Vietnam’s guidelines on signing medical examination and treatment contracts covered by health insurance

Vietnam’s guidelines on signing medical examination and treatment contracts covered by health insurance

According to the Official Dispatch, Vietnam Social Security instructs social insurance authorities of provinces to implement the signing of medical examination and treatment contracts covered by health insurance as follows: 

- Continue the signing of medical examination and treatment contracts in compliance with guidelines of Vietnam Social Security prescribed in Official Dispatch No. 4076/BHXH-CSYT dated December 13, 2021, Official Dispatch No. 3794/BHXH-CSYT dated December 12, 2022, and the health insurance assessment procedure enclosed with Decision No. 3618/QD-BHXH dated December 12, 2022. 

- Request directors of social insurance authorities of provinces to assess and assign the signing of medical examination and treatment contracts covered by health insurance to social insurance authorities of districts in compliance with Point h Clause 4 Article 6 of Decision No. 2355/QD-BHXH dated September 16, 2022 of the General Director of Vietnam Social Security on functions, tasks, entitlements, and organizational structure of local social insurance authorities. Develop plans to guide and support the assessment, payment, and settlement of medical examination and treatment costs covered by health insurance for social insurance authorities of districts. 

- Ensure the contents of medical examination and treatment contracts covered by health insurance comply with Form No. 7 prescribed in the Appendix enclosed with Decree No. 75/2023/ND-CP. Social insurance authorities of provinces shall conform to facilities of medical examination and treatment covered by health insurance concerning several contents of contracts as prescribed by laws (enclosed contents).

- Assess the necessity of the signing of medical examination and treatment contracts covered by health insurance with medical examination and treatment facilities based on the local general situation of medical examination and treatment covered by health insurance (the number of medical examination and treatment facilities with signed medical examination and treatment contracts covered by health insurance, medical examination and treatment overload, capacity for meeting the medical examination and treatment requirements of persons with health insurance cards, the increased number of health insurance cards, etc.), the use of assigned estimates of expenditures on medical examination and treatment covered by health insurance. Directors of social insurance authorities of provinces shall take responsibility for signing medical examination and treatment contracts covered by health insurance with new medical examination and treatment facilities.

- Implementation of medical examination and treatment contracts covered by health insurance:  

+ Proactively cooperate with Departments of Health in determining medical examination and treatment facilities registering initial health insurance-covered medical examination and treatment at all levels; stipulate subjects, subject structure, and number of persons participating in health insurance registering initial health insurance-covered medical examination and treatment at medical examination and treatment facilities in conformity with the actual conditions of provinces and the response capacity of such facilities; and 

Provide guidelines on the level transfer of health insurance-covered medical examination and treatment between medical examination and treatment facilities; guidelines on registration or revision to registration places of initial health insurance-covered medical examination and treatment and level transfer of health insurance-covered medical examination and treatment, and Official Dispatch No. 3637/BHXH-CSYT dated November 29, 2022 of Vietnam Social Security, etc.

See more details in Official Dispatch No. 4195/BHXH-CSYT dated December 12, 2023. 

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