Private insurance funds are always competing to attract customers to have enough money to maintain their operating apparatus.
The cost of health insurance is shared by both the employee and the employer. The government only covers the health care costs for the poor. All people must buy health insurance, except the rich who may not need to buy it, but must pay for medical treatment themselves.
People have the right to choose any private insurance fund from more than 200 health insurance funds across Germany. On average, each German citizen must pay 15% of his or her salary to the health insurance fund he or she chooses to buy.
There are also other models such as: the Beveridge model of the UK, the Semashko model of the Soviet Union and the private health insurance model represented by the United States. Today, many countries in the world still apply the above models but have their own adjustments to suit each country's economic - political - social characteristics and this customized model is called the mixed health insurance model.
1.3.2 Brief history of the formation of Vietnam Health Insurance
In 1989, with the consensus of the Council of Ministers (now the Government), the Health Sector organized a pilot Health Insurance program in some provinces and cities of Hai Phong, Vinh Phu, Quang Tri, Ben Tre and the Health Insurance fund model for the Railway Health Sector; which brought about very positive results such as: a number of technical means, clinic equipment, and medicines in hospitals and medical centers were all strengthened; the organization and arrangement of treatment and services in hospitals were also better than before, so these medical facilities have improved the quality of examination and treatment.
On August 15, 1992, the Council of Ministers (now the Government) officially issued Decree No. 299/HDBT on Health Insurance Regulations. Subjects required to participate in health insurance are: cadres, civil servants, employees in the administrative sector, employees in the production and business sector, and retired cadres with loss of working capacity.
On August 13, 1998, Decree 58/1998/ND-CP was signed and issued by the Prime Minister, clearly presenting the unified organizational structure from the central to local levels, the fund is centralized and regulated by Vietnam Health Insurance. Decree 58 also clearly stipulates voluntary health insurance; applies co-payment of health insurance, stipulates the ceiling in inpatient payment; stipulates direct payment, elective payment, payment for some high-tech services.
On January 20, 2002, Decision No. 20/2002/QD-TTg transferred the Vietnam Health Insurance system from the Ministry of Health to the Vietnam Social Security Agency. Then, the Government issued Decree No. 100/2002/ND-CP dated December 6, 2002, stipulating the functions, tasks and powers of the Vietnam Social Security system.
On May 16, 2005, Decree 63/2005/ND-CP was issued, expanding benefits for health insurance participants such as: eliminating the co-payment mechanism, eliminating inpatient ceiling payments, expanding the health insurance participants, and expanding many types of voluntary health insurance participants.
On November 14, 2008, the 12th National Assembly, 4th session, passed the Law on Health Insurance. The Law took effect from July 1, 2009. On July 27, 2009, the Government issued Decree No. 62/2009/ND-CP detailing and guiding the implementation of a number of articles of the Law on Health Insurance.
On June 13, 2014, Law 46/2014/QH13 was issued and took effect from January 1, 2015.
Table 1.3 Brief history of the formation of Vietnam Health Insurance
Time
Content | |
1989 | Pilot model of health insurance fund for railway health sector |
1992 | Subjects required to participate in health insurance are: Officials and civil servants, Workers in the administrative and career sector, Workers in production and business areas, Retired cadres with loss of working capacity |
1998 | Regulations on the organization mechanism of health insurance Apply co-payment of health insurance Regulations on payment ceiling, optional payment, direct payment |
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Time
Content | |
access and payment for some high-tech services. | |
2002 | Transfer the health insurance system from the management of the Ministry of Health to the Vietnam Social Security agency. Regulations on functions, tasks and powers of the social insurance system Vietnam. |
2005 | Expanding benefits for health insurance participants: Eliminate co-payment mechanism Eliminate inpatient ceiling payments Expanding health insurance coverage and types of voluntary health insurance participation |
2008 | Promulgate the Law on Health Insurance, detailed regulations and implementation instructions |
2014 | Issue the Law on Health Insurance, amending and innovating a number of regulations compared to the previous one. Health Insurance Law 2008 |
1.3.3 Some highlights of the revised Law on Health Insurance.
According to Law 46/2014/QH13 issued on June 13, 2014, also known as the amended Law on Health Insurance, there are the following highlights:
First, health insurance is mandatory for Vietnamese people.
