With the above difficulties and shortcomings, the implementation and propaganda of health insurance policies will be attractive, convenient and effective.
Lessons learned:
District Health Insurance has received attention from the City Health Insurance, District Party Committee, District People's Committee in leading and directing Party committees and authorities at all levels in leading and directing the implementation of Resolution 21-NQ/TW. Party committees and People's Committees of 15 wards have focused on leading and directing close coordination in implementation.
In recent times, the district's Health Insurance has focused on propaganda work to raise awareness among cadres, party members, workers and people about health insurance work so that they can pay attention and protect their legitimate and legal rights according to the provisions of the law.
Hospitals in Thu Duc district have gradually developed synchronously in terms of facilities and quality of medical examination and treatment services, creating favorable conditions for all people to participate in and enjoy health insurance regimes.
The District Health Insurance Board always pays attention to training, improving the qualifications, professional skills, and practical capacity of the District Health Insurance staff; always builds a team of staff with a serious working style and manner and good service style to the subjects; increases investment in facilities, effectively implements administrative procedure reform, focuses on simplifying administrative procedures, builds a modern, professional health insurance system, complies with regulations and is highly effective in order to facilitate agencies, organizations, and individuals in participating in and enjoying health insurance and unemployment insurance regimes.
Through the experience of universal health insurance contributing to the implementation of social security in the above-mentioned districts, the author has a more specific perspective to determine the objectives and research methods for the topic and as a basis for analyzing the current status of health insurance in Phu Nhuan district, Ho Chi Minh City, and finally, proposing solutions to promote universal health insurance contributing to the implementation of social security in Phu Nhuan district, Ho Chi Minh City by 2025.
Chapter 1 Summary
Health insurance is a form of insurance with a deeply shared community character applied in the field of medical examination, treatment and health care for everyone, not for profit purposes, organized and implemented by the State and responsible subjects participating according to the provisions of the Law on Health Insurance. Universal health insurance plays an important role in ensuring social security for the people: Firstly , on the one hand, it requires a high sense of responsibility from each worker towards themselves, their families and towards the community and society according to the motto "I am for everyone, everyone is for me" through rights and obligations; on the other hand, it demonstrates the connection of responsibility between members of society, between successive generations in a country, forming a united bloc of interests in a sustainable political and social institution. Second, the Health Insurance Policy with the goal of implementing universal health insurance has created conditions for all people to reduce the burden of medical examination and treatment costs due to illness, disease, and accidents, creating equality in health insurance examination and treatment. Third , implementing health insurance contributes to stabilizing and improving the quality of labor, ensuring equality in social status of people in different economic sectors, and promoting production development.
For developed countries, where the standard of living is high, health insurance activities have existed for a long time and are developed, health insurance can be implemented in both the form of package health insurance and regular health insurance. For poor, underdeveloped countries that have just implemented health insurance activities, the regular health insurance methods including compulsory health insurance and voluntary health insurance are often applied. In Vietnam, the health insurance fund is a financial fund formed from health insurance contributions and other legal sources of revenue, used to pay for medical examination and treatment costs for health insurance participants (accounting for 90% of the fund), management costs of the health insurance organization's apparatus and other legal costs related to health insurance (accounting for 10% of the fund). The health insurance fund is managed centrally, uniformly, publicly, transparently, ensuring a balance between revenue and expenditure and is protected by the state (Law on Health Insurance, 2008). Vietnam's health insurance policy has gone through 3 stages: the stage from August 1992 to August 1998, the stage from September 1998 to June 2005, the stage from July 2005 to 2016 with changes and is gradually being perfected . The development and perfection of
Vietnam Health Insurance also contributes to the development of universal health insurance in general and in Phu Nhuan district, Ho Chi Minh City in particular.
