Vietnam Social Security's guidance on resolving problems in the assessment and payment of health insurance medical examination and treatment costs

Vietnam Social Security's guidance on resolving problems in the assessment and payment of health insurance medical examination and treatment costs (Internet image)

On January 16, 2024, Vietnam Social Security issued Official Dispatch 109/BHXH-CSYT guiding a number of contents in documents of the Ministry of Health on guiding the resolution of problems in the assessment and payment of health insurance medical examination and treatment costs.

Vietnam Social Security's guidance on resolving problems in the assessment and payment of health insurance medical examination and treatment costs

Specifically, Vietnam Social Insurance (Social Insurance) received a number of Official Dispatches from the Ministry of Health: No. 8193/BYT-KCB dated December 26, 2023 on problems in payment of medical examination and treatment costs and health insurance (HI) in the field of medical examination and treatment; No. 8221/BYT-KHTC dated December 27, 2023 on guidance on some problems in payment of medical examination and treatment costs covered by health insurance; No. 8253/BYT-KCB dated December 28, 2023 on payment of medical expenses covered by health insurance for hospital bed fees at regional polyclinics, technical services (services) for hemodialysis and laboratory tests are not performed; No. 129/BYT-KCB dated January 10, 2024 on the scope of professional activities of Class IV Nurses performing rehabilitation techniques. Vietnam Social Insurance forwards the above Official Dispatches to the provincial Social Insurance agencies for study and coordination with health insurance medical facilities to implement the following contents:

(1) Official dispatch 8193/BYT-KCB dated December 26, 2023, of the Ministry of Health

- Content 1: Individuals with certification or training certificates in a technical specialty different from the specialty stated on their professional certificate or a decision to supplement their professional scope issued by the competent authority, and with a document from the competent authority allowing them to perform that specific technique, are allowed to practice that technique without having to supplement or adjust their professional certificate. However, they are not allowed to participate in the examination or treatment of a specialty different from the specialty stated on their professional certificate or the decision to supplement their professional scope issued by the competent authority.

- Content 2: For departments organized in the form of inter-specialties, the Head of the department must have a practicing certificate appropriate to one of those specialties.

- Content 3: In the event that the practitioner is a lecturer at a health sector training facility and also works at a medical facility that is a practice facility of that training facility, they can concurrently hold the position of dean of the medical facility from January 1, 2024, according to the provisions of Point b of Clause 5 of Article 41 of Decree 96/2023/ND-CP.

- Content 4: Preventive medicine doctors only perform internal medicine examinations, prescribe and perform techniques and procedures of types 2, 3, and are not classified in Appendix I issued together with Circular 35/2019/TT-BYT. From January 1, 2024 onwards, preventive medicine doctors have the scope of medical practice specified in Appendix VII, issued with Circular 32/2023/TT-BYT.

- Content 5: In case the training certificate does not specifically identify the specialized techniques that the practitioner is allowed to perform, for example, the training certificate states that the course has been completed according to the continuous training program "Basic knowledge and skills in Ophthalmology", "Basic Endoscopic Surgery," the head of the medical facility is responsible for reviewing, based on the training program and the actual capacity of the practitioner, serving as documents specifically defining the techniques that practitioners are allowed to perform and are responsible for their decisions.

- Content 6: Posting practitioner information and medical examination registration carried out in accordance with the provisions of Articles 12, 13, 14, and 15 of Decree 109/2016/ND-CP, from January 1, 2024, comply with the provisions of Articles 27, 28, and 29 of Decree 96/2023/ND-CP.

- Content 7: In cases where the scope of professional activities stated on the professional certificate is the names of specific medical procedures performed by the practitioner, rather than following the specialty groups listed in Appendix 4b issued with Circular 41/2015/TT-BYT or the regulations in Circular 35/2019/TT-BYT (for example, a professional certificate stating the scope of professional activities as "General medical examination, gastrointestinal endoscopy, ENT endoscopy"), the following regulations apply: For professional certificates issued prior to the issuance of Circular 35/2019/TT-BYT (issued according to the guidance in Official Dispatch 6705/BYT-KCB dated October 4, 2012, by the Ministry of Health), they may continue to be valid; For professional certificates issued after March 1, 2020, they must be implemented in accordance with the regulations of Circular 35/2019/TT-BYT.

