Principles of application of information technologies in management of health insurance-covered medical services in Vietnam

Principles of application of information technologies in management of health insurance-covered medical services in Vietnam (Internet image) 

Regarding this issue, LawNet would like to answer as follows:

1. Principles of application of information technologies in management of health insurance-covered medical services in Vietnam

Principles of application of information technologies in management of health insurance-covered medical services according to Article 37 of Decree 146/2018/ND-CP are as follows:

- Comply with legislative regulations on application of information technologies; legislative regulations on health insurance-covered medical services; laws on protection of state and other relevant secrets; legislative regulations on electronic transactions, information storage and security.

- Comply with technical standards and regulations, ensure compatibility, smooth connection and safety, facilitations for electronic transactions between healthcare establishments, the Ministry of Health and social insurance agencies.

- Ensure confidentiality and privacy of medical service data and information of health insurance policyholders.

- Ensure technical infrastructure facilities, connection lines, software and personnel meet requirements concerning management of medical services, evaluation and payment of health insurance-covered medical costs.

2. Tasks and costs of application of information technologies in management of health insurance-covered medical services in Vietnam

Tasks and costs of application of information technologies in management of health insurance-covered medical services according to Article 38 of Decree 146/2018/ND-CP are as follows:

- Tasks to be performed in the information technology application process shall include:

+ Apply information technologies to medical service tasks within a healthcare establishment;

+ Apply information technologies to meet the health insurance fund management needs;

+ Apply information technologies to exercise the state management of health insurance affairs;

+ Apply information technologies to serve tasks of management of health insurance-covered medical service activities.

- Costs of application of information technologies in management of health insurance-covered medical service activities shall be subject to legislative regulations on information technology application.

3. Persons eligible for health insurance in Vietnam

Persons eligible for health insurance in Vietnam according to Article 12 of the Law on Health Insurance 2008 (amended 2014) are as follows:

(1) The group whose insurance are paid by the employers and employees, including:

- Employees on indefinite or at least full three-month contracts; salaried business managers; officials and civil servants (hereinafter referred to as employees).

- Part-time officers in communes, wards and towns under the regulations of the law.

(2) The group of the insured whose insurance is paid by the social insurance organizations, including:

- Persons receiving monthly retirement pensions and compensation for loss of capacity for work

- Persons receiving monthly social insurance pensions due to occupational accidents or diseases or diseases needing long-term treatment; beneficiaries at the age of 80 or above;

- Officers in communes, wards and towns who have left employment and been receiving monthly social insurance benefits.

- Persons receiving unemployment benefits.

(3) The group of the insured whose insurance is paid by the State budget, including:

- Commissioned officers, professional soldiers, non-commissioned soldiers on active duty; commissioned police officers and non-commissioned police officers; police students, non-commissioned police officers or soldiers on fixed term contracts; ciphers whose salaries are the same as the salaries as the servicemen; cipher students whose benefits are the same as the benefits of students in military or police academies.

- Officers in communes, wards and towns who have left employment and been receiving monthly pensions funded by the State budget.

- Persons no longer receiving compensation for loss of capacity for work and being receiving monthly pensions funded by the State budget;

- Persons performing meritorious services in the wars, war veterans;

- Incumbent deputies of the National Assembly or the People’s Councils at all levels;

- Children under the age of 6;

- Persons receiving monthly social protection pensions;

- Poor household members, ethnics living in regions facing socio-economic difficulties, persons living in regions facing extreme socio-economic difficulties; persons living in island communes or districts.

- Relatives of persons performing meritorious services in the wars such as biology parents, husbands, wives or children of revolutionary martyrs; persons rearing revolutionary martyrs;

- Relatives of persons performing meritorious services in the wars, except for the insured prescribed at point i this Clause;

- Relatives of the insured prescribed in point a clause 3 Article 12 of the Law on Health Insurance 2008 (amended 2014);

- Persons who have donated body parts under the regulations of the law;

- Foreigners studying in Vietnam that are granted scholarships funded by the Vietnam State budget.

(4) The group of the insured whose insurance are supported by the State budget, including:

- Members of households living above the poverty line;

- Students.

(5) Group of the household insured including household members except for the ones prescribed in (1), (2), (3) and (4) of this section..

(6) The government shall prescribed the insured different from the ones prescribed in (3), (4) and (5) of this section; regulate the issuance of the health insurance cards to the insured under the management of the Ministry of National Defense and the Ministry of Public Security and the insured prescribed in point 1 Clause 3 Article 12 of the Law on Health Insurance 2008 (amended 2014);

Regulate the medical insurance procedures, scope of benefits, benefit levels , medical examination and treatment covered by health insurance, management and use of the budget used for medical examination and treatment covered by health insurance, health insurance inspection, payment for health insurance of the insured prescribed in point a Clause 3 Article 12 of the Law on Health Insurance 2008 (amended 2014).

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