Health ministry proposes 100% insurance coverage for cancer, strokes under new amendments

A paediatric patient receives care using modern equipment at the Maternity and Paediatrics Hospital in Vĩnh Phúc Province. VNA/VNS Photo Nguyễn Thảo

HÀ NỘI — The Ministry of Health (MoH) has unveiled a proposal in its latest draft amendment to the Law on Health Insurance (HI) that would provide one hundred per cent coverage for patients diagnosed with rare and serious illnesses, including cancer, stroke and paralysis.

This proposal, part of a broader set of amendments, is currently open for public consultation until October 12.

The amendments aim to adjust HI benefits to better align with contribution levels and healthcare needs.

Under the new policy, certain patients would receive full coverage for medical examinations and treatments without needing to follow the usual procedures or obtain referrals between HI-affiliated healthcare facilities.

Patients diagnosed with rare or serious conditions, or those requiring complex surgeries or advanced medical techniques, would be allowed to seek treatment directly at higher-tier specialised healthcare facilities.

The ministry believes that this policy could reduce unnecessary expenses for the HI fund by cutting down on repeated lower-level consultations and reducing the overall number of medical visits. This would not only streamline the treatment process, but also save patients the cost of travel and payments for higher-level care.

MoH has identified 42 conditions, including cancer, coronary artery surgery, stroke, hearing loss, Parkinson’s disease and paralysis, that would qualify for this expanded coverage. Patients with these conditions would bypass the standard HI procedures while still receiving maximum coverage within the eligible range.

However, the Health Insurance Department clarified that this does not mean HI will cover all treatment costs indiscriminately. Coverage will still be subject to the payment rates defined by the current HI law, which range from 80 per cent to 100 per cent depending on the case.

For example, patients with blood disorders or cardiovascular diseases that can only be treated at specialised facilities will no longer need a referral. They can directly access the necessary care and receive full coverage within the eligible scope.

Similarly, patients with rare and serious diseases will benefit from 100 per cent coverage without needing to follow the usual referral procedures.

The department stressed that the new coverage proposals for out-of-network patients would only apply to specific cases and conditions to prevent an overload of higher-tier facilities with patients seeking treatment for more common illnesses.

In addition to these changes, MoH has also proposed extending the age limit for HI coverage of eye conditions, such as strabismus, myopia and refractive errors, to 18 years.

Currently, HI only covers these conditions for children under six years old.

The ministry argues that these treatments are most effective for patients aged six to eighteen years and the current age limit is therefore medically inappropriate.

As of December 2023, over 93 million people in Việt Nam are enrolled in HI, representing 93.15 per cent of the population.

The quality of HI-funded medical services continues to improve. Patients now have access to modern medical technologies and effective new medications, helping many overcome serious illnesses.

The HI fund has remained balanced and is becoming an increasingly important financial resource for healthcare facilities, ensuring that HI participants are financially protected when they fall ill.

In 2023, the HI fund disbursed approximately VNĐ123 trillion (over US$4.9 billion) for medical services, eight times more than in 2009.

Over the past 15 years, the HI fund has paid out nearly VNĐ1 quadrillion ($40 billion) for medical services, establishing itself as a crucial financial resource for public health.

The scope of HI benefits, including the list of covered medications, medical supplies and technical services, continues to expand, meeting the evolving needs of participants. — VNS