Instructions for payment of medical insurance for TB examination and treatment

Instructions for payment of health insurance for TB examination and treatment (Illustrated image)

1. Principles of payment of health insurance for TB examination and treatment

- Health insurance participants suspected of having tuberculosis, having tuberculosis, drug-resistant tuberculosis, latent TB and users of medical services related to TB medical examination and treatment are covered by the Health Insurance Fund. Medical treatment in accordance with the law on health insurance.

- When using medical services related to TB diagnosis and treatment, the health insurance fund will cover the costs of medical examination and treatment according to the Guidelines for TB diagnosis, treatment and prevention of the Ministry of Health.

- To be transferred to medical examination and treatment facilities covered by health insurance according to regulations on referral.

2. Payment of TB medical examination and treatment expenses under health insurance

- Payment of medical examination and treatment expenses covered by insurance for people suspected of having tuberculosis, having tuberculosis, having drug-resistant or latent TB, and users of medical services related to medical examination and treatment. TB shall comply with the law on medical examination and treatment and health insurance. The health insurance fund pays medical examination and treatment expenses for the above patients when indicated by:

+ Persons with medical examination and treatment practice certificates whose professional activities are specialized medical examination and treatment for tuberculosis or pulmonary disease;

+ Persons with medical examination and treatment practice certificates other than those specified at Point a of this Clause must receive training in TB treatment according to the Guidelines for TB diagnosis, treatment and prevention of the Ministry of Health;

+ The person who makes the prescription.

- A person suspected of having tuberculosis, having tuberculosis, or having drug-resistant or latent TB disease after being transferred by a higher-level medical examination and treatment establishment to a grass-roots health facility for further monitoring and maintenance treatment, Medical examination and treatment establishments at the grassroots level are responsible for making records for monitoring, management and treatment participation as prescribed.

The health insurance fund pays for the costs of TB drugs and accompanying medical supplies to use such drugs as prescribed; does not pay for medical examination in each time of providing or dispensing TB treatment drugs to that patient.

3. Referral in TB examination and treatment for participants of health insurance

Pursuant to Article 4 of Circular 36/2021 stipulating the referral for TB examination and treatment for participants of health insurance as follows:

(1) The referral for TB medical examination and treatment for participants of health insurance shall comply with the provisions of Circular 40/2015/TT-BYT .

(2) Participants of health insurance who are suspected of having tuberculosis, tuberculosis, drug-resistant or latent TB are determined to be at the correct medical examination and treatment route covered by health insurance when they fall into the cases specified in Article 6 of this Circular. 30/2020/TT-BYT .

(3) A person suspected of having TB disease, suffering from tuberculosis and latent TB is determined to be at the correct medical examination and treatment route covered by health insurance in the following cases:

+ Comply with the provisions of (1), (2);

+ Initial medical examination and treatment registration at the commune level will be transferred to the provincial level and vice versa.

(4) A person with drug-resistant tuberculosis is determined to be at the right medical examination and treatment route covered by health insurance in the following cases:

+ Comply with the provisions of (1), (2);

+ Registration of initial medical examination and treatment at the commune level will be transferred to the provincial level and vice versa;

+ Initial medical examination and treatment registration at the district level will be transferred to the central level and vice versa.

(5) In case the insured person does not know that he or she has tuberculosis but first goes to a medical examination and treatment facility and is diagnosed with tuberculosis, then the patient is referred to hospital according to the above regulations.

Jewel

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