Vietnam: National base capitation rates for medical costs covered by health insurance

The national base capitation rates for medical costs covered by health insurance in Vietnam are stipulated in Article 5, Circular 04/2021/TT-BYT as follows:

1. The national base capitation rate (hereinafter referred to as “SPCBtq”) of the fund allocation year is calculated adopting the following formula:

Where:

a) QUY_ĐStq: comply with Clause 1 Article 4 hereof;

b) The TĐtq: The number of national equivalence cards in the fund allocation year, which is the sum of equivalence cards of all provinces in the fund allocation year.

2. The number of equivalence cards of a province = (Number of intra-provincial equivalence cards of that province in the fund allocation year) + (Number of inter-provincial receiving equivalence cards of that province in the fund allocation year).

a) The number of intra-provincial equivalence cards of a province in the fund allocation year is the sum of intra-provincial equivalence cards of 6 age groups specified in Clause 2 Article 2 hereof in the fund allocation year of that province. The number of intra-provincial equivalence cards in the fund allocation year of the age group i (hereinafter referred to as “The TĐ nội tỉnh nhóm i năm giao quỹ”) is calculated adopting the following formula:

Where:

- “Số lượt nội tỉnh nhóm itỉnh ntlk” is total times patients of the age group i who have health insurance cards and have registered for initial healthcare services in the province (excluding health insurance cards issued by other provinces) receive healthcare services from health facilities in that province in the previous year;

- “The QĐ nhóm itỉnh ntlk” is the number of conversion cards for the age group i of the province in the previous year;

- “The QĐ nhóm itỉnh năm giao quỹ” is the number of conversion cards for the age group i of the province in the fund allocation year;

- “Hệ số quy đổi lượt nhóm itoàn quốc năm giao quỹ” is the national conversion factor for times of use of healthcare services of the age group i in the fund allocation year.

b) The number of inter-provincial receiving equivalence cards of a province is the sum of inter-provincial receiving equivalence cards of 6 age groups specified in Clause 2 Article 2 hereof.

c) National conversion factor for times of use of healthcare services of the age group i (hereinafter referred to as “HSQĐLtqi”) in the fund allocation year is calculated adopting the following formula:

Where:

Sincerely.