Vietnam: Payment of the hospital stay price by the social insurance agency to the medical facility

According to Circular No. 15/2018/TT-BYT of the Ministry of Health of Vietnam, the number of bed used is determined according to the following formula:

The number of bed used in a quarter (year) = The total days of inpatient treatment in a quarter (year) : total days in a quarter (365 days in a year)

In which, days of inpatient treatment shall be calculated in the following principles:

- 2 days lying in the stretcher, folding bed or bed shared by two patients shall be counted as one day of inpatient treatment;

- 3 days lying in the bed shared by 3 or more patients shall be counted as one day of inpatient treatment.

In case the beds used in a medical facility in a quarter is less than or equal to 120% of the assigned one, 100% of prices for bed use shall be paid according to the number of days for hospital stay and the prescribed price.

In case the beds used in a medical facility in a year is more than 120% of the assigned one, such medical facility and the social insurance agency shall reach an agreement on payment as follows:

- The quarterly bed occupancy rate (hereinafter referred to as bed occupancy rate) shall be equal to (=) the number of bed used in a quarter divided (:) by the number of beds used in 2015 (the year preceding the year in which patients are permitted to use their health insurance in the hospital that is not the one registered in their insurance card) and multiplied by 100%. In case the bed occupancy rate determined according to the above-mentioned method:

+ is less than or equal to 130%, the health insurance agency shall pay the medical facility 100% the price for bed use according to the number of day for hospital stay and the prescribed price.

+ is more than 130% but not exceed 140%, the health insurance agency shall pay the medical facility 97% of the price for bed use according to the number of day for hospital stay and the prescribed price.

+ is more than 140% but not exceed 150%, the health insurance agency shall pay the medical facility 95% of the price for bed use according to the number day for hospital stay and the prescribed price.

+ is more than 150%, the health insurance agency shall pay the medical facility 90% of the price for bed use according to the number of day for hospital stay and the prescribed price.

For the case in which the medical facility is always overloaded due to subjective reasons such as extension of administrative boundaries and an increase in number of initial registration of medical services, the Health Department shall take responsibility to send a report to People's Committee of provinces for considering and increasing patient beds as well as job positions for medical service quality assurance.

For the case in which the medical facility puts reformed, extended or new construction items or works into operation without any approval for additional patient beds from competent authorities, the Health Department and social insurance agency shall mutually agree that the number of additional patient beds in this area shall count towards the designed number of bed approved by competent authorities for the purpose of making payment.

View more details at Circular No. 15/2018/TT-BYT of the Ministry of Health of Vietnam, effective from July 15, 2018.

-Thao Uyen-

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