Guidelines on direct payment of medication and medical equipment expenses for holders of health insurance cards in Vietnam

Guidelines on direct payment of medication and medical equipment expenses for holders of health insurance cards in Vietnam​ (Image from the internet)

On January 10, 2025, the Ministry of Health of Vietnam issued Official Dispatch 224/BYT-BH regarding direct payment for medication and medical equipment expenses for holders of health insurance cards according to Circular 22/2024/TT-BYT.

Guidelines on direct payment of medication and medical equipment expenses for holders of health insurance cards in Vietnam

The Ministry of Health of Vietnam received Official Dispatch 4897/BHXH-CSYT dated December 27, 2024, from Vietnam Social Security regarding direct payment for medication and medical equipment expenses for holders of health insurance cards according to Circular 22/2024/TT-BYT. Vietnam Social Security requested the Ministry of Health to comment on the confirmation slip template regarding the details of medications and medical equipment within the scope of payment and payment conditions attached to the prescription or hospital discharge paper for patients to submit to social insurance agencies when requesting direct payment. The Ministry of Health provides the following opinions:

* Regarding the confirmation slip template:

Clause 1, Article 5 of Circular 22/2024/TT-BYT stipulates as follows:

“Direct payment documents are carried out according to the provisions in Article 28 of Decree No. 146/2018/ND-CP dated October 17, 2018, of the Government of Vietnam detailing and guiding measures to implement certain articles of the Law on Health Insurance.”

Article 28 of Decree 146/2018/ND-CP stipulates the documents required for direct payment request as follows:

“1. Photocopies of the following documents (accompanied by the original for comparison):

a) Health insurance card, personal identification papers as stipulated in Clause 1, Article 15 of this Decree.

b) Hospital discharge papers, medical examination slips, or medical records for the medical examination, treatment claim being requested for payment.

2. Invoice and related documents.”.

The dossier and procedure for direct payment of medical examination and treatment expenses between social insurance agencies and health insurance participants have been announced at Decision 7291/QD-BYT dated December 7, 2018, on the announcement of newly issued administrative procedures in the field of health insurance under the management scope of the Ministry of Health in Decree 146/2018/ND-CP. Apart from the document components stipulated in Decree 146/2018/ND-CP, there are no additional confirmation templates.

Therefore, the Ministry of Health requests that Vietnam Social Security direct the social insurance agencies to cooperate with medical examination and treatment facilities to carry out the procedures and documents for direct payment to patients in accordance with the stipulations of Circular 22/2024/TT-BYT and not introduce any document components beyond the provisions.

* Regarding other related documents:

Clause 4, Article 6 of Circular 22/2024/TT-BYT stipulates that the head of the medical examination and treatment facility is responsible for:

“a) Issuing regulations or guidance documents to implement this Circular at the medical examination and treatment facility;

b) Guiding practitioners to specifically note the unavailability of medications and medical equipment in cases stipulated in Clauses 2 and 3, Article 3 of this Circular on prescriptions or medical records for patients to purchase themselves;

c) Organizing information, guidance, and counseling on the benefits of health insurance for patients; providing specific information to patients on the unavailability of medications, medical equipment, and related provisions of this Circular for patients to make decisions.”

Based on the regulations of the Circular, medical examination and treatment facilities issue guidance documents for implementation, including instructions for practitioners to note on prescriptions or medical records the unavailability of prescribed medications, medical equipment meeting the direct payment conditions stipulated.

Medical examination and treatment facilities shall provide documents including copies of prescriptions or medical records with specific notes according to the provisions in Point b, Clause 4, Article 6 of Circular 22/2024/TT-BYT to the patient or the lawful representative of the patient to carry out direct payment procedures with the social insurance agency.

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