Development Orientation of Universal Health Insurance in Phu Nhuan District, Ho Chi Minh City

CHAPTER 3

ORIENTATION AND SOLUTIONS FOR DEVELOPING UNIVERSAL HEALTH INSURANCE, TO IMPLEMENT SOCIAL SECURITY WORK WELL IN PHU NHUAN DISTRICT, HO CHI MINH CITY

3.1. Orientation for developing universal health insurance in Phu Nhuan district, Ho Chi Minh City

Pursuant to Resolution 21/NQ-TW dated November 22, 2012 of the Politburo on strengthening the Party's leadership over health insurance and health insurance for the period 2012-2020; Action Program No. 32-CTrHD/TU dated April 8, 2013 of the Standing Committee of the City Party Committee on strengthening the Party's leadership over health insurance and health insurance for the period 2012-2020.

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To overcome the shortcomings and meet the general socio-economic development of the country, the Law on Health Insurance was promulgated by the National Assembly on November 14, 2008 and started to be implemented from October 1, 2009, replacing Decree No. 63/2005/ND-CP. The 2008 Law on Health Insurance basically retains the rights of participants. However, there is a new point of great interest, which is the application of co-payment of medical examination and treatment costs at many levels, according to different levels, hospital classes and groups of subjects. In cases where medical examination and treatment use high-tech services with high costs, the Health Insurance Fund will also pay but not exceeding 40 months of minimum salary for one use of that service. The health insurance contribution rate was adjusted from 3% to 4.5% of monthly salary, wages, pension, disability allowance or minimum wage for compulsory health insurance and 4.5% of minimum wage for voluntary health insurance. For students, the health insurance contribution rate is equal to 3% of minimum wage (Le Kim Nguyet, 2010). The increase in health insurance contribution rate from 3% to 4.5% along with the minimum wage increasing many times during the period from 2009 to 2012 while hospital fees remained almost unchanged, causing the health insurance fund to have a surplus of nearly 13,000 billion VND at the end of 2012 (Standing Committee of the National Assembly, 2013). Hospital fees remained low for a long time, while the prices of electricity, water, medicines, medical supplies and health insurance contributions increased continuously, causing difficulties for hospitals in ensuring the rights of health insurance patients. In February 2012, the Ministry of Health and Finance issued a circular.

Joint Circular No. 04/2012/TTLT-BYT-BTC on adjusting the price of medical services. Adjusting the price of medical services contributes to improving the quality of medical services and operating conditions for hospitals, and improving the rights of health insurance patients (Standing Committee of the National Assembly, 2013). However, with the increasing price of medical services leading to increasingly large payments, the government will face many difficulties in calculating the balance of the health insurance fund.

On June 13, 2014, at the 7th Session of the 13th National Assembly, the Law on Amending and Supplementing a Number of Articles of the Law on Health Insurance No. 46/2014/QH13 was issued. Compared to the 2008 Law on Health Insurance, the Law on Amending and Supplementing a Number of Articles of the Law on Health Insurance amends and supplements 25/52 articles and takes effect from January 1, 2015. Of which, there are 08 (eight) important points with strong breakthroughs, overcoming the limitations and shortcomings of the current Law, creating a legal mechanism to ensure the rights of health insurance participants, in order to realize the goal of universal health insurance. Regulations on compulsory participation in voluntary health insurance by household. This is one of the extremely important breakthrough solutions, demonstrating political determination to promote the roadmap for implementing universal health insurance in accordance with the spirit of the 2013 Constitution and Resolution No. 21-NQ/TW of the Politburo on strengthening the Party's leadership over health insurance work in the 2012-2020 period. The State has used the mechanism of direct budget support for a part of the population participating in health insurance, as well as the policy mechanism on medical service prices to promote the participation of the entire population in health insurance.

Compulsory participation in health insurance by household with a mechanism of gradually reducing the contribution from the second member onwards by 70% of the first person, the third member by 60%, the fourth by 50%, and the fifth person onwards by only 40% of the first person. This regulation will limit the situation where only sick people participate in health insurance, ensuring sharing within the household and reducing the financial burden of having to pay health insurance for all members of the household. At the same time, to create favorable conditions for people to participate in health insurance, they can pay health insurance by household at health insurance agents nationwide.

Vietnam Health Insurance and the health sector have developed a basic health service package to gradually increase benefits for health insurance participants. The development of a basic health service package

The basic health service package will meet the essential needs of people's health care, so that people participating in health insurance can benefit from the health insurance policy. The basic health service package paid by health insurance is built in accordance with the payment capacity of the health insurance fund, the health insurance contribution level to ensure fairness in people's health care and the sustainability of social security policy.

The Government has also clearly defined the responsibilities of ministries and branches in implementing the Party's policy on health insurance. The Ministry of Health is responsible for implementing state management of health insurance. Therefore, to ensure the tools for implementing health insurance policies and the sustainability of the Health Insurance Fund, the Ministry of Health must issue professional and technical regulations, medical examination and treatment procedures and treatment guidelines; regulations on referrals related to health insurance examination and treatment; issue lists and rates, payment conditions for drugs, chemicals, medical supplies, technical services within the scope of benefits of health insurance participants; and basic health service packages paid by the Health Insurance Fund.