Second, households must participate in the family health insurance form, except for members who have participated in health insurance in other forms . Accordingly, the State will support the health insurance premium when participating as a household. The first person pays a maximum of 4.5% of the basic salary, the second, third, and fourth people pay 70%, 60%, and 50% of the first person's contribution, respectively, and from the fifth person onwards, they pay 40% of the first person's contribution. For those who are living in areas with particularly difficult socio-economic conditions, residents living in island communes and island districts, the state budget will pay for health insurance. Children who are 72 months old but have not yet entered school, the health insurance card is valid until September 30 of that year.
Table 1.4 Health insurance premium payment levels according to household form
Family order
1 | 2 | 3 | 4 | 5 onwards | |
Health insurance premium to be paid | 100% | 70% | 60% | 50% | 40% |
(Source: Health Insurance Law amended 2014)
Third, health insurance benefits : When health insurance participants go for medical examination and treatment according to the provisions of this Law, the health insurance fund will pay for medical examination and treatment costs as follows:
100% of medical examination and treatment costs in cases where the cost for one medical examination and treatment is lower than the level prescribed by the Government and the medical examination and treatment is at the commune level;
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 if the medical examination and treatment is in the right line. In case a person belongs to many health insurance participants, he/she will enjoy health insurance benefits according to the subject with the highest benefits.
Table 1.5 Health insurance benefits when receiving medical examination and treatment at the right facility
Object
General Audience | Special Objects | ||
Health insurance benefit level | 80% | 95% | 100% |
Note | Retirement, Near poor people, People with meritorious families network… | Military, People with revolutionary contributions, Poor people, Children under 6 years old... | |
(Source: Law on Health Insurance amended 2014)
Table 1.6 Health insurance benefits when receiving medical examination and treatment outside the designated area
Line
District route | Provincial and municipal routes | Center line nursery | |
Benefit level Health insurance | 70% inpatient and outpatient | 60% boarding | 40% boarding |
100% inpatient and outpatient (from 01/01/2016) | 100% boarding (from 01/01/2021) |
(Source: Law on Health Insurance amended 2014)
Fourth, in case a health insurance participant goes to a medical facility that is not in the right line , the health insurance fund will pay the benefit according to the following prescribed rate:
At central hospitals, 40% of inpatient treatment costs.
At provincial hospitals, 60% of inpatient treatment costs from the effective date of this Law to December 31, 2020; 100% of inpatient treatment costs from January 1, 2021 nationwide.
At district-level hospitals, 70% of medical examination and treatment costs from the effective date of this Law until December 31, 2015; 100% of medical examination and treatment costs from January 1, 2016.
Fifth, the health insurance benefit level for special groups . Near-poor people, relatives of people with meritorious services is 95%, the benefit level for parents, spouses, children of martyrs is up to 100%...; other relatives of people with meritorious services to the revolution, people in near-poor households must co-pay 5% of medical examination and treatment costs. The subjects are people in poor households, ethnic minorities living in areas with difficult socio-economic conditions, social protection subjects to increase access to district health services are exempted from payment.
Sixth, opening a health examination and treatment line for health insurance . To meet the needs of health insurance participants, the Law amending and supplementing a number of articles of the Health Insurance Law stipulates: From January 1, 2016, a health examination and treatment line will be opened at the district and commune levels within the same province. Accordingly, health insurance participants who register for initial medical examination and treatment at a commune health station or a general clinic or a district hospital are entitled to medical examination and treatment at district-level medical examination and treatment facilities within the same province. That means that health examination and treatment under health insurance for health insurance participants will be more convenient, not limited to a single initial medical examination and treatment facility, but still paid according to the prescribed benefit level.
1.4 Experience in implementing health insurance policies in some localities in Vietnam
1.4.1 Experience in implementing health insurance policy in Hanoi:
Hanoi is the capital of the Socialist Republic of Vietnam, the political, cultural and scientific-technical center, and a major center for economic and international trade transactions of the whole country. In terms of geographical location, Hanoi borders Thai Nguyen - Vinh Phuc provinces in the North; Ha Nam - Hoa Binh in the South; Bac Giang - Bac Ninh - Hung Yen in the East and Hoa Binh - Phu Tho in the West. After being expanded, the capital Hanoi has a natural area of 3,345km2, a population of more than 7 million people; including 30 administrative units at district and county levels.
