Additional regulations on medical examination and treatment costs under health insurance at private hospitals in Vietnam

Additional regulations on medical examination and treatment costs under health insurance at private hospitals in Vietnam​ (Image from internet)

Additional regulations on medical examination and treatment costs under health insurance at private hospitals in Vietnam

In Clause 6, Article 1 of Decree 02/2025/ND-CP adding Clauses 11, 12, and 13 after Clause 10 Article 27 of Decree 146/2018/ND-CP, the payment of medical examination and treatment expenses under health insurance for private hospitals in Vietnam is as follows:

(1) Private medical examination and treatment facilities propose payment for medical examination and treatment service fees under health insurance according to the price for that technical service defined or approved by the provincial People's Council for state medical examination and treatment facilities in the province, city directly under the central government (province), bear responsibility for their proposal, and are compensated by the health insurance fund based on the following specific principles:

(i) Private medical examination and treatment facilities with specialized levels are compensated not exceeding the highest price of medical examination and treatment services under health insurance of state medical examination and treatment facilities of the same specialized level in the province, or of state basic level facilities in the province if no state specialized level facilities exist;

(ii) Basic level private medical examination and treatment facilities are compensated not exceeding the highest price of medical examination and treatment services under health insurance of state basic level facilities in the province;

(iii) Primary level private medical examination and treatment facilities are compensated not exceeding the lowest price of medical examination and treatment services under health insurance of state basic level facilities in the province;

(iv) Private medical examination and treatment facilities conducting technical services already approved but not yet priced or approved by the provincial People's Council for state facilities can be compensated not exceeding the highest price of such services in adjacent state facilities or other provinces nationwide when no price exists for these technical services based on principles stipulated in points (i), (ii), and (iii).

(2) If state medical examination and treatment facilities perform technical services already approved but not priced by competent authorities, compensation cannot exceed the highest price of such services in state facilities of the same technical level within the province, an adjacent province, or nationwide if the adjacent province lacks pricing per points (i), (ii), (iii), and (iv) of (1).

(3) If state medical examination and treatment facilities conduct technically approved services (excluding services covered in daily bed treatment fees, or stages covered under other service costs) but without determined pricing nationwide, or if a service was prescribed but couldn't proceed due to patient condition, compensation covers:

- Payment for the actual amount of drugs, medical equipment covered by the insurance fund used, per legal purchase price regulations;

- Payment for salaries, wages, allowances, contributions, and surgical, procedural allowances (if applicable) at levels set by the Minister of Health of Vietnam.

Refer to Decree 02/2025/ND-CP effective from January 1, 2025.

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