According to the report of Vietnam Health Insurance, by the end of June 2017, the whole country had 77.81 million people participating in health insurance, reaching 83.4% of the population. It is expected that by the end of 2017, the whole country will have 78.195 million people participating in health insurance, reaching an estimated coverage rate of 83.8%, exceeding the target of the plan to develop the number of participants in 2017 according to the plan assigned by the Prime Minister. However, there are still 16 localities that have not achieved the health insurance coverage rate, including some localities with low rates, if not drastically implemented, it will be difficult to complete the target, such as: Dong Thap, Can Tho, Dak Nong, Lam Dong, Binh Thuan...

Developing health insurance in Phu Nhuan district cannot be separated from the health insurance development policy of the Party, the State and the People's Committee of Ho Chi Minh City such as: Resolution 21/NQ-TW dated November 22, 2012 of the Politburo; Decision No. 1167/QD-TTg dated June 28, 2016 of the Prime Minister on adjusting the health insurance implementation targets for the period 2016-2020. Decision No. 1609/QD-UBND dated April 5, 2016 of the People's Committee of the City on assigning targets for developing subjects participating in health insurance, health insurance, unemployment insurance.

Based on the policies and resolutions of the superiors and from the practical situation of Phu Nhuan district, the 11th Phu Nhuan District Party Congress (Term 2015-2020) has proposed a Resolution on developing health insurance in the district, aiming at the goal of universal health insurance. To achieve this in the coming time, the District People's Committee will focus on implementing the following contents:

- Local Party committees and authorities in the District must clearly recognize and promote their roles and responsibilities in directing and implementing policies and laws on health insurance in each locality, aiming to implement the universal health insurance policy in the District.

- Raise the sense of responsibility of agencies, departments, unions of the District and 15 wards in the area, promote propaganda to each agency, unit, organization and household about policies, regimes, obligations and rights of people when participating in health insurance, at the same time help everyone clearly understand the losses when not participating in health insurance, especially information on the State's regulations on increasing the price of medical examination and treatment services for people not participating in health insurance from June 1, 2017.

- Recommend that medical facilities in the District continuously invest in modern facilities and equipment and improve the quality of medical examination and treatment, ensuring full implementation of health insurance policies for patients.

- Continue to promote propaganda and dissemination of health insurance laws in units, enterprises, organizations and people in the District.

- Synchronously and effectively implement solutions to accelerate the development of health insurance participants in the District, moving towards universal health insurance, while ensuring full, timely and on-time collection according to regulations for health insurance.

- Strengthen the effectiveness of state management of health insurance in the District, have strong sanctions to promptly overcome the situation of evasion and late payment of health insurance, health insurance, unemployment insurance by units, enterprises and organizations in the District, ensuring legitimate and legal rights for insurance participants.

- Strengthen inspection and examination of the implementation of the Health Insurance Law at agencies, units and enterprises in the District to promptly detect, prevent and strictly handle violations, ensure the rights of employees, especially focusing on inspection, examination and coordination in suing enterprises and units that employ employees to owe or evade paying health insurance for employees.

- The Standing Committee of the District People's Committee needs to monitor the implementation of health insurance policies in the District every month through reports on the implementation results of the District Health Insurance and related departments and branches in the District. Periodically every quarter, chair meetings to inspect and evaluate the implementation results of health insurance policies, promptly resolve problems and deploy synchronous solutions to effectively implement health insurance policies in the District. At the end of the year, the District Party Committee and the District People's Committee will preside over the summary and evaluation of the implementation of health insurance in the area and deploy specific directions and tasks for the following year.

3.2. Some solutions to develop universal health insurance in Phu Nhuan district, Ho Chi Minh City

3.2.1. Developing health insurance participants in the District

To develop universal health insurance to effectively implement social security policies and share risks between healthy people and sick people, it is necessary to increase the rate of health insurance participation of people in the District.

To do this, the District People's Committee must have a policy requiring people participating in health insurance to voluntarily buy health insurance for the whole household to protect and take care of the health of all family members and ensure the principle of risk sharing right from within the family, if unfortunately they get sick and need to pay for medical examination and treatment. Forcing people to participate in health insurance by household is not an easy thing when they have not yet realized the direct, obvious benefits, especially for groups of people with economic difficulties. The understanding of the benefits of participating in health insurance by household is still limited, combined with the habit of "reverse selection" makes many people not very enthusiastic about participating in health insurance by household. They do not fully understand the humane meaning of health insurance, do not identify the responsibility to share with the community or understand

Understand the protection that health insurance can provide if illness or disease occurs to any family member.

