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Remove the legal troubles between social insurance and the health sector in Vietnam

The health sector is currently one of the hottest fields in Vietnam. Not only is the infrastructure still weak, unable to meet the demand of the large population of one of the most populous countries in Southeast Asia in particular and even in the world in general, but currently, the complicated legal aspects of social insurance and health insurance in Vietnam also make many people hesitate to put their trust in this system. Thereby, in order to solve this problem and improve the health sector and thereby the lives of the people and the country, we need to remove the legal troubles between social insurance and the health sector in Vietnam.

The health sector in Vietnam is inherently a difficult problem to solve, even after many generations of continuous improvement and development efforts, however, apart from the objective problem of the large population due to the situation of ‘too many people but too little land to live’ causing the medical facilities to be overloaded, there are still many other problems seen from many different angles that make Vietnam’s healthcare sector still sluggish and unable to develop as strongly as other countries in the region.

The medical industry in Vietnam

Recently, on the morning of May 18, 2022, The Vietnam Investment Review Newspaper organized a seminar program with the theme “Strengthening public-private partnership for sustainable healthcare transformation”. The program has attracted the participation of a large number of guests who are leading experts from the Ministry of Health, the Ministry of Planning and Investment, international organizations, and business representatives in Vietnam and abroad.

Thereby, as one of the leading law firms in Vietnam and internationally, ASL LAW Firm also received an invitation from Vietnam Investment Review to attend the seminar.

During the seminar, a study showed that Vietnam currently has a long list of 63 PPP projects related to the health sector.

Although the number of medical PPP projects is large, which should show the importance and focus of the development of the Vietnamese government on the health sector, in reality, this is not true at all. 

Because this large number only shows poorly planned projects, not highly applicable. Therefore, out of 63 projects, only a very small percentage is expected to be implemented in reality.

Not only in terms that the projects to develop the infrastructure of the health sector in the short, medium and long term need to be improved, but the legal provisions in the current Vietnamese law are still also highly complicated, not transparency, is also one of the main reasons that suppress the development of Vietnamese healthcare system.

Conflicts about ordered machines and borrowed machines in the current social insurance policy

In recent times, hospitals, medical facilities, and patients and patients’ family members can’t help but have a headache when competent authorities such as the Ministry of Health and Vietnam Social Security are constantly “kicking back and forth” with each other the official documents related to the payment of health insurance for technical services on borrowed machines and ordered machines located at hospitals.

In fact, most hospitals across the country are using machines ordered or borrowed from bid-winning companies for chemical supplies instead of purchasing the equipment themselves.

Thereby, according to conflicting dispatches of the Ministry of Health and Vietnam Social Security, hospitals will have to stop or continue to allow health insurance to cover the cost of tests performed on these borrowed and ordered devices.

Specifically, Official Dispatch No. 2348 of the Ministry of Health was issued to annul Official Letter 2009/BYT-KH-TC dated April 12, 2018, on payment of technical services using borrowed and ordered machines. The winner of the bid for materials and chemicals ordered has been issued. However, according to many experts, this is just an administrative procedure and does not affect the payment of health insurance.

The payment of health insurance for technical services using borrowed machines and machines ordered by other units for materials and chemicals is still carried out normally according to Notice No. 1039/TB-BYT-BHXH approved by the Ministry of Health and Vietnam Social Security and implemented according to the instructions in Official Dispatch 6807/BYT-BH dated November 9, 2018, of the Ministry of Health.

Remove the legal troubles between social insurance and the health sector in Vietnam
Remove the legal troubles between social insurance and the health sector in Vietnam

Basically, Official Letter No. 2348 of the Ministry of Health will still allow people to use health insurance cards to pay for machines that are ordered or borrowed for medical examination and treatment.

However, the problem is the official letter No. 1261 of the Vietnam Social Security – the unit that decides whether to pay for health insurance or not. Specifically, according to the official letter of the Vietnam Social Insurance, all hospitals must stop paying according to the health insurance regime for the cost of technical services from borrowed or ordered machines, which was issued shortly after the Official Letter 2348 of the Ministry of Health.

As mentioned above, because Vietnam Social Security is the agency that decides the payment of money for services, it is impossible for hospitals to disobey the direction of Vietnam Social Security, otherwise, they will not be able to pay for the costs of testing from the borrowed and ordered machines and have to bear those costs themselves, which is impossible (Ho Chi Minh City alone, according to research, has about VND 4 billion in testing costs from 412 medical examination and treatment facilities from machines ordered and borrowed for 1 day – Multiply this number for all cities with medical facilities using ordering machines, borrowing machines will achieve astronomical numbers).

Accordingly, medical facilities, between Official Letter 1261 of the Vietnam Social Security Administration and Official Letter 2348 of the Ministry of Health, will have to comply with Official Letter 1261 and require people to use services from ordered or borrowed machines to pay the costs.

Consequences of not uniformly promulgating legal regulations

Over the past 10 years, the Ministry of Health and Social Security of Vietnam has repeatedly adjusted and changed policies related to borrowed machines, ordered machines in particular, and other health-related policies in general. Up to now, even though more than a decade has passed, Vietnamese people still have a headache about the complicated cases regard to the price of chemicals, materials used for borrowing machines, ordering machines, service costs, etc.

Not only do patients have to pay out-of-pocket every day to receive test results from borrowed or ordered machines, but overlapping regulations can have far more serious consequences.

Specifically, the consequences of this can even lead to all hospitals stopping all tests on borrowed machines, which means that the hospital will stop working because there are not enough paraclinical, affecting the patient’s health and life until there is a clear dispatch instructing the steps that needed to be taken, the regulations that must be followed consistently among the competent authorities.

Obviously, patients can’t wait until there is a written agreement to get sick and go for treatment. Just stopping testing, and ‘powering off’ the system for 24 hours alone will have immeasurable consequences for society, losing not only money, and time but also people’s lives.

Thereby, the ASL LAW Firm suggested that the ministries and sectors when issuing official documents on the change of practice should first discuss and agree with each other so as not to make it difficult for the departments below and especially, the promulgated regulations that have a substantial impact on people’s lives need to be considered extra carefully.

In addition, if the stopping of payment of testing costs, specifically the services and techniques from borrowed or ordered machines, is inevitable, there should be a thorough schedule for a definite time, possibly 3, 6, or 12 months instead of completely imposing immediate change, leaving the underlying agencies unable to respond in time.

ASL LAW is the top-tier Vietnam law firm for Employment and Labor Law. If you need any advice, please contact us for further information or collaboration.

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