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| Patients with health insurance cards are treated at Thong Nhat General Hospital. Photo: H. Dung |
This is considered a breakthrough in expanding access to health services and ensuring equity in health care, towards universal health insurance.
Eliminate administrative boundaries in medical examination and treatment
According to the new regulations, the groups of subjects that will enjoy 100% of the health insurance benefits when examining and treating patients outside the prescribed medical facilities include: people who are examined and treated at basic or specialized facilities and are diagnosed to treat certain serious diseases, rare diseases, requiring surgery or high techniques according to regulations of the Ministry of Health ; ethnic minorities and people from poor households living in difficult or extremely difficult socio-economic areas, people living in island communes and island districts when receiving inpatient treatment at specialized facilities; people with health insurance cards who are examined and treated at primary facilities and treated at basic facilities; basic and specialized medical facilities that have been identified by competent authorities as district-level before January 1, 2025; inpatient treatment at specialized medical facilities identified as provincial-level before January 1, 2025.
62 types of critical illnesses and rare diseases as prescribed by the Ministry of Health such as: infectious diseases, cancer, metabolic syndrome, lysosomal storage disorders, neurological, cardiovascular, pulmonary, skin diseases, congenital malformations and special conditions such as anti-tuberculosis drug resistance, war sequelae, or organ transplant conditions...
People with one of the above diseases, once diagnosed at the initial level, can go directly to a specialized facility for medical examination and treatment without needing a referral letter as before.
If the patient goes to a specialist for examination and is diagnosed with the above diseases, he/she will also receive 100% of the health insurance benefits.
In Dong Nai , health insurance facilities are divided into 3 professional levels. The initial level includes health care facilities without inpatient treatment, commune health stations, regional polyclinics, and private polyclinics. The basic level includes general hospitals, specialized hospitals, regional polyclinics, medical centers with beds, and private hospitals. The specialized level includes Dong Nai General Hospital and Thong Nhat General Hospital.
People highly agree
Ms. NTT (breast cancer patient, residing in Trung Dung ward, Bien Hoa city) said that she initially bought her health insurance card at a private hospital. Previously, if she wanted to go to a specialist hospital for treatment, she had to go through complicated transfer procedures, which took a lot of time, effort and money. Sometimes when the wait was too long, she chose to go for a service examination and had to pay a much higher amount than what was covered by health insurance. Ms. T. is very happy with this new regulation.
In addition to the above regulations, from July 1, 2025, health insurance participants will also be paid for the costs of remote medical examination and treatment; remote medical examination and treatment support; family medicine medical examination and treatment; medical examination and treatment at home; rehabilitation, periodic pregnancy check-ups, childbirth; costs of transporting patients between medical facilities (previously only paid for transportation from district level to higher level). Costs of medical technical services, drugs, equipment, blood, blood products, medical gases, supplies, tools, instruments, chemicals used in medical examination and treatment; costs of treating strabismus and refractive errors of the eyes for people under 18 years old will now also be paid by the fund (current regulations only pay for children under 6 years old).
Health insurance participants are entitled to 100% of the cost for one medical examination and treatment lower than the level prescribed by the Government. According to regulations, the cost for one medical examination and treatment covered by 100% health insurance is lower than 15% of the basic salary. Currently, the basic salary is 2.34 million VND. Thus, health insurance participants will be entitled to full health insurance costs in case the cost for one medical examination and treatment is lower than 351 thousand VND.
To enjoy 100% of medical examination and treatment costs from July 1, health insurance participants need to ensure the following requirements: having participated in health insurance continuously for 5 years or more (interruption of no more than 3 months); having the total amount of co-payment in the year exceeding 6 times the reference level.
Currently, the current basic salary is 2.34 million VND. Therefore, people who have participated in health insurance for 5 consecutive years or more must have an amount of medical examination and treatment expenses paid in the year greater than 14.04 million VND (i.e. 6 months of basic salary).
Hanh Dung
Source: https://baodongnai.com.vn/xa-hoi/y-te/202506/tu-ngay-1-7-tang-quyen-loi-cho-nguoi-tham-gia-bao-hiem-y-te-c2215b0/
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