Decision No. 538/QD-TTg approves the Implementation Plan for the Gradual Progress towards Universal Health Insurance Coverage for the 2012-2015 and 2020 periods.

Pursuant to …;

Approving the Project on Implementing the Roadmap towards Universal Health Insurance Coverage for the Period of 2012-2015 and 2020

_____________________________

PRIME MINISTER

Based on the Law on the Organization of the Government dated December 25, 2001;

Pursuant to the Health Insurance Law dated November 14, 2008;

Considering the proposal of the Minister of Health,

DECISION:

Article 1. Approving the Project on Implementing the Roadmap towards Universal Health Insurance Coverage for the Period of 2012-2015 and 2020 with the following main contents:

I. OBJECTIVES OF THE PROJECT

1. General Objective:

Expanding the scope of health insurance coverage in terms of the proportion of the population participating in health insurance, the range of medical services enjoyed, and reducing the proportion of out-of-pocket payments for medical services; ensuring the rights of health insurance participants; moving towards universal health insurance coverage, contributing to creating a stable financial source for the people's healthcare work in a fair, effective, quality, and sustainable manner.

2. Specific Objectives:

a) Increasing the proportion of the population participating in health insurance: Continuing to maintain groups of subjects who have participated in health insurance at a rate of 100%; expanding groups of subjects so that by 2015, the participation rate reaches over 70% of the population, and by 2020, it reaches over 80% of the population.

b) Improving the quality of health insurance medical examination and treatment, ensuring the rights of health insurance participants according to the provisions of the law, meeting the needs of medical examination and treatment of health insurance participants.

c) Gradually reforming the financial mechanism in the direction of direct investment for service recipients through the form of supporting participation in health insurance, ensuring the balance between revenue and expenditure of the health insurance fund, striving to reduce the proportion of direct medical expenses from personal funds to below 40% by 2020.

3. Coverage Targets of Localities

Based on the objectives of the Project, provinces and centrally governed cities shall determine specific targets each year, organize implementation to achieve a population participation rate in health insurance of over 70% by 2015 and over 80% by 2020. For provinces and centrally governed cities that have already achieved and exceeded these targets since 2012, they shall continue to maintain and expand the health insurance coverage rate depending on the actual conditions of the locality.

II. MAJOR SOLUTIONS

The solutions of this Project will be implemented during the period of 2012-2015. After 2015, the objectives and solutions will be adjusted based on the summary of the implementation process of the Project during the period of 2012-2015 and the implementation of new regulations of the Law Amending and Supplementing Certain Provisions of the Health Insurance Law.

1. Building and Perfecting Health Insurance Policies

- Studying, amending, and supplementing the Health Insurance Law to be submitted to the National Assembly in 2014.

- Studying, amending, and supplementing normative legal documents on health insurance and other related normative legal documents to ensure consistency in implementing health insurance policies, including normative legal documents on medical examination and treatment, pharmaceuticals, medical equipment, preventive healthcare, hospital fees, financial autonomy, human resources in public health institutions, socialization in healthcare; while promoting the construction and implementation of various health programs, projects to reduce hospital overcrowding, improve medical examination and treatment quality, family doctor project...

2. Strong Political Commitment and Participation of the Political System

Implementing the roadmap for universal health insurance coverage within the policy of "ensuring social security" is one of the strategic tasks in national economic and social development.

Participating in health insurance is both the right and responsibility of every citizen, as well as the responsibility of the state and the whole society. Party committees, governments at all levels, agencies, organizations, and mass organizations must clearly define their tasks and strongly direct the implementation of laws on health insurance.

Advisory bodies of the Party shall build and submit to the Politburo for issuance of Resolutions and Directives of the Politburo on social insurance and health insurance work linked to the goal of universal health insurance coverage; at the same time, coordinating with the Ministry of Health and Vietnam Social Security to strengthen inspection, evaluation, and urging the Party committees to implement the Resolutions and Directives of the Party on health insurance.

Advisory bodies of the National Assembly shall coordinate with the Ministry of Health and Vietnam Social Security to monitor the implementation of state policies and laws on health insurance, evaluate results, the effectiveness of policy and law enforcement on health insurance, and the implementation of the health insurance universalization roadmap.

The Government shall issue guiding documents for all levels, ministries, and sectors, and inspect and urge the implementation of health insurance policies, considering this as one of the key tasks in implementing policies and laws on social security.

Each year, People's Councils at all levels need to build Resolutions on implementing health insurance policies in localities, making health insurance implementation targets mandatory economic and social indicators for each locality.

