Instructions for payment of medical examination and treatment expenses covered by health insurance according to the capitation rate in Vietnam

Thuy Trong

11:23, 10/06/2021

On June 9, 2021, the Ministry of Health issued Dispatch 4614/BYT-KHTC on guidelines for some contents of Circular 04/2021/TT- MOH on the payment of medical examination and treatment expenses covered by health insurance according to the capitation rate.

According to the Official Dispatch, the Ministry of Health of Vietnam requests relevant agencies and units to implement Vietnam's Circular 04 to note a number of contents, for example:

The figures to calculate the capitation fund in 2021 are based on 2019 data, in which the medical facilities perform the health insurance contract effective from January 1, 2019 and continue to perform the contract from January 1, 2021.

The scope of capitation for establishments from the district level down is all outpatient medical expenses incurred at the facility in Vietnam within the scope of benefits of the insured, except for the case specified in Clause 3, Article 3 of Circular 04.

Rate of transfer to inpatient treatment of the preceding year = Number of inpatient health care services in 2019 at the facility : The number of visits to medical care with health insurance (both inpatient and outpatient) in 2019 at the facility in Vietnam.

Vietnam's Official Dispatch 4614/BYT-KHTC was issued on June 9, 2021.

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