Vietnam Health Insurance

Transcription

1 Vietnam Health Insurance

2 Architecture of HI system

3 HI Coverage expansion

4 The evolution of SHI in Viet Nam

5 Family-based subsidy (2014) The HI contribution will be reduced for every extra family member Reference wage (2016) 1,210,000 percentage of HI contribution 4.50% Maximum HI contribution per month (VND) 54,450 HI contribution Monthly State subsidy 1st member 54,450 0% 0 2nd member 38,115 30% 16,335 3rd member 32,670 40% 21,780 4th member 27,225 50% 27,225 5th member 21,780 60% 32,670

6 Who is covered and yet to be covered Already covered Formal sector workers, Children under 6 (100% subsidized) The poorest (100% subsidized) Near poor (70% subsidized, some local government 10-20% subsidized) Full-time students (30% subsidized) Social insurance pensioners (paid by employers 3% salary, employee: 1.5%) Beneficiaries of social assistance programmes (farmers, fishers with low income) To be covered near-poor, migrants, older persons who are not entitled to social assistance nor social insurance pensions, informal sector workers

7 Sources of Financing for SHI Revenues

8 Health financing mechanism Has evolved from tax-based to a mix of three main sources Government revenue infrastructure development, recurrent spending, mainly at provincial level, and social health insurance subsidies Social health insurance contributions, and Out-of-pocket payments.

9 SHI contribution to Heal expenditure low

10 SHI package Services covered Ambulatory care (examination and treatment) Rehabilitation Advanced diagnostic and curative services, regular pregnancy check-ups, birth-giving and travelling expenses from commune or district hospitals to higher-level hospitals in some cases Services not covered Medical costs covered by other sources, routine health check-up, family planning services, infertility treatment, aesthetic services, occupational diseases, work related accidents; suicide, self-harm activities, substance abuse, consequences of law violation

11 How the cost is covered The level of the costs covered by the SHI depends on the group with a variation of 100% - 95% - 80% of the total health expenditure. No co-payment charged for services provided at commune health stations (only outpatient), including child delivery services. For insured patients who bypass lower-level referral facilities, the copayments will be higher

12 Provider payment methods Capitation Mainly at district hospitals: above 60% Some provincial hospitals and equivalent: 73 (13.4%) Diagnostic-related groups (DRGs) Pilot in 02 hospitals (Hanoi) From : Pilot in one Province (based on Thai -DRG); : expand to 5 Provinces. From 2019 for all country Fee-for-service The rest

13 Challenges Enrolment rates remain low even amongst those enrolment is compulsory, such as the formal sector, and despite large increases in the partial subsidy extended to the near-poor. In 2010, when nearly 60% of the population was already enrolled, their out-ofpocket (OOP) share in health expenses was still almost 60%. High OOP payments leave households exposed to financial risk. Quality of services Issues Moral hazard in 100% subsidized group and Adverse selection in no subsidized group High administrative costs: annual card issuance; classification of HHs

14 The coverage gap Enrollment rates % population

15 OOP still high OOP share of Total Health Spending and SHI Coverage in Vietnam

16 OOP still high OOP Share of Spending in Vietnam and Other EAP Countries (2011)

17 Roap map of reforms Expanding the breadth of coverage: Substantially increase general revenue financing to subsidize enrolment for the near poor and/or informal sector; Enhance information, education and communication about health insurance to both providers and beneficiaries; Encourage family enrolment; and Enforce enrolment compliance in the mandatory enrolment group, particularly formal sector workers. - Improving equity and financial protection - Strengthen implementation of the co-payment policy, including grievance mechanisms; - Further reduce or waive co-payments for the poor and vulnerable groups such as ethnic minorities; and - Introduce catastrophic cost coverage.

18 Roap map of reforms Strengthening health financing arrangements for Social Health Insurance (SHI) Generate additional revenues by raising tobacco taxes and gradually increasing the premium contribution rate; Rationalize and cost out the benefits package; Reduce inefficiencies arising from the current mix of provider payment mechanisms; and De-fragment the procurement of and payment for pharmaceuticals. Strengthening Organization, Management and Governance of SHI Define the objectives of UC more clearly, and revise and define the roles and mandates of key agencies; Strengthen the organization of SHI by putting in place a specialized SHI Division and eventually SHI Agency; Strengthen SHI management arrangements Strengthen SHI governance and accountability by clearly specifying financial accounting arrangements, conflict resolution arrangements and penalties.