Provincial People's Committees under the Central Government must incorporate the objectives and plans for implementing the health insurance universalization roadmap into provincial socio-economic development programs, strictly implementing health insurance development criteria in the new rural development program; directing departments, agencies, district and commune people's committees within their functions and powers to strictly and fully comply with the provisions of the Health Insurance Law.

Mass organizations and social organizations shall, in accordance with their functions and responsibilities, promote and mobilize members to participate in health insurance, while strengthening the mobilization of social resources and individual contributions to support community participation in health insurance.

3. Increasing Health Insurance Coverage Rates

For groups of subjects that have reached a coverage rate of over 90%, continue to maintain the coverage rate and implement measures to improve the quality of medical examination and treatment, increase access to medical services, while continuing to implement measures to promote health insurance policies and laws.

For certain groups with low rates of health insurance participation, along with general solutions such as strengthening propaganda on health insurance policies and laws, mobilizing participation, enhancing the attractiveness of health insurance, organizing health insurance agencies to ensure that those in need have access to information about health insurance and facilitating their enrollment in health insurance with specific measures suitable for each group as follows:

a) Group of workers in enterprises

- Inspect and supervise the implementation of health insurance policies and laws in state-owned and private enterprises, strictly handle enterprises in violation.

- Develop mechanisms for collecting health insurance contributions over time (payment cycle), and forms of collection suitable for enterprise activities, to be approved by competent authorities.

- Study and propose mechanisms for using the health insurance examination and treatment fund, consolidate medical facilities within agencies and enterprises to meet the health care needs of workers at their workplaces.

b) Individuals belonging to near-poor households

- Specify that all members must participate in health insurance under household registration.

- Propose the Government to support 100% of the contribution level for individuals from near-poor households living in difficult and extremely difficult areas in Northern mountainous regions and Central Highlands according to Government regulations; individuals from households that have escaped poverty for the first five years.

c) Students and trainees

- Determine the responsibility of schools in coordinating the implementation of health insurance laws, rights to examination and treatment and health care, administrative penalties for violations of health insurance laws; school health care work.

- Study increasing the government's financial support for student health insurance contributions to a minimum of 50% of the health insurance contribution level.

- Develop and improve the quality of school health services: Establish and supplement standards and contents of school health work, policies on the use of health insurance examination and treatment funds in schools, to be decided by competent state agencies. Ensure that school health rooms have at least one staff member with a diploma-level education in healthcare or higher, use health insurance examination and treatment funds in schools in accordance with regulations, not to use the fund to pay salaries for healthcare staff.

- Develop programs and train school health staff teams, provide human resources for schools to recruit full-time healthcare staff.

- Increase investment in infrastructure to ensure that all schools have health rooms according to regulations, operate effectively and meet the initial health care requirements for students and trainees.

- Develop plans for the development of health insurance for students and trainees in schools, incorporating the health insurance participation rate as one of the criteria for competition evaluation by Departments of Education and Training and schools.

d) Households engaged in agriculture, forestry, fishery, salt production with moderate income levels

- Propagate health insurance policies and laws so that people understand their rights and responsibilities in participating in health insurance, contribution levels and responsibilities, state support policies when participating in health insurance, responsibilities of People's Committees at all levels and relevant agencies in organizing and guiding the mobilization of health insurance participation.

- Develop and propose to the Government to promulgate criteria for defining households engaged in agriculture, forestry, fishery, salt production with moderate income levels annually.

- Participate in health insurance under household registration, applicable to all members of the household and implementing reduced contribution levels according to the Health Insurance Law, develop cooperation mechanisms and annual plans and targets for mobilizing household participation in health insurance.

e) Voluntary health insurance participants

- Propagate health insurance policies and laws, rights and responsibilities in participating in health insurance, contribution levels and responsibilities, rights to examination and treatment, administrative penalties for violations in the field of health insurance; mobilize participation in health insurance, guide registration for health insurance participation.

- Guide methods for registering for health insurance participation and coordination mechanisms between relevant agencies and organizations in organizing implementation.

- Study and propose support mechanisms for voluntary health insurance contributions for informal sector workers and participation mechanisms under household registration.

f) Group of children under six years old

- Propagate health insurance policies and laws, the right to obtain health insurance cards and rights to examination and treatment for children under six years old, guide parents and guardians to register primary examination and treatment facilities for children under six years old.

- Adjust and supplement guidance documents for compiling and transferring lists of children under six years old between People's Committees at commune, ward, town levels and labor, social affairs agencies and social insurance agencies.

