reduce medical costs, reduce inpatient costs, at the same time strengthen professional decentralization, transfer common and basic diseases to commune level; focus on treating serious diseases... thereby, saving the budget of the health insurance fund...

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A major change is the expansion of the use of 357 drugs (in 10 groups) at commune health stations and primary health facilities, instead of limiting them by hospital class. Drug groups include: pain relievers, antipyretics, detoxifiers, antiparasitics - anti-infective, cardiovascular, dermatological, digestive... to help treat non-communicable diseases right at the grassroots level, making it easier for people to access drugs covered by health insurance. The list of drugs at commune health stations has therefore nearly doubled, to more than 600 drugs covered by health insurance.

Deputy Director of Health Insurance Department, Ministry of Health Vu Nu Anh

Source: https://kinhtedothi.vn/them-nhieu-quyen-loi-cho-benh-nhan-bao-hiem-y-te.925076.html