Guidance on issues related to the payment of medical examination and treatment costs covered by health insurance in Vietnam

Guidance on issues related to the payment of medical examination and treatment costs covered by health insurance​ in cases where tests are not externally assessed or are inadequately performed for quality evaluation in Vietnam

In Official Dispatch 3300/BYT-KCB dated June 14, 2024, the Ministry of Health provides guidance on issues related to the payment of medical examination and treatment costs covered by health insurance​ in cases where tests are not externally assessed or are inadequately performed for quality evaluation in Vietnam as follows:

- According to Clause 6, Article 2 of Circular 01/2013/TT-BYT, the external assessment program is a quality control process that compares and contrasts the results of a laboratory test with the results from multiple other laboratories on the same sample and with results from domestic or international reference laboratories. This process aims to continuously improve test quality and provide evidence for the recognition of laboratories that meet national or international standards.

Therefore, internal quality control is mandatory to ensure the accuracy of tests, while external quality control is an ongoing activity to enhance test quality. External-quality control is merely one phase in the quality assessment of a laboratory's quality system and does not reflect the entire testing process. Not all tests undergo external quality control, and this service is conducted progressively, aligning with the capabilities of domestic and international providers.

- Furthermore, ensuring and controlling test quality encompasses several integrated factors: training, personnel, equipment quality, methods, reagents, and implementing quality management components throughout all three testing phases: pre-testing, during testing, and post-testing.

- Some types of tests have combined cost structures for quality control that do not separate internal and external quality control. Consequently, tests that have not undergone external quality control should be settled according to the regulations on medical examination and treatment service prices. The Ministry of Health will continue directing the implementation of the Scheme for Enhancing the Capacity of Medical Laboratory Quality Management Systems for the 2016-2025 period, approved in Decision 316/QD-TTg dated February 27, 2016, by the Prime Minister of the Government of Vietnam. This will be done progressively, encompassing the provision of external quality control services for tests. Additionally, the Ministry of Health is developing updated technical economic norms, with plans to establish specific norms for external quality control costs for individual test techniques.

- The Ministry of Health issued Official Dispatch 8253/BYT-KCB on December 28, 2023, providing guidance on this issue. The Ministry of Health requests that Vietnam Social Security implement and direct provincial social insurance agencies to comply.

Refer to Official Dispatch 3300/BYT-KCB issued on June 14, 2024.

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