How many methods are there for paying health insurance examination and treatment costs? What are the principles for paying examination and treatment costs based on service prices?
How many methods of payment for medical examination and treatment expenses under health insurance are currently regulated?
Based on the provisions at Article 30 of the Health Insurance Law 2008 (amended by Clause 19, Article 1 of the Amended Health Insurance Law 2014) as follows:
Methods of payment for health insurance medical examination and treatment expenses
1. Payment for health insurance medical examination and treatment expenses is carried out by the following methods:
a) Capitation payment is paying a predetermined fee for a registered cardholder at a healthcare service provider within a specific period;
b) Service-based payment is paying based on the cost of drugs, chemicals, medical supplies, medical equipment, and technical medical services used for the patient;
c) Case-based payment is paying based on predetermined medical examination and treatment costs for each case according to the diagnosis.
2. The Government of Vietnam prescribes the specific application of the payment methods for health insurance medical examination and treatment expenses stipulated in Clause 1 of this Article.
Thus, payment for health insurance medical examination and treatment expenses is carried out by the following methods:
- Capitation payment is paying a predetermined fee for a registered cardholder at a healthcare service provider within a specific period;
- Service-based payment is paying based on the cost of drugs, chemicals, medical supplies, medical equipment, and technical medical services used for the patient;
- Case-based payment is paying based on predetermined medical examination and treatment costs for each case according to the diagnosis.
How many methods of payment for health insurance medical examination and treatment expenses are there? How are the principles of payment for medical examination and treatment expenses according to service prices implemented?
How are the principles of payment for medical examination and treatment expenses according to service prices implemented?
Based on the provisions at Clause 3, Article 24 of the Decree 146/2018/ND-CP (amended by Clause 8, Article 1 of the Decree 75/2023/ND-CP) as follows:
Service-based payment
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Principles of payment:
a) The costs of medical examination services, hospital bed service costs, and the costs of technical services and tests used for the patient within the scope and level of health insurance coverage are paid based on the actual amount used and the current regulated prices;
b) The costs of drugs, chemicals, and medical supplies not included in the price of medical examination and treatment services or used in technical services without regulated prices that are used for the patient within the scope and level of health insurance coverage are paid based on the actual amount used and the purchase prices as regulated by the bidding law;
c) The costs of blood and blood products are paid according to guidelines by the Minister of Health.
Thus, the principles of payment for medical examination and treatment expenses according to service prices are regulated as follows:
- The costs of medical examination services, hospital bed service costs, and the costs of technical services and tests used for the patient within the scope and level of health insurance coverage are paid based on the actual amount used and the current regulated prices;
- The costs of drugs, chemicals, and medical supplies not included in the price of medical examination and treatment services or used in technical services without regulated prices that are used for the patient within the scope and level of health insurance coverage are paid based on the actual amount used and the purchase prices as regulated by the bidding law;
- The costs of blood and blood products are paid according to guidelines by the Minister of Health.
What are the regulations on the time of application of the principles of payment according to service prices?
Based on the provisions at Clause 4, Article 3 of the Decree 75/2023/ND-CP as follows:
Effectiveness
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4. The provisions at Clause 8, Article 1 and Clause 3, Article 2 of this Decree are applied from January 1, 2019. The payment and settlement of health insurance medical examination and treatment expenses from January 1, 2019, are carried out according to the provisions at Articles 30, 31, and Clause 2, Article 32 of the Health Insurance Law and the provisions at Clause 8, Article 1 of this Decree.
Thus, the principles of payment for medical examination and treatment expenses according to service prices are applied from January 1, 2019.
The payment and settlement of health insurance medical examination and treatment expenses from January 1, 2019, are carried out according to the provisions at Articles 30, 31, and Clause 2, Article 32 of the Health Insurance Law 2008 (amended and supplemented by the Amended Health Insurance Law 2014) and the provisions at Clause 8, Article 1 of the Decree 75/2023/ND-CP.
The Decree 75/2023/ND-CP will take effect from December 3, 2023.
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