SESSION III: PROBLEMS ABOUT ISSUANCE HEALTH INSURANCE CARDS FOR PERSONS WITH DISABILITIES
Health care and protection is an essential need of human beings, especially for persons with disabilities, this need becomes further more important and urgent. Rooted in the objective and legitimate needs, the rights of persons with disabilities to receive health care and protection, training and rehabilitation were acknowledged in Chapter III of Disability Law 2010 as well as other specialized legal documents[1] in Vietnam. On a fundamental basis, the system of healthcare policies for persons with disabilities in our country has ensure alignment with the spirit of the Convention on the Rights of Persons with Disabilities (CRPD, Articles 25-26), However, after a decade of practical implementations, several areas regarding healthcare in Disability Law 2010 and the specialized document system have revealed inadequacies and restraints, including the regulations about the rights to receive health insurance cards for persons with disabilities. More specifically:
In keeping with the spirit of point a, Article 25 - CRPD on the responsibility of States Parties to “provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes”[2], based on the current situation of the country, Clause 2, Article 22, Disability Law 2010 has laid down the rules to ensure the health insurance benefits for persons with disabilities as the following: “Persons with disabilities are entitled to health insurance policies in accordance with those made by the Law”. In particular, this stated that, “Persons with disabilities tend to have poorer health and use healthcare services at a noticeably higher rate than those without disabilities, therefore, they rely heavily on health insurances”[3],our State also has adopted policies about issuing health insurance cards for persons with disabilities, however, the extent of persons with disabilities who are provided with health insurance cards is limited to only those whose levels of disabilities are severe or very severe and are eligible for monthly social benefits (Point g, Clause 3, Article 12, the current Law on Health Insurance). This also means that, persons with mild disabilities who have always been in the vulnerable group but cannot access the State support to gain health insurance cards. It leads to a situation where, if persons with disabilities are not in other social protection groups (such as poor or near poor households,...) or are not eligible for compulsory employment health insurance under labor contract, then those with mild disabilities can hardly benefit from any prioritizing policies on health insurance.
In reality, the need for medical examination and treatment among persons with disabilities is extremely high. Statistics reveal that up to 89% of persons with mild disabilities show health warning signs that need to be paid attention to for medical check-up and treatment. Moreover, because persons with mild disabilities have a lower rate of reduction of bodily functions, their frequency of access to medical services is also significantly lower than that of those with severe disabilities. In the past six months, 100% of persons with mild disabilities have visited medical facilities, while this rate in the group with severe disabilities is 83%.[4] However, up to now, our country still has nearly 50% of persons with disabilities (over 3 million people) who have to purchase health insurance on their own and co-pay their medical bills [5]. Although most of the current public’s perception about persons with mild disabilities is that they are still able to work, have an income and can participate in compulsory employment health insurance or purchase household health insurance at the same price as non-disabled people; reality has shown that the employment rate of persons with disabilities in general and mild disabilities in particular is still low (37% persons with mild disabilities are unemployed, 59% have unstable jobs)[6]. This means that the percentage of persons with mild disabilities who are not eligible to purchase compulsory employment health insurance is relatively high. Additionally, not every person with mild disability can afford to purchase household health insurance when the majority of them are already in difficult circumstances[7], and the condition of their disabilities has increased their (estimated) living cost by 10% [8]. With such frequency of access to medical services, the cost of medical treatment (especially long-term ones) is a prominent problem for persons with mild disabilities. Due to restraint of income and savings accumulation, most persons with mild disabilities are unable to pay for medical examination, treatment or to take care of their health. Up to 95% of persons with mild disabilities who haven’t been granted health insurance cards all regard the cost of medical examination and treatment as high or extremely high in comparison to their household’s financial ability [9]. Therefore, being granted without any charge a health insurance card is incredibly essential and means a great deal in reassuring security and reducing burden for persons with disabilities [10].
On the other hand, for those with mild disabilities who have participated in compulsory employment health insurance or have purchased household health insurance, the rate of their health insurance payment coverage is currently only at 80%, which is not yet the highest amount of payment coverage (100%) that persons with severe or extremely severe disabilities get. Meanwhile, their highest frequency of using medical services has also cost them to face pressure in paying medical bills. Thus, increasing the payment support for medical examination and treatment is crucial for persons with mild disabilities [11].
Altogether, receiving low income while having to pay many medical bills (especially for long-term treatment), along with the fact that the State does not grant or give support on health insurance, has consequently put persons with mild disabilities at a disadvantage compared to others with disabilities. Moreover, this has led to them being “accidentally” excluded from prioritizing policies on social security, including medical examination and treatment from health insurance. These mentioned issues have and will continue to be at the risk of leading to the phenomenon “persons with disabilities who don’t have health insurance or don’t get insurance fully often delay taking care of their health” [12]. Whereas, providing health insurance cards for persons with disabilities, regardless of their levels of disabilities, has been done in many countries worldwide, for example, in Indonesia (a country in the same ASEAN region as Vietnam), one only needs to have “a certificate of disability in accordance with the law” to be eligible for social benefits and healthcare and bodily function rehabilitation support, without the classification of mild, severe or very severe disabilities [13].
