Difficult to 'cover' family health insurance

(Baonghean) - Many people today still have the mindset that they will only buy health insurance when they are sick. Although paying for health insurance is mandatory, there are still no sanctions for non-compliance, so the implementation of "coverage" of insurance to every household is facing many difficulties.

For many months now, Ms. Nguyen Thi Mai (60 years old, residing in Quynh Luu district) has considered the hospital her home because of her breast cancer. At the beginning of the year, when she was diagnosed, the doctors asked her to stay in the hospital for timely treatment. The worry about the terrible disease combined with the upcoming hospital fees for long-term treatment made her feel like she was collapsing. “Hearing the doctor say that made me almost hopeless. My house is nearly 80 km from Vinh city, and every time my children come to take care of me, it costs a lot of money,” Ms. Mai said.

Taking care of patients at the Southwest Nghe An Regional General Hospital. Photo: Thanh Son

The family only has a few fields, no savings, the few assets in the house, so they gradually "left" after paying the hospital bills. "My husband passed away a long time ago, and my children are not doing well. Now the debt is piling up. Many times I think about suicide, I just want to die to relieve my suffering. If only I had health insurance, it would be a little better" - Mrs. Mai said in a daze. Previously, Mrs. Mai used to pay health insurance regularly, but for many years now, thinking that her health was good, Mrs. Mai stopped participating. "I see many people only pay when they are sick. I have always felt healthy, thinking that I have no illness so I stopped. Who would have thought..." - the 60-year-old woman said, adding that her illness is now quite serious, requiring treatment with expensive medicines, difficulties are piling up on difficulties.

Sharing the same illness as Mrs. Mai, Mr. Nguyen Van Khanh (66 years old, residing in Dien Chau district) said that although he was sick, he was still lucky because the amount of money he had to pay since his treatment was not as high as expected. “Last year, when my daughter came back from work in the city, she advised me to buy insurance. At that time, I thought I was old and often sick, so I joined. More than a month ago, I went to the doctor and found out that I had a brain tumor, so I had to be hospitalized for treatment. Currently, I only spend a few expenses such as food and transportation, which is not much,” Mr. Khanh said.

Through research from some people, the idea of ​​"buying insurance only when sick" like Mr. Khanh and Ms. Mai is still popular. They think that if you are healthy, you should not buy insurance because it costs money. Although they know that paying for health insurance is currently mandatory. Accordingly, the Law amending and supplementing a number of articles of the Law on Health Insurance stipulates that compulsory participation in health insurance for all people is divided into five groups according to the responsibility to pay, including: the group of employees and employers paying; the group paid by social insurance organizations; the group paid by the state budget; the group supported by the state budget and the group participating in health insurance by household. The subjects participating in health insurance by household are those who have not participated in one of the remaining four groups.

According to statistics from the Vietnam Social Security, currently about 30% of the population (about 30 million people) do not have health insurance cards and have to pay for medical examination and treatment themselves. The new regulation requiring participation in health insurance for households also aims to "cover" this group of people who are still indifferent to health insurance.

Starting from January 1, 2015, people whose names are in the household registration book or temporary residence book must participate in family insurance; if one member does not participate, they cannot participate. The People's Committee at the commune level is responsible for making a list through screening and declaration. The insurance participation file is made for each household, but the health insurance card is issued to each member to ensure convenience when going to the doctor or hospital. In order to support those who participate in family health insurance, the law stipulates an incentive mechanism in the direction of gradually reducing the contribution level from the second member onwards. Specifically, the first person contributes a maximum of 6% of the basic salary; the second, third, and fourth persons contribute 70%, 60%, and 50% of the first person's contribution, respectively; from the fifth person onwards, the contribution level is only 40% of the first person's contribution level.

Paying hospital fees for patients with health insurance at Nghe An General Friendship Hospital. Photo: Document

It is expected that paying for family health insurance will overcome the situation where many families only choose to buy health insurance for sick people and people with chronic diseases, and do not have the awareness to buy for all family members to prepare for illness and share risks with others. This leads to the health insurance fund for voluntary subjects always having a deficit; the purpose of sharing risks of insurance has not been achieved. However, the implementation of family health insurance to "cover" every household is facing many difficulties.

According to Mr. Ngo Ngoc Thanh - Head of Debt Collection and Exploitation Department (Nghe An Provincial Social Insurance), despite many efforts, after more than 2 years of implementation, the number of people participating in family health insurance has only reached 47%. "The law requires it but there are no sanctions for those who do not participate, so it is difficult for us. Meanwhile, people still have the mentality of only buying insurance when they are sick," said Mr. Thanh. On the other hand, Mr. Thanh said that the reason why the rate of people participating in family health insurance is not high is because the collection agent system is not active.

Some agents are still passively waiting for people to register without proactively approaching people to propagate and mobilize them. In addition, these people are mainly part-time workers, not focusing on implementing health insurance work, so there are many limitations in mobilizing and guiding people through procedures. Meanwhile, the coordination between communes and wards in making lists of increased and decreased household members participating in health insurance with social insurance agencies is still not tight.

According to statistics up to May 31, 2017, in Nghe An, there were only more than 300,000 people participating in family health insurance. In which, they were mainly concentrated in Vinh city (46,000 people), Quynh Luu district (43,000 people), Dien Chau (36,000 people).... Meanwhile, in some localities such as Ky Son, Tuong Duong, Que Phong, the number of participants was less than 500 people.

To overcome difficulties and increase the participation rate, Nghe An Provincial Social Insurance is making efforts to expand the agency system and increase the number of employees in each village, hamlet, and residential group in the coming time. At the same time, mobilize people to participate in family health insurance in a professional manner by launching a movement to compete to develop the participants.

Tien Hung