4. Improve the quality and meet the demand for health insurance examination and treatment (The Ministry of Health will develop separate projects for each field)

a) Improve the quality of health insurance examination and treatment

The implementation of health insurance policies must be carried out gradually and in tandem with the consolidation and improvement of the quality of health insurance examination and treatment, administrative reform, and enhancement of professional ethics to ensure service quality and patient satisfaction with health insurance cards in both public and private healthcare systems:

- Direct the organization of examination and treatment, inspection, supervision to ensure that health insurance participants fully enjoy their rights as stipulated by law.

- Strengthen hospital quality management, establish hospital quality standards as a basis for inspecting and evaluating examination and treatment service quality. Enhance comprehensive patient care. Improve treatment quality and reasonably reduce the number of treatment days.

- Reform administrative procedures in medical examination and treatment, payment of medical examination and treatment costs, to facilitate patients when seeking medical services. Expand outpatient treatment models and implement new service models in medical examination and treatment (satellite hospitals, family doctors). Apply information technology in hospital management, health insurance medical examination and treatment management.

- Study and develop primary healthcare service packages, scope of benefits, and health insurance coverage levels suitable for economic and social conditions, stability of the health insurance fund, service supply system, and health care needs.

- Develop and supplement policies on providing medicine to insured patients towards meeting medical examination and treatment needs, ensuring safe and rational drug use, and aligning with the health insurance fund's financial capacity; establish mechanisms to control drug prices for health insurance payments.

- Develop support policies for satellite hospitals and technology transfer to lower-level facilities. Establish and implement the family doctor model. Develop legal foundations for remote medical examination and treatment through information technology systems (telemedicine).

b) Investment in equipment, construction, renovation, and expansion of infrastructure

- Medical examination and treatment network

+ Review, amend, and supplement the overall planning for developing the national and local medical examination and treatment networks; planning for the development of specialized departments to complete the hospital network, ensuring appropriate bed structure and ratio among technical levels and specialties by 2020.

+ Develop the preventive healthcare network with the participation and coordination of multiple Ministries and sectors to address urgent community health issues, the increase in non-communicable diseases such as cancer, cardiovascular disease, diabetes..., risk factors negatively impacting health such as lack of clean water, environmental pollution... to reduce the burden of illness and medical examination and treatment costs.

- Central and large city hospitals

+ Continue investment and expansion of the medical examination and treatment network to meet requirements for health care quality, especially at the grassroots level through implementation of the Hospital Decongestion Program; strengthen socialization in healthcare work, diversify organizational forms of medical examination and treatment to meet the increasing demand and quality of health insurance medical examination and treatment.

+ Upgrade, expand, and construct new beds to quickly increase the number of beds for central hospitals and two major cities, Hanoi and Ho Chi Minh City, which are currently severely overloaded.

- Satellite hospital system

+ Form a network of satellite hospitals of some central hospitals, end-of-line hospitals in Hanoi and Ho Chi Minh City across five specialty groups: Oncology, Cardiology, Orthopedics, Obstetrics, Pediatrics at provincial general and specialized hospitals. Invest, upgrade, and expand beds for hospitals receiving satellite hospital status from hospitals in the above specialty groups.

+ Form a network of satellite hospitals of provincial hospitals at the district level. Enhance medical examination and treatment capabilities at satellite hospitals, gradually reducing patients transferring to higher levels.

- Strengthen the capabilities of lower-level medical examination and treatment facilities

Strengthen medical equipment and infrastructure for commune health stations linked to the New Rural Development Program. Continue implementing Decision No. 47/2008/QD-TTg dated April 2, 2008, and Decision No. 930/QD-TTg dated June 30, 2009 of the Government Prime Minister on investment in building and upgrading provincial and intermediate-level hospitals through government bonds.

c) Enhance the capability of lower-level healthcare provision

- Develop and promulgate regulations on tier assignment and referral for specialized technical skills, ensuring principles compatible with the professional capabilities of medical examination and treatment facilities, facilitating health insurance medical examination and treatment cost reimbursement, strengthening training, capacity building, equipment investment, creating conditions for developing techniques at lower levels to improve grassroots medical examination and treatment quality.

- Strengthen guidance, training, and technology transfer, implement comprehensive technology transfer from upper tiers to lower tiers through sending upper-tier staff to train lower-tier staff or vice versa, or indirectly through information technology systems to enhance lower-tier capabilities, limiting patient transfers to upper tiers.

- Develop and expand the family doctor network: Develop a project to develop the family doctor model, integrating the family doctor model with existing healthcare facility networks to manage and provide comprehensive health care services for individuals and families. Initially, implement the family doctor system in Hanoi, Ho Chi Minh City, and other centrally-administered cities.