Content 8: In cases where the actual number of hospital beds in regular hospitals exceeds the approved number of beds (over a period of 6 months), an adjustment to the content of the operating license must be made due to changes in organizational structure and bed capacity, as regulated in Decree 109/2016/ND-CP. Payment for the excess beds beyond the approved number of beds, for public hospitals, or beyond the number of beds at the time of obtaining the operating license, for non-public hospitals, shall be made in accordance with the regulations of Circular 39/2018/TT-BYT and Circular 13/2019/TT-BYT, but not exceeding one year from the date the additional beds were added. From January 1, 2024, to December 31, 2026, the adjustment of operating licenses due to changes in the number of beds shall be carried out in accordance with Article 145 of Decree 96/2023/ND-CP.

(2) Official dispatch 8221/BYT-KHTC dated December 27, 2023, of the Ministry of Health

- Point 1: Hospital centers have specialized departments established in accordance with the law: payment for hospital beds according to specialties. Hospital centers have specialized departments established in accordance with the law, and hospital bed fees are paid according to specialties. Centers that establish units that are not departments or establish departments that are not qualified according to the provisions of law, pay hospital bed fees according to inter-specialty hospital bed prices stipulated in Circulars on medical examination and treatment service prices of the Ministry of Health from time to time.

- Point 2: The price for a hospital bed at a maternity home before November 17, 2023, must be paid at 50% of the price for a class 3 medical bed at a class 4 hospital. From November 17, 2023, onwards, payment will be made. according to the price specified in Circular 22/2023/TT-BYT.

- Point 3: The procurement of drugs and medical supplies by medical facilities is applied according to Clause 19, Article 3, and Clause 7, Article 4 of Decision 17/2019/QD-TTg in the following cases:

+ Procurement of drugs and medical supplies to serve emergency patients;

+ Medicines and medical supplies have had their contractor selection plan approved but did not win the bid;

+ Medicines and medical supplies are not included in the contractor selection plan for the year, arising when implementing new technical services and technical services that have been or are being transferred;

+ Medical facilities only buy drugs and medical supplies once a year, and the drug or medical supply package has a value of no more than 50 million VND for all drugs or medical supplies.

(3) Official Dispatch 8253/BYT-KCB dated December 28, 2023, of the Ministry of Health

- Point 1 and Point 3: Regarding payment for hospital beds at regional polyclinics and tests without external inspection: Vietnam Social Security will have the following written instructions. Currently, payment for hospital beds at the Regional General Clinic is carried out in accordance with the regulations in Clause 12 of Article 11 of Decree 155/2018/ND-CP.

- Point 2: In hemodialysis cases performed with the participation of a nurse or medical assistant with a 3-month training certificate in dialysis techniques from April 13, 2018 (date April 13, 2018) to November 4, 2019 (time date November 4, 2019), the health insurance fund pays the actual costs used by patients (medicines, chemicals, and medical supplies) for hemodialysis technical services.

(4) Official Dispatch 129/BYT-KCB dated January 10, 2024 of the Ministry of Health

Regarding the scope of professional activities of Class IV Nurses, guided by Official Dispatch 129/BYT-KCB dated January 10, 2024 of the Ministry of Health, Vietnam Social Security will have the following guiding document. From December 31, 2023 onwards, it will still comply with the provisions of Article 4 of Circular 46/2013/TT-BYT, Article 7 of Circular 35/2019/TT-BYT, and Joint Circular 26/2015/TTLT-BYT-BNV. From January 1, 2024 onwards, the scope of practice of practitioners with the professional title of nurse is specified in Appendix No. XII issued with Circular 32/2023/TT-BYT.

Ho Quoc Tuan

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