The Joint Learning Network for Universal Health Coverage systematically documents the reforms of its member countries and other countries that have expanded health coverage through demand-side financing. The case studies contained in these pages are brief, comparative and modular in nature, describing the key highlights and technical features of each program.
Compare various dimensions of country reform efforts using our interactive tool.
| Program | Types of benefits | Benefits package |
|---|---|---|
| Vietnam: Compulsory and Voluntary Health Insurance Schemes |
|
HCFP offers a comprehensive benefits package that includes both inpatient and outpatient care. Excluded are interventions covered by vertical programs such as HIV/AIDS prevention and treatment, treatments not yet approved by the MoH, various “luxury” interventions such as cosmetic surgery, certain dental procedures, and treatment of self-inflicted injuries and drug addiction, among others. Read full sectionHCFP offers a comprehensive benefits package that includes both inpatient and outpatient care. Excluded are interventions covered by vertical programs such as HIV/AIDS prevention and treatment, treatments not yet approved by the MoH, various “luxury” interventions such as cosmetic surgery, certain dental procedures, and treatment of self-inflicted injuries and drug addiction, among others. The benefits package is essentially the same for everyone, except the poor, children under 6, pensioners, and meritorious persons who are exempted from copayment or have lower copayment rate. The following services are covered under all health programs: medical consultation, diagnosis and treatment, X-ray and laboratory tests, functional examination, imaging diagnosis, drugs listed by the MoH, blood and transfusion, surgery, antenatal examination and delivery. In addition to these items, the insurance also covers the cost (up to a certain limit) of a defined list of high-technology treatments (including magnetic resonance imaging (MRI), hemodialysis and laser surgery among a total of 177 specified high-tech procedures). The following exemptions, some of which are covered by the national target programs, are imposed: leprosy, tuberculosis, malaria, schizophrenia, epilepsy, STD, vaccination, convalescence, early-detected pregnancy, medical check-ups, family planning services and infertility treatments, prosthesis, aesthetic surgery, artificial arm, leg, tooth, glasses, hearing-aid machines, occupational diseases, war injuries, accidents at work place, treatment for suicide, self-inflicted injuries, drug addiction, medical appraisal, forensic appraisal, mental examination, home care, rehabilitation and delivery. Compulsory and Voluntary Health Insurance SchemesBenefits package Types of Benefits: Comprehensive HCFP offers a comprehensive benefits package that includes both inpatient and outpatient care. Excluded are interventions covered by vertical programs such as HIV/AIDS prevention and treatment, treatments not yet approved by the MoH, various “luxury” interventions such as cosmetic surgery, certain dental procedures, and treatment of self-inflicted injuries and drug addiction, among others. The benefits package is essentially the same for everyone, except the poor, children under 6, pensioners, and meritorious persons who are exempted from copayment or have lower copayment rate. The following services are covered under all health programs: medical consultation, diagnosis and treatment, X-ray and laboratory tests, functional examination, imaging diagnosis, drugs listed by the MoH, blood and transfusion, surgery, antenatal examination and delivery. In addition to these items, the insurance also covers the cost (up to a certain limit) of a defined list of high-technology treatments (including magnetic resonance imaging (MRI), hemodialysis and laser surgery among a total of 177 specified high-tech procedures). The following exemptions, some of which are covered by the national target programs, are imposed: leprosy, tuberculosis, malaria, schizophrenia, epilepsy, STD, vaccination, convalescence, early-detected pregnancy, medical check-ups, family planning services and infertility treatments, prosthesis, aesthetic surgery, artificial arm, leg, tooth, glasses, hearing-aid machines, occupational diseases, war injuries, accidents at work place, treatment for suicide, self-inflicted injuries, drug addiction, medical appraisal, forensic appraisal, mental examination, home care, rehabilitation and delivery. |
| Estonia: Estonian Health Insurance Fund |
|
The EHIF covers a broad range of services, including family physicians services, in- and out-patient care, long-term care, rehabilitation, and prescription drugs. Children through 19 years of age are also eligible for free dental care, including preventive and curative services. Meanwhile, adults receive partial reimbursement for dental care. Read full sectionThe EHIF covers a broad range of services, including family physicians services, in- and out-patient care, long-term care, rehabilitation, and prescription drugs. Children through 19 years of age are also eligible for free dental care, including preventive and curative services. Meanwhile, adults receive partial reimbursement for dental care. All Estonians register on a family doctor’s practice list. Doctors can refuse to add a patient if the patient lives outside the practice region or when the practice list is full. In 2005 only 13% of patients changed doctors and these cases were primarily due to a change in residence. Family doctors are required to hold a minimum of 20 visiting hours per week and the practice must remain open at least eight hours per day. Patients must get access to their doctor within one day for acute problems and within three days for chronic conditions. If certain services are not available in Estonia, patients can seek care abroad. In non-urgent situations, patients must seek approval from the EHIF. The service must be medically justifiable and must be proven efficacious with a probability of success of at least 50%. In order to add new benefits to be covered under EHIF, the managerial board conducts an evaluation process and recommends services to the supervisory board, which then proposes them to the Ministry of Social Affairs where they are reviewed and sent to the government for approval once per year. There are four criteria for including or excluding services from the benefits package:
Estonian Health Insurance FundBenefits package Types of Benefits: Comprehensive The EHIF covers a broad range of services, including family physicians services, in- and out-patient care, long-term care, rehabilitation, and prescription drugs. Children through 19 years of age are also eligible for free dental care, including preventive and curative services. Meanwhile, adults receive partial reimbursement for dental care. All Estonians register on a family doctor’s practice list. Doctors can refuse to add a patient if the patient lives outside the practice region or when the practice list is full. In 2005 only 13% of patients changed doctors and these cases were primarily due to a change in residence. Family doctors are required to hold a minimum of 20 visiting hours per week and the practice must remain open at least eight hours per day. Patients must get access to their doctor within one day for acute problems and within three days for chronic conditions. If certain services are not available in Estonia, patients can seek care abroad. In non-urgent situations, patients must seek approval from the EHIF. The service must be medically justifiable and must be proven efficacious with a probability of success of at least 50%. In order to add new benefits to be covered under EHIF, the managerial board conducts an evaluation process and recommends services to the supervisory board, which then proposes them to the Ministry of Social Affairs where they are reviewed and sent to the government for approval once per year. There are four criteria for including or excluding services from the benefits package:
|