Social insurance industry strives to implement health insurance policy
(Baonghean.vn) - With the responsibility of being the implementing agency, in recent times, the Social Insurance sector has made continuous efforts to implement the Health Insurance Law most effectively, so that all people can soon enjoy the right to social security in Health Insurance.
Law on Health Insurance was bornfrom2008 andOkayamended and supplemented in 2014,is the legal basis for institutionalizing the viewpoints and orientations of the Party and State in implementing public health finance policies through universal health insurance in the direction of fairness, efficiency and development. It is stipulated that “Health insurance is a form of compulsory insurance applied to subjects as prescribed by this Law for health care, not for profit purposes, organized and implemented by the State.”.
Impressive results
After nearly 6 years of implementing the revised Law on Health Insurance, there have been outstanding results in organizing the implementation of health insurance policies:
The first,The rate of universal health insurance coverage has reached nearly 90% of the population; the number of people participating in health insurance has increased rapidly over the years, an average increase of 48% per year, from 2015-2019, it increased by more than 15 million people, by the end of 2019, there were 85.636 million people participating in health insurance, in which the coverage has focused on vulnerable groups, such as: the group of workers (NLĐ) has participated in health insurance reaching more than 90%; the group of retirees, people with loss of working capacity, and social protection reached 100% (about 3.1 million people); the group supported by the state budget (NSNN) such as near-poor households, students (HSSV) reached approximately 100% and over 17.5 million people participated in the form of households.
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| Directly disseminating and consulting on social insurance and health insurance policies for small traders in markets in the city: Photo by Phan Lien |
Monday,ensure the rights of health insurance participants.
If in 2014, there were only 2,111 medical examination and treatment facilities (KCB) signing health insurance contracts with the Social Insurance agency, by June 2020 the number of health insurance facilities was 2,571, an increase of 22% compared to 2014. In particular, the number of private medical examination and treatment facilities signing health insurance contracts has nearly doubled from 424 medical examination and treatment facilities in 2014 to 835 medical examination and treatment facilities in 2020.
Access to health insurance services is increasingly expanding, the number of health insurance treatments paid by the health insurance fund has increased sharply. If in 2009 there were only 92.1 million health insurance treatments, by 2019 the number of people going to health insurance treatments has nearly doubled to 186 million. The amount of medical examination and treatment expenses from the health insurance fund has also increased, from 15.5 trillion VND (equivalent to 970 million USD) in 2009, to more than 100 trillion VND (equivalent to about 4 billion USD) in 2019.
The health insurance policy has contributed to reducing direct out-of-pocket expenditures for health services, contributing to creating fairness in health care, especially for vulnerable groups in society such as the poor, near-poor, disabled, people under social protection, children under 6 years old. In many cases, the health insurance fund has paid for health insurance treatment costs in the year up to billions of VND.
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| Nghe An launched a campaign to respond to the Month of promoting the implementation of universal social insurance. Photo: PV |
To ensure that the health insurance fund is used publicly, transparently, economically, effectively, and objectively; linking the implementation of the tasks of collection, expenditure, policy settlement, fund management, and development of health insurance participants, since 2018, Vietnam Social Security has advised the Prime Minister to issue a decision to assign the health insurance fund to each locality. This is a measure to help remove obstacles in the context that most provinces have a deficit in the health insurance fund due to adjustments in medical service prices and expansion of the scope of benefits of health insurance participants. Guiding localities in allocating and managing the annual budget is also focused on; at the same time, regularly monitoring and evaluating the implementation of the budget, synthesizing data on assigning the national health insurance fund to health insurance facilities to improve the effectiveness of controlling health insurance costs.
The Prime Minister's issuance of the Decision on assigning the health insurance expenditure estimate to each locality has brought local authorities together with the Social Insurance sector to effectively manage and use the health insurance fund, while still ensuring the rights of health insurance participants.