CHAPTER 2
CURRENT SITUATION OF HEALTH INSURANCE IN PHU NHUAN DISTRICT, HO CHI MINH CITY IN THE PERIOD 2015-2019
2.1. Formation process and functions of Health Insurance of Phu Nhuan district, Ho Chi Minh City
2.1.1. Overview of the formation and development process of Phu Nhuan District Health Insurance
Along with the birth of Vietnam Health Insurance (VHI) on February 16, 1995. Phu Nhuan District Health Insurance was established under Decision 026/BHYT-QD dated August 17, 1995 of the Director of Ho Chi Minh City Health Insurance. After 18 years on the path of building trust and prestige for customers, with the professional leadership of Ho Chi Minh City Health Insurance, the attention and leadership of the District Party Committee, the District People's Committee and the support of the District's functional agencies, Phu Nhuan District Health Insurance has overcome difficult stages to innovate and develop, from passive administration to proactive work; linking theory with practical requirements in the service process to successfully fulfill the political tasks of the industry in taking care of health, protecting the legitimate and legal interests of workers in the District.
2.1.2. Functions of Phu Nhuan District Health Insurance
District Health Insurance is an agency under the Ho Chi Minh City Health Insurance, with the function of assisting the City Health Insurance in organizing the implementation of the Health Insurance and Health Insurance policies; managing the revenue and expenditure of the Health Insurance and Health Insurance regimes in the District according to the management hierarchy of Vietnam Health Insurance, City Health Insurance and regulations of law. District Health Insurance is under the direct and comprehensive management of the City Health Insurance and under the State administrative management of the District People's Committee.
Diagram 1: Organizational structure of Phu Nhuan District Health Insurance
DEPUTY DIRECTOR 1
MANAGER
DEPUTY DIRECTOR 2
BP THU
BP CHECK
BP CARD BOOK
BP MODE
IT Department
Accounting Department
Admission Department
Organization and Administration Department
Source: Phu Nhuan District Health Insurance, 1995
2.2. Current status of health insurance activities in Phu Nhuan district
2.2.1. Current status of health insurance participants in Phu Nhuan district
Pursuant to Decision No. 1389/QD-UBND dated April 9, 2018 of the City People's Committee on assigning targets for developing health insurance participants in 2018 in Ho Chi Minh City, the District People's Committee issued Decision No. 633/QD-UBND dated May 23, 2018 on assigning targets for developing health insurance participants in 2018 in Phu Nhuan District and Official Dispatch No. 837/UBND dated October 25, 2018 on accelerating the development of family health insurance participants.
In Phu Nhuan district, by the end of 2017, the total population was over 183,288 people with 828 residential groups and about 46,000 households . As one of the central districts of Ho Chi Minh City, the population is stable, the number of newly established enterprises located in the district increases every year with many types of business, mainly focusing on trade and services, the abundant labor resources of the district are also a condition for implementing the policies of the Party, the legal policies of the State, including policies on health insurance and health insurance.
Pursuant to Decision No. 539/QD-UBND dated May 29, 2017 of the District People's Committee on assigning targets for developing subjects participating in Health Insurance, health insurance,
Unemployment insurance in 2017, according to the report of the District Health Insurance, as of August 4, 2017, the district had 48,766/50,260 people participating in household health insurance, an increase of 5,062/6,556 people (reaching 77.2% of the 2017 target) and an increase of 3,792 people compared to the beginning of 2017. Regarding the inspection of the implementation of the development of subjects participating in social insurance, health insurance, and unemployment insurance, there are currently 05 wards (7, 8, 12, 14, 17) implementing insurance at a rate of less than 70% of the assigned target .
