Proposal on cases of transferring patients between Health insurance-covered primary care providers in Vietnam

Proposal on cases of transferring patients between Health insurance-covered primary care providers in Vietnam (Internet image) 

Regarding this matter, LawNet would like to answer as follows:

The Ministry of Health is seeking opinions on the draft Law amending certain provisions of the Law on Health Insurance (hereinafter referred to as the draft Law).

Proposal on cases of transferring patients between Health insurance-covered primary care providers in Vietnam

Clause 18 of Article 1 of the draft Law proposes amendments to Article 21 of the Law on Health Insurance 2008, which regulates the transfer of patients between health insurance-covered primary care providers, as follows:

- Based on the patient's condition and professional requirements, the family health insurance-covered primary care providers and the initial health insurance-covered primary care providers have the responsibility to transfer the patient to another medical facility at the basic or specialized level that is suitable for the patient's condition and the professional scope of the receiving medical facility.

- In cases where the medical facility does not have a specialized department, cannot perform technical services, does not have sufficient drugs, chemicals, medical supplies, or medical equipment, or exceeds other professional capacities, the health insurance-covered primary care provider has the responsibility to promptly transfer the patient to another health insurance-covered primary care provider at the same professional or higher or lower technical level that has sufficient capacity and professional scope for the patient's condition.

- In cases where the initial health insurance-covered primary care provider does not have a specialized department, cannot perform technical services, does not have sufficient drugs, chemicals, medical supplies, or medical equipment, or exceeds other professional capacities, the patient is allowed to go to another health insurance-covered primary care provider at the same professional or lower technical level that has sufficient capacity and professional scope for the patient's condition.

- Medical facilities with higher specialized technical levels can transfer patients who have received stable treatment but require continued monitoring or inpatient treatment to facilities with lower technical levels if the medical facility is overloaded or at the patient's request, or in cases requiring long-term treatment. The patient is then transferred back to the initial health insurance-covered primary care provider for management and monitoring of chronic diseases.

Proposal for procedures for health insurance-covered medical care in Vietnam

Clause 19 of Article 1 of the draft Law proposes amendments to Article 28 of the Currently, according to Article 27 of the Law on Health Insurance 2008, for a case falling beyond the professional and technical capacity of a health insurance-covered medical care provider, such provider may transfer the patient to another provider according to regulations on technical transfer., which regulates the procedures for health insurance-covered medical care in Vietnam, as follows:

- When there is a need for medical examination and treatment, the insured person goes to the initially registered health insurance-covered primary care provider for examination and treatment.

- The insured person, when seeking medical examination and treatment, must fulfill one of the following provisions:

+ Present a health insurance card with a photo. In case the health insurance card does not have a photo, it must be presented with one of the following documents: identity card, citizen identification card, passport, social insurance book, or other documents proving personal identity as regulated by law. For children under 6 years old, only a health insurance card needs to be presented.

+ Provide the health insurance card number or health insurance number if the health insurance card is integrated with the population database of the Ministry of Public Security.

- In emergency cases, the insured person can receive medical examination and treatment at any medical facility and must present or provide information about the health insurance card or health insurance number as regulated in Clause 1 of Article 28 of the Currently, according to Article 27 of the Law on Health Insurance 2008, for a case falling beyond the professional and technical capacity of a health insurance-covered medical care provider, such provider may transfer the patient to another provider according to regulations on technical transfer. before being discharged from the hospital.

- In cases of transferring to a specialized technical level related to health insurance medical examination and treatment, the insured person must have a transfer record from the medical facility according to the regulations on medical examination and treatment.

- In cases of re-examination at the request of treatment, the insured person must have an appointment letter for re-examination from the medical facility.

To Quoc Trinh

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