Implementing health insurance policy in Dak Mil district, Dak Nong province

INTRODUCTION

1. Urgency of the topic

Health insurance policy (HI) is one of the pillars of social security (SSS) demonstrating the role and responsibility of the State in protecting and taking care of people's health. Being communal, sharing risks, helping each other overcome difficulties and misfortunes due to illness creates solidarity, mutual love and affection. HI is a prepayment mechanism applied by most countries in the world to help people not fall into poverty when they are sick. HI is a development orientation in people's health care, actively contributing to stabilizing the socio-economy, realizing the goal of a rich people, a strong country, democracy, fairness and civilization. HI has affirmed the correctness and suitability with the process of national renewal of the SSS policy of our Party and State over the past 30 years. HI also contributes to creating fairness in medical examination and treatment, people are increasingly aware of the necessity of HI as well as their responsibility to the community and society. The majority of social insurance participants, retirees, disabled people, social policy beneficiaries and a part of the poor feel more secure when they are sick and ill because they have a reliable support from the Health Insurance Fund. Up to now, the superiority and legal system on health insurance as well as on medical examination and treatment and health insurance payment have been increasingly improved.

Implementing the Party's renovation policy, our country has transformed the centralized bureaucratic subsidy mechanism into a socialist-oriented market mechanism under the management of the State. The innovation of the economic mechanism has impacted and influenced all areas of social life, including the health care sector. The birth of the health insurance policy to meet the increasingly better health care needs of the people is an indispensable factor in the social security policy of our Party and State.

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Vietnam has implemented the health insurance policy since 1992 and the goal of universal health insurance has been affirmed in the Party's Resolutions and the State's legal documents, aiming at the goal of a fair, effective and quality society in health care for the people, and the community sharing the risk of financial loss of each individual when sick. Therefore, it is essential to expand the coverage of this system, so that all people can participate in health insurance.

However, after 30 years of implementation, it shows that most of the people participating in health insurance are only officials, civil servants, workers and a part of the community (the number of people with health insurance cards accounts for 71% of the country's population). This shows that it is not easy for the whole population to participate in health insurance. Up to now, some people have not seen the important role of health insurance, and thus voluntarily participate. The organization and implementation of health insurance policies by relevant agencies such as social insurance agencies, medical facilities, etc. still have many shortcomings, and health insurance participants have not been able to use health services conveniently and appropriately. These limitations are due to many different subjective and objective reasons, but one of the main reasons that has been creating a huge barrier to the process of implementing the goal of universal health insurance is that the policies, laws on health insurance and the management mechanism for implementing health insurance policies still have many problems that are not suitable to reality, in which on the one hand, the living standards of the community are not high, on the other hand, some people lack understanding of the benefits that health insurance brings.

In general, the process of implementing the health insurance policy has initially achieved positive results in localities across the country and Dak Mil district, Dak Nong province is no exception. By developing a plan to implement the policy; disseminating and propagating the policy; assigning coordination in implementing the policy; maintaining and adjusting the policy; monitoring,

Urging, checking the implementation of policies and summarizing and evaluating, the health insurance policy has shown that this issue is of great concern to the locality.

Implementing the objectives of Action Program No. 27-CTr/HU dated May 29, 2013 of the Standing Committee of Dak Mil District Party Committee, Dak Nong Province on the implementation of Resolution No. 21-NQ/TW dated November 12, 2012 of the 11th Politburo on strengthening the Party's leadership over social insurance and health insurance for the period 2012-2020. Expanding health insurance coverage for target groups so that by 2020, over 90% of the population will participate. In reality, the target group that already has health insurance is mostly salaried employees, social welfare beneficiaries and social allowance recipients. When there are changes in the State's policy mechanism, maintaining health insurance participation is not sustainable. The remaining group of subjects participating in household health insurance accounts for 50% of the population, with about

51,000 people, self-pay to buy health insurance cards at a limited level and have not been able to maintain this group of subjects in participating in insurance. One of the main reasons is that the implementation of health insurance policies in the area in the past has had many shortcomings, especially the problem of awareness of a part of the people, with the mindset of relying on the State; the capacity of officials directly implementing health insurance policies is still limited... Therefore, the problem requires all levels and sectors in Dak Mil district to have effective solutions to raise awareness, change behavior, and voluntarily participate in health insurance for the health of themselves, their families and the community [12, p.1].

