The Ministry of Health of Vietnam's guidance on obstacles in the payment of medical examination and treatment services covered by medical insurance

The Ministry of Health of Vietnam's guidance on obstacles in the payment of medical examination and treatment services covered by medical insurance (Internet image)

On June 14, 2024, the Ministry of Health issued Official Dispatch 3300/BYT-KCB, providing guidance on obstacles in the payment of medical examination and treatment services covered by medical insurance in Vietnam.

The Ministry of Health of Vietnam's guidance on obstacles in the payment of medical examination and treatment services covered by medical insurance 

To address these obstacles and ensure the implementation of unified payments for healthcare costs across the country, the Ministry of Health of Vietnam has the following opinions:

(1) Regarding obstacles in the payment of medical examination and treatment services covered by medical insurance in cases where tests are not externally validated or not fully performed to assess quality:

- According to the regulations in Clause 6, Article 2 of Circular 01/2013/TT-BYT dated January 11, 2013, guiding the management of test quality at medical examination and treatment facilities with testing rooms: "6. The outer examination program means the quality control, collation and comparison of the testing result of a laboratory with testing result of various laboratories on a same sample, comparison with results of international or domestic reference laboratories aiming to unceasingly raise the testing quality and contribute on supplying evidences to recognize a laboratory's obtaining national standard or international standard."

Therefore, internal validation is mandatory to ensure the accuracy of testing, external validation is an activity to continuously improve the quality of testing, and external validation is only one step in the quality assessment of the testing laboratory system and does not reflect the entire testing process. Not all tests require external validation, and external validation services are implemented step by step in accordance with the capacity to provide external validation services of units inside and outside the country.

- Furthermore, ensuring and controlling the quality of testing includes the overall implementation of many factors: training, personnel, quality of equipment, methods, reagents, and the implementation of quality management factors in all 3 stages of testing before, during, and after testing.

- Some types of tests have a common cost structure for both internal and external validation, so tests that have not undergone external validation are recommended to be paid according to the regulations for healthcare service fees. The Ministry of Health will continue to guide the implementation of the Project to enhance the capacity of the medical testing quality management system for the period 2016–2025, approved in Decision 316/QD-TTg dated February 27, 2016, by the Prime Minister according to the roadmap and coverage of the supply of external validation services for testing, and at the same time, the Ministry of Health is developing and updating the economic and technical norms, with the expectation of establishing separate norms for the cost of external validation of specific testing techniques.

- The Ministry of Health has issued Official Dispatch 8253/BYT-KCB dated December 28, 2023, providing guidance on this matter. The Ministry of Health requests the Vietnam Social Security to implement and direct the Social Security agencies of provinces and cities to implement it.

(2) Regarding the addition of regulations on equivalent codes for technical services: The Ministry of Health continues to implement according to the regulations on equivalent codes; for techniques that do not have equivalent codes, apply similar techniques at corresponding body positions and procedures. The Ministry of Health (Department of Medical Examination and Treatment Management) is coordinating with the pediatrics sector to update the content of equivalent codes and review and supplement equivalent codes for technical services.

For the payment of costs related to technical services in the pediatrics sector but performed for adults before the effective date of Circular 22/2023/TT-BYT: it is proposed to apply the payment principles as guided in Clause 2, Article 7 of Circular 39/2018/TTBYT (now Circular 22/2023/TT-BYT): "For medical procedures which have been approved by competent authorities, except care services included in the hospital stay price and services included in expenses incurred on other services but have no prices; payment shall be made according to the number of medicines and supplies given to the patient and the purchase price as regulated by law." The Ministry of Health requests the Vietnam Social Security to implement and direct the Social Security agencies of provinces and cities to implement it.

More details can be found in Circular 3300/BYT-KCB issued on June 14, 2024.

Nguyen Ngoc Que Anh

>> CLICK HERE TO READ THIS ARTICLE IN VIETNAMESE