Instructions for determining use of and prices of medical examination services not covered by health insurance in Vietnam

Instructions for determining use of and prices of medical examination services not covered by health insurance in Vietnam (Internet image)

Regarding this issue, LawNet responded as follows:

1. Instructions for determining use of and prices of medical examination services not covered by health insurance in Vietnam

According to Article 5 of Circular 37/2018/TT-BYT, in certain cases, the number of times of use of and prices of medical examination services shall be determined as follows:

(1) If a patient comes to an outpatient department to receive his/her health check-up and then is advised to be hospitalized for inpatient treatment services to meet medical requirements, payment of medical examination fees shall be subject to provisions laid down in (2)

In case where that patient does not register at the outpatient department but receives medical examination and inpatient treatment services at other clinical departments according to medical requirements, payment of medical examination fees shall not be covered.

(2) With respect to healthcare establishments having specialized exam rooms in clinical departments, if a patient registers at outpatient departments and receives medical examination at these specialized exam rooms, he/she shall be considered as using medical examination services provided by outpatient departments.

Calculation of costs and the number of times of use of medical examination services shall follow instructions given in (3).

(3) At the same time of use of medical examination services at a healthcare establishment (maybe on the same day or for objective reasons or subject to medical requirements, medical examination services have not yet been finished in the first day and must be continued in the next day),

If a patient needs to come to another department after visiting the first department, the price of the second or later time of use of medical examination services shall be 30% of the price of the single time of use of medical examination services and the maximum amount of payment of medical examination costs shall not be 2 times greater than the price of the single time of use of medical examination services.

(4) If a patient visits a healthcare establishment where he/she has used medical examination services and received medicines, but then finds abnormal signs and immediately returns to that healthcare establishment within the same day to check his/her health again, this use of medical examination services shall be considered as the second or later time of use of medical examination services within the same day.

Payment shall be made according to instructions given in (3);

2. Instructions for implementation of prices of medical technical and clinical laboratory services in Vietnam

Instructions for implementation of prices of medical technical and clinical laboratory services according to Article 7 of Circular 37/2018/TT-BYT are as follows:

- Medical technical services shall be priced in the following order:

+ Specific services of which prices have been prescribed in appendices to this Circular shall be priced in accordance with regulations in force.

+ Medical technical services of which prices have been regulated in appendices to Circular 37/2018/TT-BYT, but which are ranked equal in terms of technical contents and costs, may apply the prices of services ranked equal by the Ministry of Health in terms of technical contents and costs.

+ If there is any overlap between different departments, medical technical services performed at a department shall apply the prices of services rendered at that department.

- Fees for medical technical services present in the list of medical technical services approved by competent authorities (Ministries, central regulatory bodies with respect to healthcare establishments under their management, Departments of Health with respect to units under the management of local jurisdictions) (except medical care services of which costs have already been included in the cost of per-day beds, services deemed as a technical stage of which costs are included in costs of other services),

But which have not been priced yet; indicated medical technical services which are not continued for reasons of pathological changes or physical conditions of patients, shall be paid based on the actual quantity of medicines and medical supplies used for these patients and at the purchase prices prescribed by lawsoft.

- If multiple medical actions are taken in the same surgery, fees for such actions shall be paid at the price of the most complicated surgery which is highest.

Meanwhile, payments for other medical technical services arising outside the aforesaid surgical procedures shall be as follows:

+ Equal to 50% of the prices of additional surgeries if these additional surgeries are still performed by the same surgical team;

+ Equal to 80% of the prices of additional surgeries if these additional surgeries are performed by another substitute surgical team;

+ If additional services are medical procedures, 80% of the prices of these additional services shall be paid.

- Price of the medical technical service called “Changing a medical bandage or surgical dressing at the length of ≤15 cm” shall be applied to an inpatient only if his/her wound or incision is infected;

A skin tissue dissection or open wound at the skin area of more than 6 cm2 is impregnated with bodily fluid or blood; a wound is covered with a gauze pad; a large amount of bodily fluids flow at the contact point between an effusion tube and a wound;

Multiple traumas or incisions appear; he/she has undergone a surgery with at least two incisions; that price shall not be applied to changing bandages with respect to an endoscopic surgery, change of a common incision dressing, wound bandage or umbilical bandage.

- Price of the medical service called “Changing a surgical incision dressing at the length ranging from more than 15 cm to 30 cm” for an inpatient shall be applied:

+ In case of infected surgical incision, gastrointestinal, bile duct or urinary tract leak;

+ In case a post-surgery incision is infected (peritoneal membrane infection, bone infection or abscess), an incision made after intestinal tube, genitourinary or abdominal ascite;

+ In case of a surgery making at least two incisions;

+ In case of an obstetric surgery which is performed no more than 03 times.

- Prices of immunocompatibility tests performed at temperature of 37ºC and using anti-globulin serum (indirect test Coombs) for blood transfusion shall be the same as the price of the medical service called “Immunocompatibility reaction using anti-human globulin serum” numbered 1340 or 1341 in the Appendix III of Circular 37/2018/TT-BYT.

>> CLICK HERE TO READ THIS ARTICLE IN VIETNAMESE