Dak Mil District Social Insurance, as the agency implementing social insurance and health insurance policies in the district, is fully responsible to the District Party Committee, People's Council, and District People's Committee for expanding the health insurance coverage rate; organizing implementation; and developing health insurance participants. Therefore, it is necessary to have a scientific assessment from the approach.

of public policy science on the implementation of health insurance policy in the district as a basis for implementing tasks for the next phase.

In that context, the topic "Implementation of health insurance policy in Dak Mil district, Dak Nong province" was chosen as the topic of the Master's thesis in Public Policy to systematically evaluate the theoretical basis and the current status of the implementation of health insurance policy in the past time, point out the achievements, the limitations and propose solutions to improve the health insurance policy in Dak Mil district. This is a topical topic, urgent in terms of theory and practice.

2. Research status related to the topic

The Health Insurance policy in Vietnam was established in 1992. After more than 30 years of implementation, the Health Insurance policy has been constantly changing to suit the development needs of the country. Creating favorable conditions for people to participate and enjoy benefits during the medical examination and treatment process. Many projects, proposals, and topics have been researched and published, such as:

- The book "Propaganda documents on the implementation of Resolution 21-NQ/TW dated November 22, 2012 of the Politburo" was compiled and published by Vietnam Social Security in 2013. The book summarizes the basic contents of Resolution 21-NQ/TW, summarizes the main results through the implementation of the Social Insurance Law and the Health Insurance Law, from which the book clarifies the limitations and shortcomings in the implementation of the two above-mentioned Laws. The book also provides a number of guiding documents, programs, and plans for the implementation of the Resolution so that reporters and collaborators of Social Security in provinces and cities have propaganda documents about the Resolution for target groups.

- Professor Pham Tat Dong and Dr. Dam Viet Cuong in the book "Hospital fees, health insurance and use of health services" (2002) in the Vietnam - Sweden health cooperation program. The article analyzes the impact of hospital fees.

and health insurance for equitable access to health care services, thereby providing solutions to ensure social equity and effectiveness in public health care in the coming time.

- Project "Assessing the operation of the Social Insurance and Health Insurance Funds, calculating and forecasting the balance of the Social Insurance and Health Insurance Funds to 2020 and a vision to 2030" (2011). This is a major project with the coordination between Vietnam Social Insurance, the Ministry of Labor, War Invalids and Social Affairs, the Ministry of Health, the Ministry of Finance, the Government Office and the General Statistics Office implemented in 2011, chaired by Dr. Do Van Sinh. Regarding health insurance, the project has made quite comprehensive and realistic assessments of the operation of the health insurance fund through the stages since health insurance was implemented in our country. In the recent period, the research project has confirmed the achievements and limitations of the health insurance fund's operations, thereby providing accurate assessments of the operation of the health insurance fund and forecasting the balance of the health insurance fund to 2020, a vision to 2030.

- The topic " Health insurance in the social security system. Some current theoretical and practical issues " by author Trinh Hoa Binh and the research team mentioned health insurance in the social security system, implementing social welfare policies and some mechanisms to ensure fairness in health care. In addition, the research team also analyzed the access to health insurance services of disadvantaged groups in society and changes in health insurance policies, the need to participate in health insurance of different subjects.

- Associate Professor, Dr. Dang Nguyen Anh, who is the head of the project "Factors determining the ability to participate in health insurance in Vietnam", has studied the current status of health insurance in the world and in Vietnam. The factors determining the ability to access health insurance of some specific groups of people such as the poor in rural areas, migrant workers from rural to urban areas and urban cadres and civil servants are very different in terms of occupational characteristics and advantages, economic resources and capital.

society. Comparing the level of access to health services of the three groups above has clarified the decisive factors in the ability to access health services. Based on the research results, the topic points out some orientations and policies to improve the coverage of the health insurance program in Vietnam.

