Guidelines for payment of medical examination and treatment covered by health insurance in Vietnam (Draft)

Guidelines for payment of medical examination and treatment covered by health insurance in Vietnam (Draft) (Illustration)

This draft Circular guides the payment of medical examination and treatment expenses covered by health insurance according to service prices as prescribed in Article 24 of Vietnam's Decree 146/2018/ND-CP dated October 17, 2018 of the Government detailing and guiding measures to implement a number of articles of the Law on Health Insurance.

In the draft Circular, it is clear that the scope of this Circular does not apply to medical care costs covered by health insurance of subjects participating in health insurance according to Vietnam's Decree 70/2015/ND-CP dated September 1, 2015 of the Government detailing and guiding the implementation of a number of articles of the Law on Health Insurance for the people's army, people's police, and cipher workers.

Accordingly, the Draft Circular stipulates the payment according to service prices as follows:

- Service price payment is the method of payment for medical expenses on the basis of medical service prices prescribed by competent authorities and costs of drugs, chemicals, medical supplies, blood and blood products not yet included in the service price used for patients at the medical facility .

- Payment according to the price of medical services is applied to pay the cost of medical care and health insurance, minus the cost of medical services already paid by other methods.

- Principle of payment according to service price:

• Prices of medical care services covered by health insurance are uniformly applied to hospitals of the same class nationwide;

• Expenses for drugs, chemicals, and medical supplies that have not been included in the price of medical care services shall be paid according to the purchase price in accordance with the law on bidding;

• The cost of blood and blood products shall be paid according to the guidance of the Minister of Health of Vietnam.

At the same time, the advance, payment, and settlement of health care costs covered by health insurance for health care facilities with health insurance are made quarterly in accordance with regulations on advance, payment, and settlement of medical expenses with health insurance as prescribed in Clause 1, Points a, b and c, Clause 2, Article 32 of the Law on Health Insurance and its guiding documents.

Thuy Tram

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