Guidelines on determining the frequency, pricing, and payment of medical examination fees in specific cases regarding health insurance in Vietnam

Guidelines on determining the frequency, pricing, and payment of medical examination fees in specific cases regarding health insurance in Vietnam

Circular 39/2024/TT-BYT has added regulations on defining frequency, pricing, and payment for medical examinations in specific cases in Vietnam as follows:

(1) In the case where a patient visits the medical examination department and is then assigned to inpatient treatment according to professional requirements, payment for the medical examination is carried out in accordance with the regulations specified in (3). If the patient does not register for an examination at the medical examination department but proceeds to medical examinations and inpatient treatment in clinical departments as per professional requirements, the examination fee will not be paid.

(2) Medical examination and treatment facilities that organize specialist examinations at clinical departments, and where a person registers for an examination at the medical examination department and has a specialist examination at the clinical department, will be considered as an examination at the medical examination department. The calculation of frequency and pricing will follow the regulations specified in (3).

(3) During the same visit to a medical examination and treatment facility (whether on the same day or due to objective conditions or professional requirements necessitating continuation on the following day), if a patient, after consulting one specialty, needs further consultations with additional specialties, from the second consultation onward, only 30% of the cost of one consultation will be charged. The maximum payable examination expense will not exceed twice the cost of one consultation.

(4) If a patient revisits a facility for further examination on the same day due to abnormal symptoms after having been examined, dispensed medication, and prescribed treatment, this subsequent examination is considered the second and subsequent examination of the day, except in emergency cases, which will be treated as a new examination. Payment will be made in accordance with the provisions of (3).

(5) Medical examination and treatment facilities must coordinate and arrange personnel and examination stations as needed to ensure the quality of service. For examination desks handling over 65 consultations in any 8-hour day, the social insurance agency will only reimburse 50% of the consultation fee from the 66th consultation onwards. If a facility sustains more than 65 consultations per day at any desk over a maximum of three consecutive months, the social insurance agency will not reimburse consultation fees from the 66th visit onward at that examination desk.

More details are available in Circular 39/2024/TT-BYT, effective from January 1, 2025.

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