- Pham Dinh Thanh, Luu Thi Thu Thuy (2013), “Basic solutions to move towards implementing universal health insurance” , AMBN.vn. This is a scientific research topic that addresses some basic theoretical issues on health insurance. The two authors introduced the health insurance models of some countries in the world and proposed basic solutions to move towards implementing universal health insurance.

- Do Ngan Binh with the article " Improving the law on Health Insurance in Vietnam today " in the Journal of Law No. 1/2008 focused on a general assessment of the promulgation and implementation of regulations on Health Insurance in Vietnam, thereby identifying a number of basic groups of solutions to improve the law on Health Insurance, improving the effectiveness of applying these regulations in the health care of all people in Vietnam.

- Dao Van Dung with the article " Implementing the health insurance policy in our country: Achievements, challenges and solutions ", Propaganda Magazine, No. 8/2009 mentioned the system of organization and health insurance policy; the subjects participating in health insurance are increasingly expanded and increased in number; the rights of health insurance participants are increasingly more complete; the organization of medical examination and treatment (KCB) and payment of health insurance costs are increasingly more appropriate; the revenue and expenditure of the health insurance fund increase gradually every year; analyzed some shortcomings in the implementation of the health insurance policy, from which the author proposed some solutions to overcome and gradually improve the health insurance policy, improve the quality of health insurance examination and treatment, meet the increasingly high and diverse needs of health insurance card holders.

- Nguyen Thi Kim Hoa and Mai Linh with the article "Current status of people's use of health insurance cards" , Journal of Sociology, No. 2 (130) 2015. Authors

shows the differences in health care habits and the use of health insurance cards between urban and rural areas, thereby proposing some solutions to help improve the quality of health insurance care to motivate people to participate in health insurance.

Through research works on health insurance and implementation of health insurance policies from different perspectives and different agencies and units as well as articles related to the research topic, it shows that this is the basis for being able to refer to and inherit existing research results, at the same time having a more comprehensive view of health insurance policies and current implementation of health insurance policies, which can be applied in researching related topics.

However, up to now, there has been no research project discussing the implementation of health insurance policy in Dak Mil district, Dak Nong province. This is considered a research gap that needs to be studied from the perspective of the Public Policy sector, so the topic "Implementation of health insurance policy in Dak Mil district, Dak Nong province" is not duplicated and is very necessary to assess the current situation, difficulties as well as propose solutions suitable to reality, contributing to improving the effectiveness of local authorities in implementing health insurance policy to create better conditions for policy beneficiaries.

3. Research purpose and tasks

3.1. Research purpose

Based on the systematization of theoretical and practical foundations of health insurance policy, the thesis assesses the current situation and proposes solutions to implement health insurance policy in Dak Mil district, Dak Nong province in the coming period.

3.2. Research tasks

- Systematize theoretical and practical basis of health insurance policy.

- Assess the current status of health insurance policy implementation in Dak Mil district, Dak Nong province.

- Proposing solutions to implement health insurance policy in Dak Mil district, Dak Nong province in the coming period.

4. Research object and scope

4.1. Research subjects

Focus on researching the implementation of health insurance policy in Dak Mil district, Dak Nong province.

4.2. Scope of research

- Spatial scope: Dak Mil district, Dak Nong province.

- Scope of content: research on the implementation of health insurance policy in Dak Mil district, Dak Nong province.

- Time scope: 2015 - 2020 period and solutions to 2025.

5. Theoretical basis and research methods

5.1. Theoretical basis

The thesis is researched on the basis of the methodology of dialectical materialism, historical materialism and the viewpoints of Marxism-Leninism.

5.2. Research methods

To clarify the research objectives, the author uses various synthetic research methods such as: comparison, analysis, description, and combines theoretical research methods with current situation analysis.

The thesis was conducted through desk study method. At the same time, secondary documents were used such as: Socio-economic development report of Dak Mil district; Report on results of social insurance and health insurance work in Dak Mil district; Summary report on health insurance work for students in Dak Mil district;

Implementing health insurance policy in Dak Mil district, Dak Nong province - 2

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