Participating in family health insurance is an important solution to ensure the expansion of universal health insurance coverage in the District. Along with the development trend, the quality of medical services is increasingly high, the hospital fees are increasing, causing financial pressure on patients and their families, especially in cases of serious illness, long-term treatment, and limited economic conditions, participating in health insurance in general, and family health insurance in particular, is an effective solution to limit the financial burden when facing the risk of illness and disease as well as limit the problem of adverse selection in participating in voluntary health insurance. In order to effectively implement family health insurance, moving towards universal health insurance in the District, in the coming time, it is necessary to implement the following solutions:

(i) Strengthening information and propaganda work to raise awareness of people in the District about health insurance policy. To raise awareness of people in the District about participating in health insurance, it is necessary to strengthen information and propaganda work. Expand and enhance the effectiveness of propaganda work on health insurance law, including participation in health insurance by household. In addition, the District's health insurance agency needs to have appropriate propaganda and mobilization solutions for each target group, especially for people with low qualifications or self-employed people. It takes a lot of time to propagate and explain the health insurance purchase policy thoroughly and thoroughly, helping people clearly understand their responsibility to participate in health insurance by household, along with the benefits enjoyed and shared in the community when participating in health insurance.

(ii) The district needs to study and have policies to support people to buy health insurance cards. Currently, the State regulates the voluntary purchase of health insurance for the whole household; for poor and near-poor families, the State has supported 100% of the cost of buying health insurance cards, but for households with an average living standard (not poor or near-poor), the cost of buying health insurance is really a difficult problem. The practice of implementing health insurance in the past and present shows that people always have to consider when participating in health insurance: if participating for members of the household, the common economic cost of

The whole family will have to set aside an amount to ensure the illness of each member, while the current policy of paying personal income tax and implementing annual family deductions for workers still has many shortcomings, especially for workers living, studying and working in Ho Chi Minh City. Because of this, workers cannot accumulate and save to buy health insurance for family members to prevent illness and disease; if they do not participate, the family will reduce that cost but must accept the high risk of having to pay all medical expenses when each member needs to use medical services. Therefore, the budget needs to support part of the cost of buying health insurance cards for the middle-income group in the District.

To develop the number of family health insurance participants in the District, the following specific solutions are needed:

- The leaders of the People's Committees of 15 wards in the District need to direct the health insurance collection agents to base on the list of households due for health insurance participation (Form D08-TS) sent by the District Health Insurance every month, remind people of the deadline to continue registering to participate, mobilize and propagate to ensure that 100% of people in the District participating in health insurance continue to renew their health insurance cards. Currently, in the District, the District Health Insurance has signed contracts with 22 health insurance collection agents, and is discussing and proposing to sign agency contracts with 04 public service and economic units in the area, specifically: Phu Loc Commercial Cooperative, Phu Thinh Commercial Cooperative, District Hospital and District Women's Union.

- Health insurance collection agents must clearly post the time for paying family health insurance registration fees (renewal, new increase, etc.) so that people know and proactively register. Family health insurance collection staff need to research and improve collection procedures, comply with regulations on health insurance registration procedures, and create favorable conditions for people to participate in health insurance.

- District Health Insurance coordinates with the People's Committees of 15 wards, the Vietnam Fatherland Front Committee of the district, and the District Women's Union to organize seminars and dialogues with people about health insurance policies, especially family health insurance, to raise awareness and understanding of local people about health insurance. Every month, District Health Insurance needs to notify the People's Committees of 15 wards of the number of people

Participate in family health insurance, the achieved rate compared to the assigned target for the ward to propagate and mobilize people to participate.

- Conduct screening in neighborhoods and residential groups with low rates of people participating in health insurance, especially families of cadres, party members, officials, civil servants residing in the area, members, core members of socio-political organizations, and ward militia forces who have not participated, to focus on propaganda and mobilization for participation.

- The District People's Committee and relevant agencies regularly monitor the collection of family health insurance by collection agents; organize meetings with collection agents every quarter to resolve problems, summarize people's legitimate proposals and recommendations on health insurance policies and submit them to superiors for adjustment and supplementation. Health insurance collection agents mobilize, propagate, and arrange suitable time (including after hours, Saturdays, and Sundays) to create favorable conditions and serve people well when they come to participate in family health insurance.

- District Health Insurance continues to organize meetings with staff of the Family Health Insurance Collection Agent to deploy and discuss the implementation of directive documents of Vietnam Health Insurance and City Health Insurance, and at the same time receive people's problems and recommendations on health insurance policies to synthesize and submit to superiors, in order to help Collection Agent staff understand the professional process, properly perform the collection of family health insurance and be able to answer people's problems in the process of collecting family health insurance.

- The District Party Committee and the District People's Committee direct the Department of Labor, War Invalids and Social Affairs to: Coordinate with the District Health Insurance based on the population in each ward and the number of people participating in health insurance to calculate and advise the District People's Committee to issue a Decision to assign targets for developing family health insurance for each ward to ensure suitability and effective implementation. At the same time, monitor the progress and urge the People's Committees of 15 wards to implement the assigned targets.

Continue to promote the development of health insurance for students in the area.

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