What are the regulations on price list of medical examination and treatment services covered by health insurance in Vietnam according to Circular 22/2023/TT-BYT?
- What are the regulations on price list of medical examination and treatment services covered by health insurance in Vietnam?
- What are the regulations on direct expenses included in prices for medical examination in Vietnam?
- Vietnam: What are the rules for application of medical service prices for regional polyclinics?
What are the regulations on price list of medical examination and treatment services covered by health insurance in Vietnam?
On November 17, 2023, the Minister of Health issued Circular 22/2023/TT-BYT on unifying prices of medical examination and treatment services covered by health insurance among hospitals of the same class across the country and guidelines for applying prices and payment for medical services in certain cases.
Specifically, the price list of health insurance medical examination services (including direct costs and salaries) in Appendix I issued with Circular 22/2023/TT-BYT is as follows:
- Special class hospital: 42,100 VND
- Class I hospital: 42,100 VND
- Class II hospital: 37,500 VND
- Class III hospital: 33,200 VND
- Class IV hospital: 30,100 VND
- Commune health station: 30,100 VND
- Consultation to determine difficult cases (expert/case; only applicable to cases inviting experts from other units to consult at medical examination and treatment facilities): 200,000 VND.
What are the regulations on price list of medical examination and treatment services covered by health insurance in Vietnam according to Circular 22/2023/TT-BYT?
What are the regulations on direct expenses included in prices for medical examination in Vietnam?
In Clause 1, Article 3, Circular 22/2023/TT-BYT stipulates the price structure of health insurance medical examination and treatment services:
Composition of prices for medical services covered by health insurance
Prices for medical services specified in this Circular shall be calculated based upon direct expenses and salaries in order to ensure the provision of medical examination and treatment; to be specific:
1. Direct expenses included in prices for medical examination:
a) Expenses incurred on patient clothing, scrubs, medical cap, surgical mask, bedspread, pillow, mattress, mat, stationery, medical glove, cotton wool, bandage, alcohol, gauze, brine and other supplies serving the medical examination.
b) Expenses incurred on electricity, water, fuels, daily-life waste treatment, medical waste (solid and liquid waste); laundry, steaming, drying, washing or disinfecting cloth, examination equipments; expenses incurred on cleaning and ensuring environment hygiene; antiseptic supplies and chemicals during the examination;
c) Expenses incurred on maintenance and care of equipment, purchase of assets and tools for replacement such as air conditioners, computers, printers, dehumidifiers, fans, desks, chairs, cabinets, lights and other necessary tools during medical examination.
2. Direct expenses included in prices for hospital stay:
...
Thus, according to the above regulations, from November 17, 2023, direct expenses included in prices for medical examination include:
- Expenses incurred on patient clothing, scrubs, medical cap, surgical mask, bedspread, pillow, mattress, mat, stationery, medical glove, cotton wool, bandage, alcohol, gauze, brine and other supplies serving the medical examination.
- Expenses incurred on electricity, water, fuels, daily-life waste treatment, medical waste (solid and liquid waste); laundry, steaming, drying, washing or disinfecting cloth, examination equipments; expenses incurred on cleaning and ensuring environment hygiene; antiseptic supplies and chemicals during the examination;
- Expenses incurred on maintenance and care of equipment, purchase of assets and tools for replacement such as air conditioners, computers, printers, dehumidifiers, fans, desks, chairs, cabinets, lights and other necessary tools during medical examination.
Vietnam: What are the rules for application of medical service prices for regional polyclinics?
In Article 4, Circular 22/2023/TT-BYT stipulates rules for application of medical service prices in medical facilities contracted to provide medical services covered by health insurance as follows:
Rules for application of medical service prices in medical facilities contracted to provide medical services covered by health insurance
1. For institutes with patient beds, medical centers providing medical services that are licensed to serve functions of hospitals, classed medical centers in districts providing medical services, apply the prices by hospital of the same class.
2. For health protection and care clinics for public officials in provinces, cities not affiliated to general hospitals in provinces and central-affiliated cities, apply the service prices issued by class II hospitals.
3. For unclassed medical facilities, army medical clinics, civil-military medical clinics, military infirmaries, infirmaries, private polyclinics and specialty clinics, apply the prices issued by class IV hospitals.
4. For regional polyclinics:
a) If regional polyclinics are licensed to serve functions of hospitals or fall into the cases specified in clause 12, Article 11 of the Government’s Decree No. 155/2018/ND-CP dated November 12, 2018 on amendments to certain articles related to the business and investment conditions under state management of the Ministry of Health, apply the prices for medical services issued by class IV hospitals;
b) If only providing emergency medical response and medical services for outpatients, apply the prices for medical services issued by class IV hospitals. If permitted by the Department of Health to have patient beds, the price for an outpatient bed shall be equal to 50% of the price for hospital stay of type 3 inpatient bed of class IV hospitals. An outpatient can only be confined to a bed for maximum 3 days for each medical treatment. Payment for medical examination service is not required if the price for outpatient bed is paid.
...
Accordingly, the principles for applying service prices to regional polyclinics include the following principles:
- If regional polyclinics are licensed to serve functions of hospitals or fall into the cases specified in clause 12, Article 11 of the Government’s Decree 155/2018/ND-CP.
- If only providing emergency medical response and medical services for outpatients, apply the prices for medical services issued by class IV hospitals
If permitted by the Department of Health to have patient beds, the price for an outpatient bed shall be equal to 50% of the price for hospital stay of type 3 inpatient bed of class IV hospitals
LawNet