- Enhance the capabilities of commune health stations

+ Establish technical standards and material infrastructure, equipment to meet the initial medical examination and treatment needs of health insurance participants, ensuring that 100% of commune health stations organize health insurance medical examination and treatment by 2015;

+ Increase the proportion of commune health stations with doctors working there, ensuring that 100% of commune health stations have doctors working there by 2015;

+ Promote primary health care, supplement functions and responsibilities of commune health stations for managing and treating certain non-communicable diseases; establish incentives for health insurance participants to register for initial health insurance medical examination and treatment at commune health stations.

- Develop appropriate mechanisms for private healthcare facilities, including qualified private clinics to participate in health insurance medical examination and treatment.

d) Ensure human resources

- Develop policies to attract human resources for grassroots healthcare, prioritizing satellite hospitals, district hospitals, and commune health stations;

- Develop policies defining the social responsibility obligations of medical practitioners.

5. Strengthen preventive healthcare and primary health care

- Prevention of infectious diseases: Effectively implement national target programs, vaccination programs, community and individual preventive measures for infectious diseases, develop specific plans to launch the patriotic hygiene movement aimed at enhancing public health.

- Prevention of non-communicable diseases: Efficiently implement the national target program on preventing certain non-communicable diseases, focusing on communication activities, education on healthy habits and lifestyles, strengthening physical exercise, along with medical measures to manage non-communicable diseases at healthcare facilities and in communities.

- Prevention of malnutrition: Fully implement tasks under the national target program on preventing malnutrition and preventing overweight and obesity among children.

- Continue to improve and strengthen the network of reproductive health care, maternal and child health services; increase budget investment in mountainous provinces, remote areas to enhance maternal and child health and achieve the Millennium Development Goals on reducing maternal and child mortality.

6. Strengthen propaganda and dissemination of laws on health insurance

- The Vietnam Social Security is responsible for organizing activities to promote health insurance policies, such as developing separate proposals on communication work and promotion.

- Forms and contents of propaganda

+ Innovate content and intensify information, promotional, mobilization, and educational activities through various forms to raise awareness among party committees, authorities, agencies, organizations, mass organizations, and all citizens about the significance and importance of health insurance and their obligations in participating in health insurance and implementing health insurance policies. Enhance the responsibility of party committees and authorities at all levels in leading, directing, and organizing the implementation of health insurance policies and the Health Insurance Law.

+ Vigorously carry out information, promotional, and mobilization activities among the people regarding health insurance policies, changing perceptions and increasing understanding of health insurance laws from economic and social development perspectives, benefits for individuals and society, methods of joining health insurance through health insurance agents, representatives, or at the Social Insurance Office; rational use of health insurance cards; accessing healthcare facilities according to technical specialties.

- Communication and propaganda efforts must be conducted for all target groups, including government levels, mass organizations, schools, branch party cells, Party members..., and implemented regularly and continuously with appropriate forms to ensure that all communication targets have full access to information on health insurance policies and participation methods.

- The Vietnam Social Security is responsible for budgeting annual communication funds from the management fund transferred to localities to implement communication work. In addition to the annual budget forecasted by the Vietnam Social Security, localities should proactively support and supplement funds to enhance health insurance policy communication activities in their areas. At the same time, encourage the mobilization of social resources towards the socialization of health insurance communication activities.

7. Reform financial mechanisms and payment methods for health insurance examination and treatment costs (The Ministry of Health has a separate proposal)

- Reorganize the health budget towards ensuring basic state funding such as research funding, preventive healthcare, part of construction funding, and service provision costs will be covered from health insurance examination and treatment revenue.

- Continue the process of transitioning state budget allocation mechanisms linked to the adjustment schedule of healthcare service prices, shifting from direct state budget allocation to service providers to allocation through health insurance for beneficiaries, suitable to each stage's socio-economic conditions.

- Ensure state budget funding for health insurance for the poor, ethnic minorities in difficult regions, children under six years old, and other social policy beneficiaries, and support contributions for certain groups such as near-poor, students. Study and propose increasing the annual allocation ratio for localities that successfully mobilize many people to join health insurance.

- Amend and supplement healthcare service pricing towards accurately reflecting cost components.

- Reform payment methods for examination and treatment costs: Gradually replace fee-for-service payments with case-based or diagnosis-related group payments. Accelerate the development and encourage healthcare facilities to adopt case-based, diagnosis-related group, or capitation payment methods.

- Establish financial incentives or higher health insurance benefits (such as reducing co-payments for those who consistently refrain from using health insurance cards for examination and treatment over several years) to encourage cardholders to maintain good health, prevent illness, and use health insurance cards rationally.

