Orthopedic and rehabilitation devices play a very important role to people with physical disabilities, as these devices support mobility, improve body functions that were lost or altered, minimize the deformation of the body after diseases or accidents; help prevent some diseases, and integrate people with disabilities to the society. A research has shown that, 60% of people with physical disabilities, who don’t use orthopedic and rehabilitation devices, has encountered tendinitis, bursitis and arthritis.1
During the implementation of the project, it can be seen that, the rate of people with physical disabilities that use orthopedic and physical rehabilitation is low. One of the main reason is that these devices (prosthetics, orthopedic crutches, etc.) are not covered by the Health Insurance. It is stated in the Article 23 of Law on Health Insurance, which was passed in 2008 and then amended in 2014, that “Use of replaced itemsincluding artificial limbs, eyes, teeth, optical glasses, hearing aids or movement aids in medical examination, treatment and function rehabilitation” are not eligible for health insurance coverage. Also, as of circular 11/2009/TT-BYT issued on 14th August 2009, health insurance only covered 33 rehabilitation techniques and medical devices relate to orthopedic, but doesn’t belong to rehabilitation for people with disabilities, such as powder coat, powder splints; nails, braces, bolts, screws, cages used in bone surgery of all kinds; artificial vertebrae, pieces spine, the discs for spine surgery regulated in . circular 27/2013/TT-BYT issued on 18th September 2013.
It’s nearly impossible for people with physical disabilities to pay for these devices/services, as their income is very low. According to the Economic costs report, 50% of people with disabilities have a monthly income of equal or under $552. Meanwhile, the cost of an orthopedic device ishigh, and can be more than double the amount. For example, the cost of an ankle-foot orthosis (AFO) is about $115. This is one of the main reason why people with disabilities cannot afford orthopedic and rehabilitation devices. Without these devices, people with disabilities are greatly affected in terms of health, education and mobility.
In The Ministry of Health, with clear understanding of the issue, has enacted Circular 18/2016/TT-BYT dated 30th June 2016 about “Regulations for rehabilitation techniques and items andreimbursement of daytime rehabilitation cost under coverage of health insurance fund”. Of which, it is stated that besides 299 rehabilitation itemss that have already been covered by the health insurance, as regulated in the Circular 27/2013/TT-BYT, 20 more items are now covered by health insurance. There is a highlight that these newly added devices are mostly orthopedic and rehabilitation devices, such as leg splints (foot orthosis, ankle-foot orthosis, knee ankle foot orthosis, and hip orthosis), elbow orthosis, spinal orthosis, trunk orthosis, orthotic chair, orthotic shoes, cerebral palsy chair, anti-decubitus cushion, etc. order to get reimbursement for these orthopedic and rehabilitation devices, it is required that a person with disability must have a health insurance card, and must come to one of the orthopedic and rehabilitation centers/hospitals stated in Circular 46/2013/TT-BYT, including: Orthopedic and rehabilitation departments or orthopedic and rehabilitation centers of health facilities; rehabilitation clinics; orthopedic and rehabilitation centers/hospitals that operate under the regulations of the Ministry of Health.
Still, the Circular 18/2016/TT-BYT fails to include some very essential devices for people with disabilities, such as orthotic wheelchair and prostheses. Also, there are many challenges in implementing this Circular, as technical criteria, implementation process and technical guidance must be set as basement for Social Insurance Fund’s reimbursement.
Despites the challenges, this Circular is a good sign for people with physical disabilities that some orthopedic and rehabilitation devices are now regulated to be covered by health insurance. It helps promote the access to mobility and transportation for this disadvantaged group. It is hoped that this Circular would be a great support for people with disabilities in general, and for people with physical disabilities in specific.
Since 2014, the Action to the Community Development Center (ACDC), as well as the International Committee of the Red Cross-Special Fund for the Disabled (ICRC-SFD), in cooperation with the Ministry of Health, have been consulting and providingevidences to prove the necessity of orthopedic and rehabilitation devices, in order to advocate for the inclusion of these devices to the coverage of health insurance fund. The 02 organizations commit to continue the support for the Ministry of Health during the implementation of this Circular, especially on the building of technical criteria and guidance for reimbursement.