Report on communication work of Dak Mil District Social Insurance; Report on results of investigation and review of poor households in Dak Mil District... and related data and documents at agencies in Dak Nong province.
In addition, closely linked to practical activities at the unit, the author combines research through relevant documents collected with field trips and interviews with people working in the industry to learn and carry out the research purpose of the topic.
6. Theoretical and practical significance
6.1. Theoretical significance
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The thesis has contributed to systematizing the theoretical basis of health insurance policy, implementing health insurance policy, and at the same time studying the experiences of some localities and drawing lessons on implementing health insurance policy that can be applied to Dak Mil district, Dak Nong province.
6.2. Practical significance
Based on the assessment of the current situation as well as the analysis of factors affecting the implementation of health insurance policy in Dak Mil district, the thesis has proposed a number of solutions to improve the implementation of health insurance policy in Dak Mil district, Dak Nong province in the coming period.
The results of this study can be used as reference material for interested people and localities with similar points to implement in practice.
7. Structure of the thesis
The thesis consists of 3 chapters, as follows:
Chapter 1. Theoretical and practical basis for implementing insurance policies
medical.
Chapter 2. Current status of health insurance policy implementation in the area
Dak Mil district, Dak Nong province.
Chapter 3. Solutions to implement health insurance policy in Dak Mil district, Dak Nong province in the coming period.
Chapter 1
THEORETICAL AND PRACTICAL BASIS OF
IMPLEMENTATION OF HEALTH INSURANCE POLICY
1.1. Related concepts on implementing public policy and health insurance policy
1.1.1. Public policy
Policies are ideas, directions, and desires that need to be aimed at and achieved (strategies or plans, even laws are just forms, means to convey and express policies). Policies are the concrete manifestation of general political lines. Based on the general political lines and political platforms of the ruling party, policies are made.
Public policy is a set of interrelated decisions issued by the State, including goals and solutions to solve a public problem in order to achieve development goals.
Public policy manifests itself in various forms such as laws, decrees, circulars, and guidelines. These are short-term policies. At a longer level, public policy manifests itself through mechanisms (management, distribution, benefits, etc.).
To date, the definition of public policy in the world is still a hotly debated topic in the research community. The first person to establish policy science was Harold Lasswell and then developed by other scholars in the US and UK. Since then, policy science has been constantly developing, gradually replacing traditional political studies, especially the integration of theoretical research and political practice. In terms of political activities, public policy is rich, so scientists have many approaches to come up with the concept of public policy. For
Although approached in many different ways, the concepts all agree that policy is a program of action of the State used to solve common problems for the benefit of community life. Thomas Dye gives a brief definition of public policy: "Public policy is whatever the State chooses to do or not to do" [32].
In our country, there are also many different views on public policy, such as: The Institute of Political Science believes that: "Public policy is a targeted action program of the subject holding or controlling public power" [31]. Also discussing public policy, according to Associate Professor, Dr. Nguyen Huu Hai: "Public policy is the result of the political will of the State expressed by a set of related decisions, including the orientation of the goals and ways to solve public problems in society [13]. According to Associate Professor, Dr. Ho Viet Hanh, the concept of public policy is understood as: "Public policy is the decisions of the subject granted public power to solve problems for the common benefit of the community" [14].
Up to now, there are many viewpoints on implementing public policy in the world, such as:
- According to Amy DeGroff, Margaret Cargo, public policy implementation reflects a complex process of change in which government decisions are transformed into programs, procedures, regulations or activities to achieve social improvements [33, p47].
- Ottoson and Green argue that public policy implementation is an iterative process in which ideas expressed in public policy are transformed into behavior, which is expressed into social action. Typically, social action is transformed from policy to achieve social improvement and is most commonly expressed in the form of programs, procedures, regulations and actions [33, p. 62].
- According to Thomas Dye, public policy implementation includes all activities designed to carry out public policies that have been adopted by the legislature. Since public policies have desired or intended effects, they must be translated into programs and projects that are then implemented to achieve a set of goals or objectives [32].
From the above perspectives, it can be understood that: Public policy implementation is the process of putting public policy into practice in social life through the issuance of documents, programs, and projects to implement public policies and organize their implementation to realize public policy goals. Policy implementation is one of the important stages of the public policy cycle; without this stage, the policy cycle cannot exist. The organization of public policy implementation is the center that connects the steps in the public policy cycle into a system, especially with policy planning. Compared to other stages in the policy cycle, the organization of implementation has a particularly important position, because this is the step of realizing policies in social life.