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| Consulting people to participate in health insurance. Photo courtesy of Duc Anh |
Since January 2017, the Health Insurance Appraisal Information System has been officially exploited to carry out the procedures of the Health Insurance appraisal service. With the application of the System, most of the business processes that can be automated have been performed by the software functions, thereby improving the quality of the services and helping to reduce hundreds of working hours of the appraisal staff. The advance and settlement services in the health insurance examination and treatment of the provincial and district Social Insurance with medical facilities are carried out in a closed, interconnected process and have a control and reconciliation mechanism between the business software, ensuring transparency and accuracy in financial management.
The functions of the Health Insurance Appraisal Information System are increasingly improved, developed and updated regularly. The system has promptly analyzed, detected and regularly notified the medical examination and treatment facilities and local social insurance agencies of unusual fluctuations such as: cases of prescription of drugs, technical services that are not in accordance with regulations, are excessive, are not in accordance with professional procedures, the frequency of service prescriptions has increased abnormally; widespread outpatient clinical test prescriptions; excessive use of drugs...; detection and publicization of cases of health insurance abuse such as: going to many places for medical examination and treatment in a day; admitting patients with health insurance cards for personal gain... helping the provincial and municipal social insurance agencies promptly check and re-appraise health insurance expenditures, and medical examination and treatment facilities have also proactively reviewed and adjusted payment statistics and the prescription of medical services.
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| Provincial Social Insurance officers conduct propaganda on Social Insurance and Voluntary Insurance for people in Hung Dung Ward, Vinh City. Photo courtesy of Thanh Chung |
Issuing a single social insurance number brings many benefits to both the management agency and the participants, meeting the requirements of the social insurance industry for centralized database management nationwide. Accordingly, this database helps eliminate duplicate card issuance, prevents the use of fake cards, abuses of the health insurance fund, and ensures the rights of health insurance participants.
The Social Security Number has also been regulated by the Ministry of Health to be used as a unique medical identification code for each citizen. Medical facilities use the medical identification code to link people's health information with Electronic Medical Records, Electronic Health Records and other medical information software.
Towards sustainable health insurance development
Health insurance is an important social policy, one of the main pillars of the social security system, contributing to the implementation of social progress and equity, ensuring political and social stability and socio-economic development. Expanding and perfecting the health insurance regime and policies must have steps and roadmaps in line with the country's socio-economic development, ensuring sustainable development.
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| Deputy General Director of Vietnam Social Security Pham Luong Son. Photo courtesy |
The first,Developing sustainable health insurance participants.
The proposed solution is that the Social Insurance sector needs to coordinate closely with the Ministry of Health, the Ministry of Labor, War Invalids and Social Affairs and local authorities to propose solutions to support people participating in health insurance, helping these subjects have initial advantages when participating in health insurance. At the same time, there are solutions to ensure stability and sustainability for groups of subjects who have participated in health insurance by raising people's awareness of sharing with the community and the opportunity to have a solid financial source in case of illness; strengthening administrative procedure reform towards implementing level 4 online public services, allowing health insurance participants to pay fees and receive results online, creating convenience for people when participating in health insurance.
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| The rights of health insurance participants are always guaranteed. Illustrative photo |
- Closely coordinate with the health sector to improve the quality of patient care; perfect health insurance policies, develop appropriate health insurance benefit packages, review and prioritize the list of health insurance funds to pay for medical services with high cost efficiency; ensure publicity and transparency in management, appraisal and payment of health insurance treatment costs.
- Change the payment method for health insurance medical examination and treatment costs towards capitation payment for outpatient medical examination and treatment and according to DRG diagnosis group for inpatient medical examination and treatment.
- Control costs by assigning budgets to medical facilities.
- National centralized bidding for drugs, medical supplies and medical equipment.
- Strengthen inspection and guidance on professional appraisal for provincial and municipal social insurance agencies and health insurance treatment facilities, promptly detect and prevent forms of health insurance abuse as well as cases where health insurance patients are not guaranteed maximum benefits.
By implementing such synchronous and effective solutions, we will achieve the goal of universal health insurance coverage and ensure sustainable health insurance development./.