- Study and build health insurance benefit packages that match contribution levels, meet health care needs, and ensure fund balance and sustainability of the health insurance policy.

8. Strengthen inspection and supervision

- The Ministry of Health performs specialized inspection functions related to health insurance; inspect, investigate, handle violations, and resolve complaints and reports on health insurance nationwide.

- Provincial People's Committees are responsible for inspecting, investigating, handling violations, and resolving complaints and reports on health insurance within their jurisdictions.

- Ministries, sectors, People's Committees at all levels strictly implement the measures for imposing penalties according to Decree No. 92/2011/ND-CP dated October 17, 2011 of the Government on administrative sanctions in the field of health insurance.

9. Enhance state management capacity and the implementation system of health insurance

a) State management work on health insurance

- Study and build a management model and organization for implementing health insurance that ensures effectiveness, efficiency, and quality suitable to Vietnam's political, economic, and social conditions.

- Strengthen state management capacity on health insurance, establish Health Insurance Departments at Provincial Health Departments; consolidate and enhance the capacity of the health insurance implementation machinery from central to local levels; strengthen training to improve the professional and vocational capabilities of the health insurance workforce.

b) Implementation work of health insurance policies

- Study and reform the organizational model and operational mechanism of the Management Council of the Vietnam Social Security to enhance effectiveness and quality, in line with practical conditions.

- Study and propose the establishment of a health insurance appraisal agency to ensure objectivity, fairness, and effectiveness (in cost control, quality of medical examination and treatment, and rights of related parties).

- Propose dedicated staff for social security and health insurance at commune level, organize health insurance agents to develop the target group participating in health insurance: Continue signing agency contracts with school principals to collect health insurance premiums for students; coordinate with Commune People's Committees to promote awareness campaigns and collect health insurance premiums from voluntary participants.

- Continue supporting costs for issuing health insurance cards to beneficiaries who are fully supported by the state budget for health insurance contributions. Strengthen the responsibility of the social security agency in protecting the rights of health insurance participants. Propose solutions to increase public access to health insurance policies.

10. Balance and preserve the Health Insurance Fund

- Gradually increase health insurance contribution levels in line with citizens' and the state budget's ability to contribute based on the provisions of the Health Insurance Law to ensure balance in the health insurance fund.

- Amend regulations on managing and using the health insurance fund to ensure stable and sustainable development of the health insurance fund through rational adjustment of surplus fund ratios, enhancing the quality of medical examination and treatment, and strengthening local responsibilities in effectively managing and utilizing the health insurance fund.

- Strengthen health insurance appraisal work in both quantity and quality; innovate appraisal methods towards centralized appraisal and expand the implementation of file-based payment review for health insurance medical examination and treatment costs; enhance the application of information technology systems in health insurance appraisal.

11. Application of Information Technology in Management

Build a synchronized and appropriate healthcare information system. Increase the deployment of information technology applications in management and operation; upgrade software for information management of revenue, expenditure, appraisal, statistics, and reporting on health insurance medical examination and treatment nationwide, contributing to improving management quality and reducing administrative procedures. Specific solutions include:

- From 2013, study the use of smart health insurance cards or health insurance cards with photos for certain groups with less change (such as civil servants, retirees, ethnic minorities, etc.) (Vietnam Social Security will develop a separate proposal). Encode technical services and medicines to manage uniformly and provide data for policy-making.

- Develop open-source software for application by the social security agency and healthcare facilities; build shared databases and information sharing between the social security and healthcare sectors.

12. Scientific Research and International Cooperation

- Conduct studies to evaluate the impact of health insurance on healthcare finance, understanding and voluntary participation in health insurance, satisfaction of insured patients, cost-effectiveness analysis of healthcare services, serving the formulation of policies and improvement of health insurance implementation methods.

- Promote scientific research, strengthen international cooperation, and summarize practical experiences regarding payment methods, family-based health insurance, other types of health insurance, and models of health insurance management and implementation systems.

III. IMPLEMENTATION

The Project "Implementing the Roadmap towards Universal Health Insurance for the Period 2012-2015 and 2020" has impacts on the health care of the entire population, sustainable healthcare financing mechanisms, and social security assurance, necessitating the involvement of the entire political system in guidance, direction, organization, and implementation, and requiring consensus and support from the whole society.

1. Establish a Central Steering Committee

- Minister of Health: Chairman.

- Deputy Minister of Health: Vice-Chairman in charge.

- General Director of Vietnam Social Security: Vice-Chairman.

