Notable new points of the revised Law on Health Insurance

(Baonghean) - From January 1, 2015, the amended and supplemented Law on Health Insurance will take effect. To help people better understand the law, their rights and obligations, the Provincial Social Insurance in coordination with Nghe An Newspaper will open a column "Learning about the Law on Health Insurance" posted on page 5 of the newspaper every Tuesday starting from January 6, 2015. For any questions, readers can call the Social Affairs Department - Nghe An Newspaper, phone number 0383.835570 or the Administrative - General Department - Provincial Social Insurance, phone number 0388.947777 for answers.

1. Encourage participation in family health insurance

Participation in health insurance by household is encouraged with a mechanism of gradually reducing the contribution level from the second member onwards, from the fifth member onwards, the contribution level is 40% of the first member's contribution level. The above regulation will overcome the situation of duplicate health insurance cards, limit the situation of only sick people participating in health insurance, and ensure sharing within the household.

2. Expanding the scope of benefits and levels of health insurance

The amendment and supplement of this law pays much attention to the rights of health insurance participants in order to reduce the burden of medical examination and treatment costs, and increase access to health services for some policy subjects. Accordingly, people living in areas with particularly difficult socio-economic conditions; people living in island communes and island districts are granted free health insurance cards from the guaranteed State budget.

The law abolishes the regulation of co-payment of 5% for the poor, social protection, ethnic minorities living in areas with difficult socio-economic conditions; people living in areas with especially difficult socio-economic conditions; people living in island communes and island districts. The regulation of co-payment of 20% is abolished for relatives of people with meritorious services to the revolution who are biological fathers, biological mothers, spouses, children of martyrs, and people who have contributed to raising martyrs. The law also reduces the co-payment rate from 20% to 5% for other relatives of people with meritorious services and people in near-poor households. Notably, the Health Insurance Fund will pay 100% of medical examination and treatment costs when the patient has participated in health insurance for 5 consecutive years or more and the amount of co-payment for medical examination and treatment costs in the year is greater than 6 months of basic salary.

Cases of self-examination and treatment outside the prescribed health insurance coverage level are specifically regulated, and benefits for children under 6 years old are also supplemented.

Under this new law, cases of suicide, self-inflicted injury, traffic accidents, work accidents and occupational diseases will also be covered by the health insurance fund.

3. Open medical examination and treatment lines with health insurance

Along with reforming procedures and processes for medical examination and treatment, this is an extremely important regulation that creates maximum convenience for health insurance participants in accessing health services. Accordingly, from January 1, 2016, health insurance examination and treatment lines will be opened between commune and district levels in the same province.

Open up health insurance coverage to provincial and central levels for inpatient treatment for people from poor households and ethnic minorities living in areas with difficult or especially difficult socio-economic conditions; and people living in island communes and island districts.

From January 1, 2021, the Health Insurance Fund will pay for inpatient treatment costs according to the benefit level for health insurance participants when they are examined and treated at non-line medical examination and treatment facilities at provincial-level medical examination and treatment facilities nationwide.

4. Health insurance balance can be used to improve the quality of medical examination and treatment.

The law specifically regulates the allocation and use of health insurance funds. In the current period, due to the lack of uniformity in the rate of health insurance participation and medical examination and treatment services among provinces (some places reach nearly 100%, but some provinces only reach 50-60% of the population participating in health insurance, some provinces have full modern medical technology but some provinces still lack a lot of medical equipment), the law allows localities with surplus health insurance funds to use 20% to support the completion of technical infrastructure, improving the quality of health insurance examination and treatment.

From January 1, 2021, when the health insurance participation rate of localities is at a high level, the quality of medical services is quite uniform, there is no longer much difference in the surplus or deficit of the health insurance fund between provinces, the health insurance fund will be managed in the direction of completely centralized management, unified and regulated nationwide, ensuring the correct implementation of the goal of risk sharing among subjects. In addition to the above important new points, to overcome the shortcomings in organization and implementation, the law adds subjects belonging to the military and police forces to participate in health insurance, adds benefits for children under 6 years old...

5. Clearly define the responsibilities of relevant parties

The Law also clearly stipulates the responsibilities of relevant parties in organizing the implementation of policies, especially: The responsibility of the Minister of Health in regulating the unified price of medical examination and treatment services covered by health insurance among hospitals of the same rank nationwide, regulating the Basic Health Service Package paid by health insurance, promulgating the list and rates, payment conditions for drugs, chemicals, medical supplies, and medical technical services within the scope of benefits of health insurance participants.

The responsibility of the People's Committee at the commune level is to make a list to issue health insurance cards to subjects, make a list to request health insurance cards for children, and at the same time issue birth certificates.

The responsibility of Vietnam Social Security is to check and review to avoid duplicate health insurance cards for subjects and organizations so that people can access and pay health insurance for their families conveniently in all localities nationwide.

Currently, the Ministry of Health has developed a Plan to implement the law and is developing documents guiding the implementation of the law as well as propaganda and dissemination work to implement the law, aiming to create a strong change in the awareness and actions of agencies, organizations and citizens on health insurance, create consensus, strengthen the responsibility of leadership, state management and organization of implementation of health insurance policies and laws, contributing to bringing the Health Insurance Law into life, ensuring social security in stable and sustainable development, moving towards universal health insurance as the goal set by the Party and the State./.