According to the Hanoi Social Insurance Agency, the current health insurance coverage rate in Hanoi is 77.23% (2015), with 5,480,163 people in the capital participating in health insurance; achieving the health insurance coverage rate target set by the Prime Minister for Hanoi in 2015.
In the process of implementing the health insurance policy, Hanoi has encountered some shortcomings such as:
The implementation of some provisions of the amended Law on Health Insurance is still slow. Specifically, the work of supporting health insurance contributions for non-professional officials at the commune level; and households working in agriculture, forestry, and fishery with average living standards has not been fully implemented.
The regulation on initial medical examination and treatment registration by level has many shortcomings, causing a situation where in border areas, people living near the city-level hospital area, cannot participate in health insurance at that hospital, but must participate at a more distant grassroots level.
The human resources of health insurance agents in communes, wards and towns are still part-time and unprofessional... This is also one of the reasons why the rate of people participating in health insurance has not been effective in Hanoi, especially in suburban areas.
For the group of household health insurance, the registration for health insurance participation is still inadequate due to cumbersome administrative procedures, causing the rate of participation in family health insurance to be low. The quality of health insurance examination and treatment is not yet guaranteed.
Faced with difficulties, Hanoi has proposed many solutions to ensure the roadmap for implementing the goal of universal health insurance, as follows:
Improve administrative procedures in health insurance registration : for the family health insurance group, the authorities need to simplify administrative procedures and reduce unnecessary paperwork in the registration procedure. Apply the "one-stop" model to simplify administrative procedures to create the most favorable conditions for people to participate in family health insurance.
Strengthen propaganda work : carry out propaganda and dissemination of laws and policies on health insurance; especially focus on the outstanding contents of the 2014 amended Law on Social Insurance.
Applying new technologies to implementing health insurance policies : promoting the application of information technology in health insurance work, focusing on statistics, making lists, issuing and changing cards to reduce people's waiting time as well as reduce work pressure for specialized staff.
Improve health examination and treatment under health insurance : medical facilities need to continue to implement synchronous solutions to improve the quality of medical examination and treatment. Primary health stations need to be invested in human resources, material resources and financial resources to improve the quality of primary health care services for the people, contributing to reducing overload at upper-level hospitals.
Organization and management : At the same time, the Party committees, authorities and functional branches have paid due attention, taken synchronous and drastic actions to overcome shortcomings, so the number of people participating in health insurance has increased, contributing to the completion of the goal of developing universal health insurance.
1.4.2 Experience in implementing health insurance policy in Dong Nai:
Dong Nai province is located in the Southern key economic zone, in the Southeast region, with a natural area of 5,862.37 km2, Dong Nai province's population is nearly 2.5 million people. Geographical location: the North borders Lam Dong and Binh Duong provinces; the East borders Binh Thuan province; the South borders Ba Ria - Vung Tau province and Ho Chi Minh city, including 11 administrative units: 1 provincial city, 1 town, 9 districts, According to the Social Insurance agency of Dong Nai province, the health insurance coverage rate in the province
Dong Nai achieved the target set by the Prime Minister of 78% in 2015, from the group of provinces with low health insurance coverage, it has now surpassed the average health insurance coverage rate in Vietnam. It is a typical province for the effective implementation of health insurance policy.
However, the implementation of the health insurance policy still faces many difficulties due to inadequacies in regulations on health insurance payment in some cases such as:
Payment of inpatient transportation costs beyond the prescribed line; direct payment of medical examination and treatment costs; conditions for primary health care at educational institutions, enterprises...
The form of participating in health insurance by household group is still new; the allocation of health insurance cards by level while people want to register for medical examination and treatment at provincial hospitals also causes the number of people participating in health insurance to decrease.
Faced with that situation, the Social Insurance Agency of Dong Nai province coordinated with the People's Committee of Dong Nai province to implement solutions such as:
Propaganda work : Require units to organize propaganda and widely disseminate the amended and supplemented Law on Health Insurance, in order to exploit and expand the target audience, pay attention to localities with low participation rates and focus on target groups such as: employees working in enterprises, people participating in household health insurance, students studying at educational institutions in the national education system. Specifically, carry out propaganda work well on the radio system and visual forms.