- Members include: Leaders of relevant ministries and sectors such as Vietnam Social Security, Ministry of Finance, Ministry of Labor, Invalids and Social Affairs, Ministry of Planning and Investment, Ministry of Education and Training, Ministry of Home Affairs, Ministry of Information and Communications; other members from social organizations (Vietnam Fatherland Front, Vietnam General Confederation of Trade Unions, Vietnam Chamber of Commerce and Industry, Vietnam Women's Union, Vietnam Farmers' Association, Communist Youth Central Committee, Vietnam Medical Students' Association, and others as proposed by the Chairman and decided by the Prime Minister when necessary.

2. Establish Local Steering Committees

BASED ON the functions and tasks of the People's Committees at all levels, based on the current legal regulations and the contents of this project, localities establish Steering Committees chaired by the Chairman of the Provincial People's Committee, with the Director of the Department of Health and the Director of the Social Insurance Office of the province as Deputy Chairmen, and other members being representatives from relevant Departments, Boards, and organizations at the locality. The Steering Committee is responsible for developing implementation plans for the Project that are suitable to the economic and social conditions of the locality.

IV. ASSIGNMENT OF RESPONSIBILITIES

The Ministry of Health and the Vietnam Social Security shall coordinate with relevant Ministries, Boards, and Departments to advise on the establishment of Steering Committees to implement the Project towards universal health insurance coverage for the period 2012-2015 at the central level and guide the establishment of Steering Committees at the provincial level; develop plans, contents, and programs of activities for the Steering Committee at the central level and guide the organization and operation of the Steering Committee at the provincial level.
Relevant Ministries, Departments, and organizations shall be responsible for coordinating with the Ministry of Health and the Vietnam Social Security in organizing the implementation of the Project.

1. Responsibilities of Ministries and sectors

Relevant Ministries, Departments, and organizations shall be responsible for coordinating with the Ministry of Health and the Vietnam Social Security in organizing the implementation of the Project.

a) Ministry of Health

- Develop specific programs and plans to implement the solutions of the Project in each phase; direct, guide, urge, inspect, supervise, and evaluate the results of implementing the Project.

- Coordinate with the Ministry of Planning and Investment to include the target of universal health insurance coverage in the national system of targets and plans to be submitted to the Prime Minister for approval; guide the People's Committees of provinces and centrally-administered cities to submit the target of universal health insurance coverage of their locality in the annual and five-year socio-economic development targets to the respective People's Councils for approval.

- Take the lead in coordinating with the Vietnam Social Security and relevant Ministries and Departments to study, draft, amend, and supplement legal documents on health insurance (Laws, Decrees, Circulars...); issue lists of medicines, medical supplies, and technical services in health insurance-covered medical examinations and treatments; research and propose the establishment of an independent health insurance inspection agency to ensure objectivity, transparency, and effectiveness in health insurance inspection activities.

- Organize the implementation of measures to improve the quality of medical examinations and treatments to meet the needs of health insurance-covered medical examinations and treatments and preventive measures to enhance health.

- Implement the Government Decree No. 85/2012/ND-CP dated October 15, 2012, "On the operational mechanism and financial mechanism for public health service units and the pricing of medical examination and treatment services provided by public medical facilities"; amend and supplement the partial hospital fee payment method in the correct and full manner; innovate and apply appropriate payment methods.

- Continue to implement the transition from state budget allocation linked to the adjustment of medical service prices to shift the form of state budget allocation from service providers to beneficiaries through health insurance, in line with the actual conditions of each stage of development.

- Develop support policies for health insurance contributions for certain groups. Study and propose increasing the annual health care budget allocation, including support for expanding health insurance participation among localities that have successfully mobilized many people to join health insurance.

- Organize inspections and checks on the implementation of health insurance policies.

- Develop projects to reduce hospital overcrowding, improve the quality of medical examinations and treatments, satellite hospitals, family doctors...

- Coordinate with the Vietnam Social Security to develop plans and organize the dissemination and popularization of health insurance policies and laws for all groups across the country.

b) Vietnam Social Security

- Take the lead in coordinating with the Ministry of Health to develop implementation plans for the Project, guide localities in developing plans and organizing the implementation of specific health insurance development targets for each group. Monitor and promote the achievement of health insurance coverage targets in each locality. In the short term, focus on increasing the health insurance participation rate in localities where the participation rate is below 50% of the population.

- Take the lead in coordinating with relevant Ministries and Departments to organize the dissemination and popularization of health insurance policies and laws for all groups across the country.