According to Wayne Hayes, the process of implementing public policy has 4 possibilities: (1) Good public policy and good implementation lead to success; (2) Good public policy, but poor implementation leads to failure; (3) Bad public policy, but good implementation leads to success; (4) Bad public policy and poor implementation lead to double failure [34, p.1]. Thus, planning a good policy is extremely difficult and goes through many stages, but no matter how good the policy is, if it is not organized for implementation or poorly implemented, it will not be effective, will not achieve the goal and the State's reputation will be affected. From there, it helps us realize the importance of
implement public policy and actively participate in organizing the effective implementation of public policy.
1.1.2. Concept of health insurance
Born in the late 19th century, health insurance is one of the most effective measures to help people when they encounter health risks to cover some of the medical examination and treatment costs, helping to stabilize their lives and contribute to ensuring social security. Health insurance is one of the contents of social insurance stipulated in Convention 102 dated June 28, 1952 of the International Labor Organization (ILO) on minimum standards for social insurance benefits.
The concept of health insurance, according to the Vietnamese Encyclopedia (1995), "Health insurance is a type of insurance organized and managed by the State to mobilize contributions from individuals, collectives and the social community to take care of health, medical examination and treatment for people" [18, p.42].
According to the Law on Health Insurance No. 25/2008/QH12 passed by the National Assembly on November 14, 2008: Health insurance is a form of insurance applied in the field of health care, not for profit purposes, organized and implemented by the State and responsible subjects participating according to the provisions of this Law. [15, p. 2].
According to the Law amending and supplementing a number of articles of the Law on Health Insurance (No. 46/2014/QH13) passed by the National Assembly on June 13, 2014: Health insurance is a form of compulsory insurance applied to subjects as prescribed by this Law for health care, not for profit purposes, organized and implemented by the State. [16, p. 1].
Thus, health insurance is a form of mobilizing financial resources of the community, under the organization and protection of the State, implementing the principle of risk sharing, taking finance from the contributions of the majority of healthy people, compensating and assisting in paying hospital fees for a small number of participants who are unlucky enough to fall ill or go to the hospital.
Health insurance is both social in nature because it is a type of insurance for social security purposes, demonstrating state assistance and community support.
However, health insurance also has economic elements in the economic-health category. Health insurance is necessary for everyone, it is a tool to ensure basic human social security rights, is the sharing of risks among people in the community, creates fairness in medical examination and treatment, increases the quality of medical examination and treatment and medical management, contributes to reducing the burden on the State budget and on families.
1.1.3. Concept of health insurance policy
Health insurance policy is a form of insurance applied in the health care sector organized and implemented by the State and the subjects are responsible for participating according to the provisions of the Law on Health Insurance.
The goal of the health insurance policy is to achieve universal coverage, ensure health care, and access to health services in a fair and equal manner for different groups in society. Health insurance is an important financial mechanism and also a prepayment mechanism applied by countries around the world to help people avoid falling into poverty when they are sick, and to orient the development of health care for the people, contributing positively to socio-economic stability, realizing the goal of a rich people, a strong country, fairness, democracy and civilization. Health insurance is a social policy with humanistic meaning, sharing the community, which the Party and State pay great attention to and value.
1.1.4. Concept of implementing health insurance policy
Health insurance is one of the important public policies of the State for the purpose of social security, creating an important financial source for people's health care, actively contributing to stabilizing people's lives.
people, promoting socio-economic development. Therefore, from the concept of implementing public policy mentioned above, it can be understood that: Implementing health insurance policy is the process of bringing health insurance policy into social life through the promulgation of documents, programs, and projects to implement health insurance policy and organizing their implementation to realize the goals of health insurance policy, specifically the goal of universal health insurance. Health insurance policy in Vietnam began to be implemented in 1992. Article 39 of our country's Constitution stipulates that "Implementing health insurance creates conditions for all people to receive health care" which is an important legal basis for implementing health insurance policy. On August 15, 1992, the Government issued the Health Insurance Regulations along with Decree No. 299/HDBT.
After 30 years of implementing the health insurance policy, many new Decrees and Circulars have been issued to adjust and amend the health insurance policy, demonstrating the State's interest in developing health insurance, while affirming the correctness of a social policy of the State. Therefore, attracting people to participate in health insurance towards universal health insurance coverage is the goal that Vietnam pursues in line with the country's development innovation process.
Some regulations on implementing health insurance policy in our country, specifically as follows:
- Regarding the medical examination and treatment (KCB) connection, from January 1, 2016, health insurance participants who register for medical examination and treatment at any medical facility when going to district-level hospitals nationwide will enjoy health insurance benefits. Health insurance participants who register for initial medical examination and treatment at commune-level health stations or polyclinics or district-level hospitals are entitled to medical examination and treatment at these facilities within a province. This regulation creates favorable conditions for health insurance participants to choose a medical examination and treatment facility suitable for their medical condition while still having the Health Insurance Fund pay for medical examination and treatment costs.