Therefore, to ensure the implementation of rights for persons with disabilities as decided by CRDP, where Vietnam has participated, ensure the rights of all persons with disabilities, especially persons with mild disabilities (and moderate disabilities - if added to the Disability Law later on [14]), we find that for long-term effects, it’s essential to fix and review Clause 2, Article 22 of current Disability Law on the principles of the health insurance issuing policies for all persons with disabilities. This will not only ensure that all persons with disabilities have equal access to health insurance, but also guarantee the rights for medical examination and treatment of persons with mild (and moderate) disabilities, minimize the risk of illness for persons with disabilities as well as other potential risks for their families and community in general.
We also understand that, issuing health insurance cards for all persons with disabilities can immediately create a noticeable “weight” on the state’s budget. Therefore, to reassure that the practicability of the proposal aligns with the condition of the financial aspect and budget of the State, we reckon that in the present period, we can regulate on issuing free health insurance for persons with severe or very severe disabilities. For those whose disabilities are under the severe level (including mild and moderate disabilities), regulations need to be considered in the direction that: The State has a supporting policy for persons with mild (and moderate) disabilities to be prioritized in buying health insurance and to have payment support for medical examination and treatment. For example: The State has a supporting policy for persons with mild (and moderate) to be prioritized in buying health insurance and to have payment support for medical examination and treatment in the same prioritizing level as for near poor households.
Regulating the principles in Disability Law is also the basis for specifying the rights for issuing health insurance of persons with disabilities (regardless of their levels of disabilities) in the amendment of the Law on Health Insurance./.
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[1] Such as Health Insurance Law 2008, with revision and amendments in 2014; Medical Examination and Treatment Law 2009,...
[2] Point a, Article 25, the Convention on the Rights of Persons with Disabilities.
[3] According to the Summary board of Rights to Access Healthcare for Persons with Disabilities (The U.S. National Council on Disability), extracted from the article “Roles of communication about the importance of healthcare insurance for persons with disabilities" by author Nguyễn Thanh Xuân at the workshop “Policy recommendation on issuance health insurance card for persons with mild disabilities", organized on July 16th 2021.
[4] Expert group (2021), Report “Reviewing and proposing amendments to regulations for Persons with disabilities in the Health Insurance Law Amendments Bill", at the workshop “Health Insurance for Persons with Disabilities Current Situation and Solution" on December 21st 2021, Hanoi, p.14.
[5] Thảo Hương, “Equal rights for Persons with Disabilities - Session 3: Difficulties in accessing medical and healthcare services", at: https://baophunuthudo.vn/article/31041/170/ky-3-kho-khan-trong-tiep-can-dich-vu-y-te-cham-soc-suc-khoe/, updated on September 3rd 2019.
[6] Nguyễn Thị Thanh Uyên (Research Director), “Policy recommendation on issuance health insurance card for persons with mild disabilities”, at the workshop “Policy recommendation on issuance health insurance card for persons with mild disabilities”, held in HCM City, on July 16th 2021.
[7] According to the National Survey Report on Persons with Disabilities, nearly three-quarters of persons with disabilities from the age of 15 and up live in multidimensional poor households, don't go to school and don't have any degrees. According to an expert group survey in 2021, 82% of persons with mild disabilities have unstable lives.
[8] Nguyễn Thị Thanh Uyên (Research Director), “Policy recommendation on issuance health insurance card for persons with mild disabilities”, at the workshop “Policy recommendation on issuance health insurance card for persons with mild disabilities”, held in HCM City, on July 16th 2021.
[9] Expert group (2021), Report “Reviewing and proposing amendments to regulations for Persons with disabilities in the Health Insurance Law Amendments Bill", at the workshop “Health Insurance for Persons with Disabilities Current Situation and Solution" on December 21st 2021, Hanoi, p.14.
[10] Survey data shows that. 85% of persons with disabilities in local regions believe that health insurance cards are extremely necessary for them.
[11] According to an expert group survey in 2021, up to 95% of persons with disabilities wish to have a higher level of financial support for medical bills.
[12] According to the Summary board of Rights to Access Healthcare for Persons with Disabilities (The U.S. National Council on Disability).
[13] Action to the Community Development Institute (2016), Policy research in some ASEAN nations about education and training, vocational training and access to work, transport, health and rehabilitation, Hanoi.
[14] In Session I of the Seminar, author Lê Hoa proposed to “modify the regulations on disability degree of persons with disabilities in Disability Law 2010 (Clause 2, Article 3) to classify them more detailedly into 04 levels of disabilities: very severe; severe; moderate and mild”.
