Ministry of Health to guide settlement of medical examination and treatment expenses covered by health insurance in Vietnam 2022

Ministry of Health to guide settlement of medical examination and treatment expenses covered by health insurance in Vietnam 2022

According to Official Dispatch 2568/BYT-BH, on the settlement of medical examination and treatment expenses covered by health insurance in 2022, the Ministry of Health of Vietnam has the following comments:

- Regarding determining the total payment in 2022:

According to the provisions at point b, clause 4, Article 24 of Decree 146/2018/ND-CP, Tn-1 is the cost of medical examination and treatment covered by the health insurance of the preceding year at the establishment that has been appraised and settled by the social insurance agency;

Therefore, when calculating the total payment for medical examination and treatment costs, health insurance for medical examination and treatment establishments in 2022, based on the medical examination and treatment expenses covered by the health insurance in 2021 at the establishment, which have been appraised and settled by the social insurance agency;

(Including medical examination and treatment expenses, health insurance is paid according to the provisions of Clause 3 of Resolution 144/NQ-CP dated November 5, 2022 on the guarantee of drugs, medical equipment, and payment of medical examination and treatment expenses covered by health insurance as follows:

- Fees for medical examination, bed and technical services, tests, and blood and blood products have been used for patients within the scope and benefit level of the health insurance participants: The settlement and payment shall be made according to the actual quantity used and the price according to current regulations.

- Expenses for drugs, chemicals, and medical supplies that are not included in the price of medical examination and treatment services covered by health insurance or used in techniques for which medical examination and treatment prices have not yet been issued have been used for patients within the scope and benefit level of the health insurance participants:

Settlement and payment shall be made according to the actual quantity used and the purchase price in accordance with the law on bidding.)

- Regarding the adjustment coefficient due to fluctuations in prices of drugs, chemicals, and medical supplies at the respective medical examination and treatment establishments, each element of drugs, chemicals, and medical supplies has not been included in the service price.

On April 5, 2023, the Ministry of Health of Vietnam issued Official Dispatch 1921/BYT-BH to the Ministry of Finance to unify the adjustment coefficient k. After the Ministry of Finance has comments, the Ministry of Health will notify the Vietnam Social Insurance for implementation.

More details can be found in Official Dispatch 2568/BYT-BH issued on April 28, 2023.

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