- Strengthen administrative reform: Organize professional collection and issuance of health insurance cards that are convenient for health insurance participants, suitable for different regions; apply technological advancements in card issuance, fee collection, registration for medical examinations and treatments, health insurance-covered medical expense reimbursement, and health insurance fund management, ensuring convenience and reducing inconvenience for health insurance participants.

- Take the lead in coordinating with relevant Ministries and Departments to implement solutions related to health insurance for various groups, especially those who are near-poor, students, workers in enterprises...

- Develop plans to consolidate organizational structures, improve professional expertise, and develop human resources to meet service requirements.

- Develop projects on: Dissemination and popularization of health insurance policies and laws; application of information technology in health insurance management.

c) Ministry of Finance

- Coordinate with the Ministry of Health to study and propose amendments and supplements to legal documents related to current health insurance policies.

- Allocate sufficient and timely funds to cover health insurance contributions and support contribution levels for various groups.

- Take the lead in coordinating with the Ministry of Health and relevant Ministries and Departments to implement solutions related to health insurance collection and payment mechanisms; support contribution levels; funding for card issuance for various groups.

- Take the lead in coordinating with the Vietnam Social Security and relevant Ministries and Departments to inspect and check the management and use of health insurance funds.

d) Ministry of Labor, Invalids, and Social Affairs

- Develop and propose to the Government to promulgate criteria for defining households engaged in agriculture, forestry, fishery, salt production with moderate income levels annually.

- Propose specific solutions regarding policies, mechanisms, and methods for organizing the identification of beneficiaries, compiling lists, managing beneficiaries (poor people, near-poor people, average-income households in agriculture, forestry, fishery, salt production, children under six years old...), mechanisms for collecting and paying health insurance premiums, issuing health insurance cards for various beneficiary groups.

đ) Ministry of Education and Training

- Take the lead and coordinate with the Ministry of Health, Vietnam Social Security, and other relevant ministries and sectors to implement measures for developing and improving the quality of school health work, establish criteria for health insurance development plans at each educational institution, and implement measures related to expanding health insurance coverage for students and trainees as prescribed.

- Direct provincial Departments of Education and Training, academies, universities, colleges, and vocational schools nationwide to fully and strictly implement the Health Insurance Law; set a target of 100% participation in health insurance as a standard for recognizing national standards for primary, secondary, and high schools, and as one of the competition criteria for provincial Departments of Education and Training and schools.

e) The Ministry of Information and Communications

- Direct news agencies, radio stations, television stations to annually develop plans for promoting and disseminating policies and laws on health insurance, ensuring that promotional activities are carried out regularly, with good quality, and achieving high effectiveness.

- Coordinate with Vietnam Social Security, the Ministry of Health, and relevant ministries and sectors to implement communication and promotion tasks through various forms and contents suitable for different beneficiary groups as prescribed.

- Develop a mechanism for free promotion of health insurance policies.

g) The Ministry of Home Affairs

Lead and coordinate with relevant ministries and sectors to build an organizational system for implementing health insurance policies appropriately, ensuring professionalism and specialization, and adapting to the extent of health insurance expansion.

h) The Ministry of National Defense

Lead and coordinate with the Ministry of Health and relevant ministries and sectors in implementing the Project. Develop and direct the implementation of health insurance policies for beneficiaries managed by the People's Army according to appropriate timelines and steps, suitable to the characteristics of military operations.

i) The Ministry of Public Security

Lead and coordinate with the Ministry of Health and relevant ministries and sectors in implementing the Project. Develop and direct the implementation of health insurance policies for beneficiaries managed by the People's Public Security according to appropriate timelines and steps, suitable to the characteristics of their operations.

k) The Ministry of Planning and Investment

- Coordinate with the Ministry of Health, Vietnam Social Security, and relevant ministries and sectors in implementing the Project; build investment projects in the field of health insurance according to this Project, and review these projects as prescribed.

- Agree with the Ministry of Health to include the target of universal health insurance coverage into the national system of indicators and plans.

l) The Government Inspectorate

Based on the assigned functions and tasks: Organize inspections on the implementation of health insurance policies and laws, and inspect other cases assigned by the Prime Minister.

m) Audit

Carry out audit tasks as stipulated in Article 10 of the Health Insurance Law.

2. Responsibilities of localities

a) Provincial People's Councils directly under the central government

Annually build Resolutions on implementing health insurance policies at the locality level, considering this as an economic and social indicator of the locality; strengthen supervision over the implementation of health insurance policies and the realization of universal health insurance coverage by all levels and sectors within the locality.

b) Provincial People's Committees directly under the central government

- Bear responsibility before the Government and the Prime Minister for organizing the implementation of annual health insurance coverage targets at the locality level. Build plans, direct, and organize the implementation of the Project at the locality to achieve the set goals. Report periodically annually on the implementation results of the Project to the Ministry of Health for consolidation and reporting to the Prime Minister.

