Vietnam Social Security to provide guidance on signing health insurance medical examination and treatment contracts in Vietnam

Vietnam Social Security to provide guidance on signing health insurance medical examination and treatment contracts in Vietnam (Internet image) 

On December 12, 2023, Vietnam Social Insurance issued Official Dispatch 4195/BHXH-CSYT with instructions for signing health insurance medical examination and treatment contracts.

Vietnam Social Security to provide guidance on signing health insurance medical examination and treatment contracts in Vietnam

Implementing the Law on Health Insurance (HI), Decree 146/2018/ND-CP detailing and guiding measures to implement a number of articles of the Law on Health Insurance and Decree 75/2023/ND-CP amending and supplementing a number of articles of Decree 146/2018/ND-CP, Vietnam Social Insurance (Social Insurance) guides provincial social insurance agencies to implement the signing of medical examination and treatment contracts under health insurance as follows:

(1) Continue to sign health insurance medical examination contracts according to the instructions of Vietnam Social Security in Official Dispatch 4076/BHXH-CSYT dated December 13, 2021, Official Dispatch 3794/BHXH-CSYT dated December 12, 2022 and the health insurance appraisal process issued with Decision 3618/QD-BHXH dated December 12, 2022.

(2) Request the Director of the Provincial Social Insurance to evaluate and decentralize the signing of health insurance medical examination contracts to the district-level Social Insurance in accordance with the provisions at Point h, Clause 4, Article 6 of Decision 2355/QD-BHXH dated September 16, 2022 of the General Director of Vietnam Social Insurance, which stipulates the functions, tasks, powers, and organizational structure of local social insurance. Develop a plan to guide and support the assessment, payment, and finalization of health insurance medical examination and treatment costs for the district-level social insurance agency.

(3) Content of the health insurance medical examination and treatment contract according to Form No. 7, Appendix issued with Decree 75/2023/ND-CP. The Provincial Social Insurance Agency agrees with the health insurance medical examination and treatment facility to supplement a number of contents in the Contract according to the provisions of law (attached content).

(4) Evaluate the necessity of signing a health insurance health care contract with a new health care facility based on the general health insurance health care situation in the area (number of health care facilities that have signed health insurance health care contracts, health care overload, ability to meet health insurance card holders' medical needs, increased number of health insurance cards, etc.), the use of assigned health insurance medical examinations, and treatment expenditure estimates. The Director of Provincial Social Insurance is responsible for signing the health insurance medical examination and treatment contract with the new medical examination and treatment facility.

(5) Organize the implementation of health insurance medical examination and treatment contracts

- Actively coordinate with the Department of Health in: identifying medical facilities to register initial health insurance medical services at all levels in the province; Regulation of subjects, structure of target groups, number of health insurance participants registering for initial medical examination and treatment at health care facilities in accordance with actual local conditions, and response capacity of medical facilities; Guidance on health insurance and health care referrals between health care facilities; Instructions for registering or changing the place of registration of initial medical examination under health insurance... according to the provisions of Articles 13 and 14 of Circular 40/2015/TT-BYT regulating registration of initial medical examination under health insurance and referral for medical examination under health insurance and Official Dispatch 3637/BHXH-CSYT dated November 29, 2022, of Vietnam Social Security.

- Closely review contract documents to ensure completeness and compliance with regulations: operating license, person in charge of the medical facility, decision on hospital classification, operating location of the medical facility, people registered to practice medical examination and treatment, etc. In case of any changes or expiration, request the medical examination and treatment facility to fully supplement according to regulations.

- Work with medical facilities and have a record determining the number of hospital beds and medical staff as required at medical facilities, ensuring compliance with regulations at Points c and d, Clause 1, Article 8 of Circular 13/2023/TT-BYT, which regulates the price framework and method for determining the price of on-demand medical services provided by state medical facilities.

- Strengthen inspection of patient service quality at medical facilities according to the provisions of Point a, Clause 4, Article 9 of Circular 22/2023/TT-BYT. Note that clinics and patient rooms must use air conditioning to serve patients if it is included in the medical service price structure. It is recommended that medical facilities ensure the number of people working in accordance with the provisions in Article 3 of Circular 03/2023/TT-BYT, providing guidance on job positions, quotas on the number of employees, and employee structure by professional title in public health units.

More details can be found in Official Dispatch 4195/BHXH-CSYT, issued on December 12, 2023.

Ho Quoc Tuan

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