What is proposal for patients with health insurance cards to buy medicine outside and have costs paid by the health insurance fund in Vietnam?

What is proposal for patients with health insurance cards to buy medicine outside and have costs paid by the health insurance fund in Vietnam?

In Article 2 of the Draft Circular regulating the payment of costs of drugs and medical supplies directly to patients participating in health insurance, the following proposals are proposed:

Conditions apply

The health insurance fund pays the costs of drugs and medical supplies directly to patients with health insurance cards or pays the costs of drugs and medical supplies to medical examination and treatment facilities in cases where there is enough 03 following conditions:

1. Medicines and medical supplies prescribed to patients are within the scope of benefits of health insurance participants.

2. The patient is diagnosed, prescribed and prescribed drugs and medical supplies, but at the time of using the active ingredients of the drug, the medical supplies are not available at the medical examination and treatment facility:

a) There is no available finished drug containing the active ingredient that the patient is prescribed;

b) Appropriate medical supplies that the patient is prescribed to use are not available.

Thus, it is expected that when a patient with a health insurance card buys medicine outside, the cost will be paid by the health insurance fund when the following conditions in Vietnam are met:

- Medicines and medical supplies prescribed to patients are within the scope of benefits of health insurance participants.

- The patient is diagnosed, prescribed and prescribed drugs and medical supplies, but at the time of using the active ingredients of the drug, the medical supplies are not available at the medical examination and treatment facility:

+ There is no available finished medicine containing the active ingredient that the patient is prescribed;

+ Appropriate medical supplies that the patient is prescribed to use are not available.

Note: the Draft Circular regulating the payment of costs of drugs and medical supplies directly to patients participating in health insurance is still in the consultation process and has not yet taken effect in Vietnam.

What is proposal for patients with health insurance cards to buy medicine outside and have costs paid by the health insurance fund in Vietnam? (Image from the Internet)

How many years is health insurance card valid for in Vietnam?

Article 12 of Decree 146/2018/ND-CP stipulates health insurance cards as follows:

Health insurance cards

Health insurance cards shall be issued by competent social insurance agencies and contain the following information:

1. Personal information of a policyholder, including full name, gender, date of birth, permanent residence or workplace address.

2. Health insurance coverage rate stipulated in Article 14 hereof.

3. Start date of a health insurance card.

4. Name of the primary healthcare establishment.

5. The consecutive 5-year or longer period of health insurance participation of policyholders making co-payment of healthcare costs. The consecutive period of health insurance participation refers to the date subsequent to the previous date of issue inscribed on a health insurance card; in case of an interval, it must be less than 03 months.

 

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Thus, currently the health insurance card will not show the expiry date of the card, but only the time when the health insurance card is valid for use in Vietnam.

However, the current health insurance card will show information about the duration of health insurance participation for 5 consecutive years or more for subjects who must jointly pay for medical examination and treatment costs in Vietnam.

Continuous health insurance participation period is the period of use recorded on the health insurance card for the next time following the previous time; In case of interruption, the maximum duration is not more than 03 months in Vietnam.

What are regulations on payment method for medical examination and treatment costs in Vietnam?

Article 30 of the 2008 Health Insurance Law, amended by Clause 19, Article 1 of the 2014 amendments Health Insurance Law, stipulates methods of payment of costs of insured medical care as follows:

Methods of payment of costs of insured medical care

1. Costs of health insurance-covered medical care shall be paid by one of the following methods:

a) Rate-based payment is a payment of fixed charges for covered services of an insurance policy registered at a medical facility over a certain period of time.

b/ Service charge-based payment, which means payment on the basis of costs of medicines, chemicals, medical supplies and equipment as well as technical services provided for patients;

c/ Disease-based payment, which means payment according to medical care costs pre-determined for each case based on diagnosis.

2. The Government shall specify the application of methods of payment of health insurance-covered medical care costs defined in Clause 1 of this Article.

Thus, payment of medical examination and treatment costs under health insurance in Vietnam is carried out by the following methods:

- Rate-based payment is a payment of fixed charges for covered services of an insurance policy registered at a medical facility over a certain period of time;

- Service charge-based payment, which means payment on the basis of costs of medicines, chemicals, medical supplies and equipment as well as technical services provided for patients;

- Disease-based payment, which means payment according to medical care costs pre-determined for each case based on diagnosis.

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