- Direct functional agencies under the province to carry out tasks of promoting and disseminating health insurance policies and laws.

- Include the objectives, plans, and rates of health insurance coverage as an indicator in long-term and short-term socio-economic development programs and plans of the locality, and implement the goal of universal health insurance in the new rural development program.

- Lead the implementation of measures for developing health insurance participants, focusing on tasks such as reviewing and approving lists of beneficiaries supported entirely or partially by the state budget for health insurance premiums; compiling lists of members of average-income agricultural, forestry, fishery, and salt-producing household families, and building cooperation mechanisms, plans, and annual targets for mobilizing this group to participate in health insurance.

- Ensure funding support for policy beneficiaries participating in health insurance as prescribed; and be responsible for directing the management and effective use of the health insurance fund at the locality.

- Direct the implementation of inspections, audits, and handling violations in the implementation of health insurance laws at the locality and enterprises under its jurisdiction.

3. Responsibilities of organizations and mass organizations:

a) The Vietnam Fatherland Front:

- Coordinate in promoting health insurance policies and laws, mobilizing the people, union members, and association members to participate in health insurance.

- Mobilize resources to support the participation of the people in health insurance.

- Coordinate in supervising and evaluating the implementation of health insurance policies and laws and the implementation of the project.

b) The General Confederation of Labor of Vietnam:

- Coordinate in promoting laborer and employer policies and laws on health insurance.

- Mobilize employers and workers to comply with health insurance regulations.

- Participate in supervising, auditing, and inspecting health insurance participation in enterprises and propose health insurance mechanisms and policies for workers.

c) The Vietnam Women's Union:

- Coordinate to promote propaganda on health insurance policies, mobilize members of women's associations at all levels and their families to actively participate in health insurance.

- Advise and propose participation in building policies related to health insurance for women in implementing health insurance laws and healthcare policies, in conjunction with gender equality and women's advancement goals.

- Coordinate to monitor and evaluate the implementation of health insurance policies and laws and the implementation of the project.

d) The Vietnam Farmers' Association:

- Promote and educate cadres and members of farmers' associations at all levels about health insurance policies, mobilize farmers and their families to participate in health insurance, particularly focusing on near-poor households and farmer households with average living standards supported by the state budget for health insurance contributions.

- Mobilize resources to support farmer households in participating in health insurance.

- Coordinate to monitor and evaluate the implementation of health insurance policies and laws.

đ) The Central Committee of the Ho Chi Minh Communist Youth Union:

- Promote and educate League members, youth, students, and trainees about health insurance policies.

- Mobilize League members and youth to participate in health insurance.

e) The General Association of Vietnamese Medical Science:

- Participate in research activities, policy and law construction regarding health insurance, improving the quality of medical examination and treatment.

- Promote and mobilize members to implement health insurance policies and laws effectively, mobilize members and their families to participate in health insurance.

g) Other organizations

Based on their functions and tasks, participate in propaganda, mobilization, resource mobilization, and support for families and individuals in the community to join health insurance.

V. EXPENSES FOR IMPLEMENTING PROJECT ACTIVITIES

1. Funding from the state budget for contributions and partial support for certain groups

- From 2012 to 2015, it is estimated that the percentage of state budget support for health insurance contributions compared to total health insurance fund revenue will be approximately 40.6% to 45.5%. The state budget increase forecast for each year is as follows: In 2013, approximately 4.817 trillion VND; in 2014, approximately 6.448 trillion VND; and in 2015, approximately 8.034 trillion VND to support health insurance contributions under unchanged contribution rates.

- From 2016 to 2020, state budget support for health insurance contributions will be implemented according to new regulations stipulated in the Law Amending and Supplementing Certain Provisions of the Health Insurance Law.

2. Funding for Implementing the Project

Funding for implementing the project's contents will be sourced from regular state budget allocations and other legitimate fundraising sources for the following main activities: Propaganda; management, list creation, and issuance of health insurance cards to eligible subjects; inspection and supervision; research and evaluation; seminars, conferences, and training sessions; capacity building and enhancement.

Article 2. This Decision takes effect from the date of issuance.

Article 3. The Minister, Heads of Ministries equivalent to Ministries, Heads of Government Agencies, Chairmen of Provincial People's Committees directly under the Central Government, and Heads of relevant agencies and units are responsible for enforcing this Decision./.