Contents of data-based assessment of health insurance costs in Vietnam

Tran Thanh Rin

16:49, 16/12/2022

Vietnam Social Security issued Decision 3618/QD-BHXH dated 12/12/2022 on the process of medical insurance assessment (HI).

According to Vietnam's Decision 3618/QD-BHXH, the assessment of health insurance costs based on data is carried out according to the following contents:

- Structure, data format, and logic of information fields in XML data.

- Data consistency on Form C79-HD, Form 19/BHYT, Form 20/BHYT, Form 21/BHYT, and XML data.

- Health insurance card information with health insurance card issuance data

- Health insurance benefits and entitlements based on XML data

- Drugs, medical supplies, medical examinations, and treatment services within the scope of health insurance entitlement, appropriate to payment conditions at medical examination and treatment establishments.

- The number of medical examination and treatment visits covered by health insurance.

- Detecting abnormal indicators and information that need proactive assessment.

Among the data used to assess the cost of a medical examination covered by health insurance in Vietnam are:

- Detailed information on medical examination expenses to be paid for patients covered by health insurance;

- Data summarizing medical examination expenses of the participants in health insurance;

- General information on medical supplies, drugs, and technical services used by insured patients.

Vietnam's Decision 3618/QD-BHXH takes effect on January 1, 2023, and replaces Vietnam's Decision 1456/QD-BHXH of 2015.

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