Draft amended health insurance law offers more benefits for patients

February 27, 2024 - 08:24
It has also improved efficiency in appraisal management and implementation of health insurance medical treatment contracts and efficient allocation of health insurance funds.


A patient registers for medical examination and treatment with health insurance cards at Văn Chấn District's medical centre in the northern mountainous province of Yên Bái. — VNA/VNS Photo Việt Dũng

HÀ NỘI — The Ministry of Health has proposed amendments to the draft Law on Health Insurance, which stipulates that patients under 18 years old undergoing treatment for strabismus, myopia and eye refractive errors will be covered by health insurance.

Currently, the Health Insurance Law only covers children from 0 to six years old.

This is one of the ministry’s proposals to expand the age range covered by health insurance in the draft amended Health Insurance Law.

The draft law has adjusted the scope of participants in health insurance; the scope of health insurance benefits; and the health insurance regulations according to the level of technical expertise in medical facilities.

It has also improved efficiency in appraisal management and implementation of health insurance medical treatment contracts and efficient allocation of health insurance funds.

The ministry has proposed to amend some content of Article 22, in which patients who seek medical treatment at hospitals or healthcare facilities not at the appropriate technical level or outside the basic level will have two options for health insurance benefits.

In Option 1, patients with health insurance will be reimbursed 60 per cent of inpatient costs and 40 per cent of outpatient costs, except for district-level facilities which will supply 100 per cent for both inpatient and outpatient.

In Option 2, the current provisions will be applied with 100 per cent reimbursement of inpatient treatment costs and no payment for outpatient costs.

Additionally, the draft law has stipulated not to cover health insurance for the use of substitute medical supplies, including prosthetic eyes, dentures, eyeglasses and mobility aids during medical examination and treatment as well as functional rehabilitation.

Currently, health insurance funds don’t cover the use of substitute medical supplies such as prosthetic limbs, prosthetic eyes, dentures, eyeglasses, hearing aids and mobility aids. Therefore, health insurance participants will only be reimbursed for prosthetic limbs and hearing aids.

The draft law has also retained cases where health insurance does not cover expenses, including nursing at nursing facilities; health check-ups; prenatal diagnostics not intended for treatment.

Use of reproductive assistance techniques, family planning services and abortion are not on the reimbursement list except for cases where pregnancy termination is required due to pathological reasons. The health insurance funds don’t cover cosmetic services, functional rehabilitation in cases of disaster, medical examination and treatment for addiction to drugs, alcohol, or other addictive substances, forensic examination and psychiatric forensic examination.

The draft law has also reduced the allocated amount for management expenses with the excess amount to be transferred directly to medical examination and treatment. Accordingly, the maximum expenses for health insurance fund management activities will be reduced from 5 per cent as currently to a maximum of 4 per cent. The remaining will be immediately added to the health insurance medical examination and treatment.

The draft law is expected to be submitted to the 15th National Assembly for comments at its 7th session in this May. — VNS