Is tonsillectomy in Vietnam a type of surgery covered by health insurance? What is the remaining cost that the patient has to pay?
What is tonsillitis? What type of surgery is the tonsillectomy in Vietnam?
- Tonsillitis is a common disease, widely affecting all ages. The disease occurs when two lymph nodes located behind the pharynx become inflamed. Normally, this organ takes on the important task of detecting and producing antibodies against the entry of harmful agents that enter the body through the nose or mouth, such as viruses, fungi, Because it is located at the intersection between the upper respiratory tract and the oral cavity, the tonsils are also easily attacked by microorganisms, leading to swelling.
- Tonsillectomy is a surgical surgery that applies modern techniques such as plasma knives or lasers to remove inflamed and infected tissues. This method is highly effective, after recovering the unpleasant symptoms of the disease will cease completely.
Health insurance coverage for tonsillectomy in Vietnam?
Article 14 of Decree 146/2018/ND-CP guiding Article 22 of the Law on Health Insurance 2008 stipulates the level of health insurance benefits as follows:
“Article 14. Health insurance benefits for the cases specified in Clauses 1 and 7, Article 22 of the Law on Health Insurance
1. Health insurance participants when going for medical examination and treatment according to the provisions of Articles 26, 27 and 28 of the Law on Health Insurance; Clauses 4 and 5, Article 22 of the Law on Health Insurance, the health insurance fund will pay medical examination and treatment expenses within the scope of entitlement with the following enjoyment rates:
a) 100% of medical examination and treatment expenses for the subjects specified in Clauses 3, 4, 8, 9, 11 and 17, Article 3 of this Decree;
b) 100% of medical examination and treatment expenses and no limit on payment rates for drugs, chemicals, medical supplies and technical services as prescribed by the Minister of Health for:
- People who were active in the revolution before January 1, 1945;
- People who were active in the revolution from January 1, 1945 to the day of the August uprising, 1945;
- Vietnamese heroic Mother;
- War invalids and beneficiaries of policies such as war invalids, class B war invalids, sick soldiers with a working capacity decrease of 81% or more;
- Invalids and beneficiaries of policies such as war invalids, class B invalids, and sick soldiers when treating recurrent wounds and diseases;
- Resistance activists infected with toxic chemicals have a working capacity reduction rate of 81 % or more;
- Children under 6 years old.
c) 100% of medical examination and treatment costs at the commune level;
d) 100% of medical examination and treatment expenses, for cases where the cost of a medical examination and treatment is lower than 15% of the base salary;
dd) 100% of medical examination and treatment expenses when the patient has participated in health insurance for 5 consecutive years or more and the amount of money jointly paid for medical examination and treatment expenses in the year is greater than 6 months' salary. establishments, except for cases of going to medical examination and treatment at the wrong level;
e) 95% of medical examination and treatment expenses for the subjects specified in Clause 1, Article 2, Clause 12, Article 3 and Clauses 1 and 2, Article 4 of this Decree;
g) 80% of medical examination and treatment expenses for other subjects;
h) The patient is diagnosed, assigned to be treated by a higher-level medical examination and treatment facility, and transferred back for management, monitoring and drug distribution at the commune-level medical examination and treatment establishment according to the Minister's regulations. The Ministry of Health is funded
Health insurance pays within the benefit scope and level specified at Points a, b, dd, e and g, Clause 1 of this Article.
2. In case a person belongs to many subjects participating in health insurance, he/she shall be entitled to health insurance benefits according to the subject with the highest benefit level specified in Clause 1 of this Article.
3. In case a person with a health insurance card goes to the wrong medical examination and treatment on their own, and then is transferred by the receiving facility to another medical examination and treatment facility, the health insurance fund will pay for it. medical examination and treatment expenses at the level of enjoyment specified in Clause 3, Article 22 of the Law on Health Insurance, except for the following cases: emergency; is being treated as an inpatient and is diagnosed with another disease outside the scope of expertise of the medical examination and treatment establishment; The medical condition has progressed beyond the professional capacity of the medical examination and treatment establishment.
