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Last updated: Tuesday, December 11, 2018

 

Ensuring Benefits of the Insured Is always an Ultimate Goal

Posted: Monday, November 26, 2018


In the past time, the public has paid much attention to the Health Insurance Fund’s surplus of nearly VND39 trillion (US$1.7 billion) and raised concern whether interests of health insurance policyholders are tightened to result in the surplus. To help provide readers full information about this issue, out reporter has an interview with Mr Dao Viet Anh, Deputy General Director of the Vietnam Social Security (VSS). Tue Anh reports.

Could you tell exactly whether the Health Insurance Fund had a surplus of VND39 trillion (US$1.7 billion) in 2017?
First and foremost, in any case, health insurance benefits are always guaranteed in accordance with laws on health insurance, no matter the status of surplus or deficit.

Secondly, according to Article 35 of the Health Insurance Law, we must “spend at least 5 per cent of health insurance premiums for reserve funds.” So, to be exact, this surplus is the reserve fund for health insurance accrued since previous years of enforcing the Law on Health Insurance till the end of 2017.

Thirdly, in designing health insurance policies in many countries as well as in Vietnam, the Health Insurance Fund is needed to ensure the sustainability of health insurance policies and guarantee sufficient payments for risks of emerging natural disasters and epidemics. In Vietnam, the reserve fund for medical examination and treatment is very important because we need resources to pay for medical services in case tariffs increase according to the roadmap in addition to paying off risks of natural disasters and epidemics.

Finally, in fact in 2017 and in the past few years, we overpaid health insurance funds and we had to use the reserve fund to offset. If medical costs are not well controlled and the health insurance fund is insufficient, health insurance premiums will be revised up and this will affect people’s incomes, enterprises’ capabilities, State budget balance and the country’s competitiveness. In my view, the reserve fund must be inclusive, taking into account annualised medical tariff rising trends, medical expenditures (about VND90 trillion) and the level of overspending of the Health Insurance Fund. If the fund is not economically and effectively managed, the current reserve fund will no longer be available in a short time.

There are concerns that the surplus of the Health Insurance Fund - a short-term fund - will affect rights and interests of health insurance policyholders. Would you be kind enough to explain this?
I must affirm that there is no such thing because, under the law and according to consistent guidance of the Government, competent authorities and the Vietnam Social Security (VSS) must effectively manage and use the Health Insurance Fund and must ensure more rights and interests for health insurance policyholders. In all cases, ensuring the best interests of the insured is always defined as the ultimate goal of the Health Insurance Fund; ensuring benefits for the insured is the sole purpose of the Health Insurance Fund.

In fact, benefits of health insurance policyholders are fully guaranteed in accordance with the law. If not fully compliant, it will be severely punished. In the past years, medically insured patients are paid medical expenses by the Health Insurance Fund and the value has been on the rise year after year. In 2017 alone, social insurance agencies paid over VND88 trillion to nearly 170 million insured patients, with many paid huge coverage.

Finally, I want to reiterate that, at the current growth rate of medical service costs, medically insured expenditures rose 1.8 fold. Without good management of medical costs, the reserve fund will soon no longer available and this will impact people, businesses and society.

In addition, it is said that health insurance policies are inclined to low-cost health with poor drug list. What do you think about this?
I think we must move towards an advanced, modern, equitable health service based on the development of basic social health insurance (ensure that basic healthcare needs are available to all and basic health packages paid by the Health Insurance Fund as defined in the Law on Health Insurance) and the development of supplementary health insurance (for those who wish to receive higher benefits, enjoy on-demand medical services and choose physicians.

According to many international organisations, Vietnam is among countries with best health insurance policies in the world. Our health insurance premiums are currently only around US$30 - 40 per person a year while Vietnam's health insurance portfolio includes more than 1,000 drug types, more than other countries (averaging 700 types) beside thousands of technical services, including many expensive high-tech services paid by the Health Insurance Fund (in 2017, nearly 170 million insured patients were covered, with many claiming and getting huge sums of money a year). For that reason, it is not right to say that we are inclined to low-cost health cares with a poorer portfolio of drugs and services.

Once again, we very much hope that media agencies will further communicate the rights, obligations and humanity of our ongoing universal health insurance policies to help people fully understand this.

Thank you very much!








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