Realising the Party and State’s policy on health insurance, on September 1^st, 2015, the Government issued Decree No.70/2015/ND-CP on “stipulating in detail and instructing the implementation of some articles of the Law on Health Insurance concerning people working for Vietnam’s People’s Army (VPA), People’s Public Security and Cryptographical sector.” Right after this promulgation, the Ministry of National Defence (MND) seriously perceived and directed the execution of the law through steps commensurate with the Government’s plans. Accordingly, medical care for active military personnel (hereafter referred to as military personnel) in the form of health insurance will be initially conducted from January 1^st, 2016 in several units. Finally, this policy will be applied to every military personnel from January 1^st, 2018, which is 2 years earlier than the Government’s plan.

In response to the MND’s instruction, units have taken comprehensive measures with the aim of realising the policy on health insurance for military personnel. Many items of medical care are dealt with in a better and more timely manner, which serves to substantially reduce expenditures, time, energy, and so on. In fact, this is a sound guideline, which is congruent with our country’s development trend and the VPA’s demands and missions in peacetime. According to regulations of the Law on Health Insurance and other relevant documents, once having participated in health insurance, the military personnel are entitled to register medical care at any medical facilities nationwide. The military personnel’s health insurance premiums is taken from the state budget. The Military personnel are covered 100% of the costs of medical care, including those not within the ambit of health insurance and covered by the health insurance fund. In addition, 10% of the total health insurance premiums will be transferred to units (up to regimental level) by the social insurance in order to fund medicine, dressings, chemicals, medical equipment, and technical services dedicated to soldiers’ initial health care.

Military personel now can go to any hospitals at their convenience

Providing health insurance-covered medical care for military personnel represents a new issue, which does not change the nature and content of protection and care of soldiers, but changes the regimes and procedures of medical care, especially the financial regime and source of finance available for medical care for military personnel (a shift from the defence budget to health insurance fund).

From the financial perspective, the development of estimates of military personnel’ health insurance premiums, transfer to the MND’s Social Insurance, and allocation of 10% of the premiums to units have been carried out as regulated in recent times. In spite of concurrently serving two beneficiary groups, hospitals and infirmaries have strictly managed the costs of medical care for military personnel who have or have not participated in health insurance. The budget for health insurance-covered medical care has been separate from defence budget to prevent duplication. Those outcomes have contributed to maintaining stability in medical care for soldiers.

However, since this policy is implemented for the first time in the VPA, there remain several shortcomings during its execution. The payment of health insurance premiums and transfer of 10% of that money to units have been slow at some time and in some places. The ambits and items of spending 10% of health insurance premiums do not match the reality of medical care for military personnel in units.

Another weakness is that regulations on payment and final settlement of expenses of medical care for military personnel have not been fully realised due to differences between medical facilities and the social insurance institution. Consequently, a number of expenditures of medical care are refused by the social insurance institution, causing difficulty for medical facilities. This requires the medical facilities to devote more time and energy to explanation, which will result in late settlement of expenditures and hesitation in providing military personnel with health insurance-covered medical care. Even when the medical facilities directly collect money paid by military personnel, they are not fully entitled to the Party and State’s preferential policy.

Furthermore, the reduction of budget expenditures, or refunds to upper-level budget regarding expenditures falling within the ambit of health insurance fund has shown several limitations. In principle, salaries and special allowances of officials and physicians have been included in the prices of health insurance-covered medical care services. Nevertheless, because current military hospitals and infirmaries have not applied the self-financing regime yet, these expenditures are still covered by the defence budget. Therefore, to avoid duplicated payment in salaries, allowances and other expenditures, the hospital and infirmaries have to consider reducing final accounts or refunding the upper-level budget regarding the aforementioned expenditures. In fact, the management of salaries, allowances, etc., which is designed in the costs of health insurance-covered medical care services to cut down on final settlement or refund the upper-level budget in hospitals and infirmaries, has not been strictly realised yet. Health insurance-covered expenditures have not included every medical care service, which will serve as the basis for reducing final settlement or refunding the upper-level budget.

Apart from the above-mentioned shortcomings, the current execution of health insurance policy witnesses some issues, which have influence on the base budget of medical institutions in general and military hospitals and infirmaries in particular. These issues consist of the social insurance institution’s allocation of health insurance cards, application of multiple-line payment ceilings, incorrect calculation of prices of health insurance-covered medical care services, etc., making it difficult for these hospitals and infirmaries to balance revenues from health insurance, especially the small-scale ones.

To successfully implement the policy on health insurance-covered medical care for military personnel to contribute to improving the VPA’s combat strength and carry out the Party and State’s plan for all-people health insurance, functional agencies, first and foremost the Military Medicine, Military Finance and the MND’s Social Insurance, need to proactively study and work out solutions to overcome difficulties and timely recommend amendment and supplement of regulations on the management and use of military personnel’s health insurance premiums in accordance with reality and military specificity. On other hand, they also have to promote cooperation with relevant agencies of Vietnam Social Insurance to scrutinise and completely address inadequacies and emerging issues in this field. In the immediate term, it is necessary to study and recommend amendment with a view to widening the ambit and items entitled to the 10% of health insurance premiums in units to ensure a comprehensive cover for military personnel’s initial medical care. They also have to take initiative in coordinating with Vietnam Social Insurance and social insurance at provincial and municipal levels to review and supplement regimes for payment and final settlement of military personnel’s health insurance; and reach consensus on resolving the expenditures in excess of the cap and the provision of drugs and medical supplies not in the list of health insurance, ensuring military personnel’s access to medical care in every medical facilities. At the same time, the military medicine, military finance and the MND’s Social Insurance need to develop and perfect a system of documents guiding the procedures of payment and final settlement, and supervision, inspection and examination of the use of medical insurance fund.

As far as medical facilities in the military are concerned, it is imperative to strengthen leadership and instruction on the implementation of the policy and law on health insurance. Particularly, special attention should be attached to training and appointing cadres and staff who are competent to perform medical care and manage health insurance premiums. It is important to invest in medical equipment; apply information technology to the management of health insurance premiums, payment and final settlement of medical care expenditures; strictly calculate expenditures embedded in the costs of health insurance-covered medical care services to cut down on final settlement  and refund the defence budget as regulated, and so forth. Most notably, hospitals need to make significant breakthroughs in innovating management regimes and realising the self-financing regime according to the guideline of the State and MND, thus enhancing their comprehensive capabilities and effective participation in the protection and care of soldiers and people’s health in the new situation.

Senior Colonel Do Manh Hung, Ph.D, Deputy Director of the Department of Finance, Ministry of National Defence