4. Health insurance participants who register for initial medical examination and treatment at the bordering commune health stations of the bordering province are paid 100% of medical examination and treatment expenses by the health insurance fund within the scope of the health insurance fund. entitled to and the level of benefits specified in Clause 1 of this Article when visiting for medical examination and treatment at a health station at a bordering commune of a contiguous province.
5. In case of conversion of health insurance benefits, the new health insurance benefits will be calculated from the time the new health insurance card becomes valid.”
Accordingly, when registering for tonsillectomy on the right or the wrong side, you will enjoy different rates and as follows:
- 80% of the cost of surgery when on the right route
- 100% if treatment is not done at the provincial or district hospital, 40% at the central hospital.
Is tonsillectomy in Vietnam a type of surgery covered by health insurance? What is the remaining cost that the patient has to pay?
How much is the direct payment for tonsillectomy in Vietnam with health insurance card?
Pursuant to the provisions of Article 30 of Decree 146/2018/ND-CP stipulating the level of direct payment when patients receive medical examination and treatment with health insurance as follows:
“Article 30. Direct payment level
1. In case a patient comes for medical examination and treatment at a medical examination and treatment facility at the district level or the equivalent without a contract for medical examination and treatment covered by health insurance (except for emergencies), payment is as follows: :
a) In case of outpatient medical examination and treatment, payment shall be made according to actual expenses within the scope of entitlement and the level of health insurance benefit as prescribed, but not exceeding 0.15 times the base salary at the time of medical examination and treatment. medical examination and treatment;
b) In case of inpatient medical examination and treatment, payment shall be made according to actual expenses within the scope of benefit and health insurance allowance as prescribed, but not exceeding 0.5 times the base salary at the time of medical examination and treatment. discharge.
2. In case a patient comes for inpatient medical examination and treatment at a provincial-level medical examination and treatment establishment and does not have a contract for medical examination and treatment covered by health insurance (except for emergencies), payment shall be made. according to the actual costs within the scope of entitlement and the level of health insurance benefits as prescribed, but not exceeding 1.0 times the base salary at the time of discharge from the hospital.
3. In case a patient comes for inpatient medical examination and treatment at a central-level medical examination and treatment establishment and the equivalent does not have a contract for medical examination and treatment covered by health insurance (except for emergencies), payment shall be paid according to actual expenses within the scope of benefits and health insurance benefits as prescribed, but not exceeding 2.5 times the base salary at the time of hospital discharge.
4. In case a patient goes for medical examination and treatment at the place of initial medical examination and treatment registration, which does not comply with the provisions of Clause 1, Article 28 of the Law on Health Insurance, the health insurance fund shall pay the actual expenses. health insurance within the scope of entitlement and the level of health insurance coverage, but not exceeding 0.15 times the base salary at the time of medical examination and treatment, for outpatient medical examination and treatment, and not more than 0.5 times the base salary at the time of discharge for inpatient medical examination and treatment.”
Accordingly, the level of direct payment when you have surgery on your tonsils is regulated as follows:
- For surgery at the district level without a contract for medical examination and treatment with health insurance:
+ Outpatient: Not more than 0.15 times the base salary at the time of examination
+ Inpatient: Not more than 0.5 times the base salary at the time of discharge
- Inpatient medical examination and treatment at the provincial level and equivalent:
Not more than 1 times the base salary at the time of hospital discharge
- Inpatient medical examination and treatment at the central recruitment agency and the equivalent without a contract for medical examination and treatment covered by health insurance:
Not more than 2.5 times the base salary at the time of leaving, which means direct payment
- Medical examination and treatment at the place of initial registration is not in accordance with regulations:
+ Outpatient: Not more than 0.15 times the base salary at the time of discharge, equivalent to the direct payment
+ Inpatient: Not more than 0.5 times the base salary at the time of discharge, equivalent to the direct payment.
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