Developing sustainable health insurance

Monday, 2019-07-01 16:43:34
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Patients register for medical services at the Hanoi-based Saint Paul Hospital (Photo: VNA)
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NDO - By June 2016, about 89.6% of the country’s population had joined the health insurance; exceeding the target assigned by the Prime Minister in Decision No.1167/QD-TTg (health insurance covers 88.1% of Vietnam population by 2019). Notably, many countries with social and economic conditions similar to Vietnam, despite many efforts, still have not achieved the same health insurance coverage as Vietnam.

Currently, the access to medical examinations and treatment services for people s8 with health insurance is more favourable. Since 2016, people with health insurance cards being examined and treating for diseases at the health facilities at commune and district levels in provinces and district hospitals across the country have enjoyed the same benefits as they take would when taking medical examinations and treatment at the right level.

At the same time, the quality of medical examination and treatment has been enhanced as the health sector has taken many positive measures such as reforming medical examination and treatment procedures; a renewal of annual hospital inspections and assessment methods; issuing a national action program to improve the quality of management of medical examinations and treatment, among others.

Since 2019, the health insurance fund has paid antiretroviral drug (ARV) for HIV/AIDS patients, contributing to ensuring regular treatment for this group. Health insurance has also created an important source of public finance for medical examinations and treatment. Currently, the health insurance fund has become the main source of income for hospitals, especially district hospitals (more than 80%), contributing to improving the quality of health services and facilities at all levels and reducing costs for families.

The obtained result is attributed to the fact that Vietnam has gradually improved the provisions of the law on health insurance; the involvement of the whole political system and people's trust in health insurance policies.

However, the current health insurance policy is facing many challenges. There’s still nearly 11% of the population (equivalent to 10 million people) who have not yet obtained health insurance, mainly those who belong to the group of people participating in agricultural, forestry and fishery households with average living standards and workers in some private businesses and students.

The organisation of health insurance examination and treatment at commune health stations has not yet been promoted for people with health insurance cards. The overspending of the health insurance fund is still increasing; the source of the surplus of the health insurance fund from previous years is running out. The health insurance assessment is still limited whilst there is a lack of consistency in assessing the reasonableness of the indications.

Resolution No.20/NQ-TW sets a target of striving to achieve 95% of the population having health insurance by 2025; in which direct expenditure from households for health is 35% and by 2030, the rate of health insurance participation is more than 95%, of which direct household health spending is 30%.

In order to implement the above-mentioned goal, many experts believe that, in the coming time, it is necessary to focus on concurrent solutions to overcome the above limitations and weaknesses. It is necessary to adjust health insurance premiums in accordance with economic development conditions, people’s income and service quality; diversify health insurance packages to meet people's needs.

More effective measures should be taken to ensure the balance of the health insurance fund and benefits of health insurance participants and medical establishments. On the other hand, it is also necessary to improve the quality of service, drastically improve the process of medical examinations and treatment for health insurance to facilitate patients and medical staff.

In addition, communication work should be identified as a breakthrough solution, with a focus on groups of people who have not yet participated in health insurance; in order to create consensus, a sense of responsibility to use health insurance in each family and society as a whole.