Enhancement of rights assurance for health insurance cardholders during medical exams and treatment in Vietnam

Enhancement of rights assurance for health insurance cardholders during medical exams and treatment in Vietnam (Image from the internet)

On June 10, 2024, Vietnam Social Security issued Official Dispatch 1733/BHXH-CSYT regarding the enhancement of rights assurance for health insurance cardholders during medical exams and treatment in Vietnam.

Enhancement of rights assurance for health insurance cardholders during medical exams and treatment in Vietnam

To ensure the legitimate rights of health insurance participants, Vietnam Social Security requests provincial social security offices to issue documents to healthcare facilities participating in health insurance schemes, asking them to ensure the full rights of health insurance cardholders when they come for medical exams and treatment, as follows:

- Implement the medical examination procedures at the Outpatient Department conformably to Decision 1313/QD-BYT dated April 22, 2013, by the Ministry of Health (Hanoi, Vietnam) and the guidance of the Department of Medical Examination and Treatment Management - Ministry of Health through Official Dispatch 855/KCB-QLCL&CDT dated July 5, 2023, to reduce waiting times for medical exams, streamline procedures for health insurance patients, and improve the quality of medical exams and treatment. Measures include: applying information technology in registration and medical exams, online appointment scheduling, registering for exams by time slots, providing clear directions for procedures at the outpatient department, ensuring patients do not have to collect their own test results, and not requiring prepayments for each test or X-ray.

- Ensure the provision of medications, medical supplies, and technical services within the scope of health insurance fund payments, consistent with the professional capacity of the healthcare facility. If there is an inability to provide or if it exceeds the facility's expertise, the healthcare facility must transfer the patient to another facility capable of providing the required services and expertise, ensuring patients do not have to bear the costs covered by health insurance (except at the patient's or their family's request).

- Inpatient wards must ensure full direct cost elements included in the bed-day price structure as stipulated in clause 2, Article 3 of Circular 22/2023/TT-BYT dated November 17, 2023, by the Ministry of Health, such that inpatient rooms have operational air conditioning without requiring patients to opt for higher-tier rooms just to access such facilities.

- If a patient suffers from conditions listed under the referral paper usage in the calendar year, as per Appendix 01 issued with Circular 40/2015/TT-BYT dated November 16, 2015, by the Ministry of Health, and has been referred by one healthcare facility, the receiving facility must provide medical exams and treatments according to regulations even if the patient arrives past the appointment time.

- If an insurance card shows that the patient has participated in health insurance for five consecutive years and the co-payment amount exceeds 6 months' statutory pay rate either in one visit or accumulated over a year, the healthcare facility should not charge the co-payment exceeding the limit as per clause 3, Article 27 of Decree 146/2018/ND-CP dated October 17, 2018, by the Government of Vietnam detailing some provisions of the Health Insurance Law.

Provincial social security directors are required to intensify health insurance verification efforts. If a healthcare facility fails to ensure full rights for health insurance cardholders, such as insufficient provision of medications, medical supplies, or technical services, and makes patients self-fund, report to the provincial People's Committee and Department of Health for penalties, and require the facility to reimburse patients as per clause 1, Article 86 of Decree 117/2020/ND-CP dated September 28, 2020, governing administrative penalties in the healthcare sector.

For detailed content, refer to Official Dispatch 1733/BHXH-CSYT dated June 10, 2024.

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