The District has regularly promoted the dissemination of the meaning and importance of the rights and obligations of each citizen when participating in health insurance in order to effectively implement the goal of participating in universal health insurance; strengthened the coordination of agencies and units to effectively implement policies and laws on health insurance, health insurance, unemployment insurance to ensure the rights of participants and beneficiaries; promptly prevented the situation of evasion, appropriation, arrears of health insurance funds, health insurance and abuse of health insurance funds, improved the quality of medical examination and treatment, and health care for beneficiaries of health insurance policies... Organized many dissemination and discussion sessions on health insurance policies in the District, including: discussion sessions for people at the People's Committees of 15 wards. Propaganda for members of the District Women's Union, discussion for small traders of Phu Loc, Phu Thinh, Phu Hung Cooperatives, propaganda of health insurance law policies for more than 2,000 labor-using units in the District. Regularly review and propagate, mobilize neighborhoods and residential groups with low rates of people participating in health insurance, especially families of cadres, party members, civil servants, and public employees residing in the area, core members and union members of socio-political organizations, and militia and self-defense forces to actively and fully participate in family health insurance.
Implementing the "one-stop" mechanism, publicly posting administrative procedures at the office and on the website, along with simplifying administrative procedures, to improve service quality; organizing the connection of administrative procedures in the fields of household registration, household registration and health insurance with 15 wards in the District, creating convenience for people, helping people save time, costs and effort in traveling many times; Providing health insurance payment results of employees and
monthly units on the Internet for convenient monitoring, helping people to easily look up the health insurance payment process and strengthen the supervision of employees over employers in the implementation of health insurance payment for employees. Over 95% of employers conduct electronic transactions, postal transactions, the average number of input files reaches 97.5% and the return of results reaches 99% compared to the total number of files. Promote the application of information technology in the management of software use from the reception stage to the processing and return of health insurance files, ensuring a strict implementation process, controlling work progress, and shortening work processing time. In addition, the District Health Insurance has sent notices to newly established enterprises about the implementation of health insurance registration for employees by email; has directly visited enterprises to guide the procedures for health insurance registration for employees.
The settlement of health insurance and health insurance for employees is carried out by Phu Nhuan District Health Insurance to ensure accuracy and compliance with the provisions of law and the industry. The District Health Insurance regularly coordinates with the postal sector and the People's Committees of 15 wards to effectively pay health insurance benefits to subjects in full, timely and on time. As of October 31, 2018, the number of people participating in health insurance in the District is:
-The number of new employees participating in health insurance increased by 3,216 employees, reaching 97.16% of the assigned target of 3,310 employees.
-The number of people participating in family health insurance in the area is 57,065 people, reaching 101.52% of the assigned target of 56,208 people.
-Yes, 31/31 schools in the area registered to participate in health insurance for 25,290/26,604 students, reaching a rate of 95.06%.
Table 2.1: Total number of people participating in health insurance in Phu Nhuan district from 2009 to 2019
Year
Total number of participants | Rate (%) | |
2009 | 77,375 | 44.3 |
2010 | 108,291 | 63.3 |
2011 | 112,435 | 63.5 |
2012 | 116,082 | 64.5 |
2013 | 118,188 | 65.4 |
2014 | 122,170 | 65.8 |
2015 | 133,636 | 66.8 |
2016 | 146,162 | 75.4 |
2017 | 156,996 | 81.1 |
2018 | 172,708 | 85.45 |
2019 | 165,000 | 89.9 |
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Source: Phu Nhuan District Health Insurance, 2019
Thus, it can be seen that the number of people participating in health insurance in the District has continuously increased over the years, currently reaching over 89.9%.
Not only increasing in quantity, the subjects participating in health insurance in the district also increased and diversified. As of November 5, 2018, the number of new employees participating in health insurance was 3,420/3,310, reaching a rate of 103.32%. The district health insurance sent a notice to more than 700 newly established enterprises about registering for health insurance for employees by email. Results: 263 units with fake email addresses, 03 units participating in health insurance elsewhere, 20 units not employing workers, more than 400 units did not reply to emails. The district health insurance directly went to 120 enterprises to guide the procedures for registering for health insurance for employees. Results, more than 68 enterprises did not hang signs, did not operate at the place of registration; 19 enterprises have participated in health insurance elsewhere, 22 units are still operating but can be contacted, 11 units are operating (but only 5 enterprises employ workers). By December 31, 2019, the number of newly participating employees