New regulations on health insurance medical examination service prices from November 17, 2023 in Vietnam

New regulations on health insurance medical examination service prices from November 17, 2023 in Vietnam (Internet image) 

Regarding this issue, LawNet would like to answer as follows:

On November 17, 2023, the Minister of Health issued Circular 22/2023/TT-BYT regulating the uniformity of prices for medical examination and treatment services covered by health insurance among hospitals of the same class nationwide and guiding the application of prices and payment of medical examination and treatment costs covered by health insurance in some cases.

New regulations on health insurance medical examination service prices from November 17, 2023 in Vietnam

The price of health insurance medical examination services from November 17, 2023, will be implemented according to Appendix I issued with Circular 22/2023/TT-BYT, specifically as follows:

Price structure of medical examination and treatment services covered by health insurance in Vietnam

According to Article 3 of Circular 22/2023/TT-BYT, medical examination and treatment service prices are built on the basis of direct costs and salaries to ensure medical examination and treatment, specifically as follows:

(1) Direct costs included in the price of medical examination services:

- Costs for clothes, hats, masks, sheets, pillows, mattresses, mats, stationery, gloves, cotton, bandages, alcohol, gauze, saline, and other consumables for medical examination;

- Electricity costs; water; fuel; treatment of household waste and medical waste (solid and liquid); washing, ironing, steaming, drying, washing, and sterilizing linen and examination instruments; cleaning costs and ensuring environmental hygiene; Supplies and chemicals for disinfection and anti-infection during a medical examination:

- Expenses for repairing and maintaining houses and equipment and purchasing replacement assets, tools, and equipment such as: Air conditioners, computers, printers, dehumidifiers, fans, tables, chairs, beds, cabinets, lights, and other necessary kits and tools during the medical examination process.

(2) Direct costs included in the bed-day service price:

- Costs for clothes, hats, masks, blankets, sheets, pillows, mattresses, curtains, mats; stationery; gloves used for examination, injection, infusion, cotton, bandages, alcohol, gauze, saline, and other consumables for daily care and treatment (including costs for changing wound dressings or surgical incisions for inpatients, except for cases where payment is made in addition to the bed-day service price specified in Clause 5 and Clause 6, Article 7, Circular 22/2023/TT-BYT); electrodes, ECG cables, blood pressure measuring tape, and SPO2 cables during the use of patient monitors for emergency and intensive care beds.

- The costs specified in Points b and c, Clause 1, Article 3 of Circular 22/2023/TT-BYT serve the care and treatment of patients according to professional requirements.

- Particularly for the costs of drugs, whole blood, standard blood products, infusion fluids, and medical equipment (in addition to the supplies mentioned above); syringes, needles, and medicine needles used for injection and infusion; feeding pump; Infusion lines, connecting tubes, electric injection pump connecting lines, infusion machines used for injection and infusion; Oxygen gas, oxygen breathing circuit, and oxygen breathing mask (except in cases where the patient is prescribed to use a ventilator) are not included in the bed-day service price structure and are paid according to the actual use of the patient.

(3) Direct costs included in technical service prices:

- Costs for clothes, hats, masks, sheets, pillows, mattresses, mats, and linen; stationery; drugs, infusion fluids, chemicals, consumables, and replacement materials used in the process of performing technical services;

- The costs specified in Points b and c, Clause 1, Article 3 of Circular 22/2023/TT-BYT serve the implementation of technical services according to professional requirements.

(4) Salary costs included in the price of medical examination services, bedside services, and technical services include:

- Salary, rank, position, allowances, and contributions according to the regime prescribed by the State for public service units and the base salary specified in Decree 24/2023/ND-CP;

- Permanent allowances, surgical and procedural allowances according to Decision 73/2011/QD-TTg stipulating a number of specific allowances for civil servants, public employees, and workers in public health facilities, and anti-epidemic allowances.

(5) Salary costs in the price of medical examination and treatment services specified in (4) do not include expenses under the regime guaranteed by the state budget according to the following provisions of law:

- Preferential allowances, attractive allowances, subsidies, and other incentives for medical officers and employees, contract workers, and military medical officers and employees directly performing medical professional work at medical facilities of the State in areas with particularly difficult socio-economic conditions;

- Attraction allowances, long-term service allowances, some subsidies, and transportation fare payments for officials, civil servants, public employees, and salary earners in the armed forces (people's army and people's police) working in areas with particularly difficult socio-economic conditions;

- Special allowance regime for officials and employees working at Huu Nghi Hospital, Thong Nhat Hospital, and Da Nang Hospital C under the Ministry of Health, Central Health Protection Departments 1, 2, 2B, 3 and 5; Department A11 of Central Military Hospital 108; and Department A11 of the Military Institute of Traditional Medicine;

- Specific allowances according to profession or job.

(6) Payment of medical examination and treatment costs between social insurance agencies and medical examination and treatment facilities according to service prices specified in Circular 22/2023/TT-BYT and costs for drugs, whole blood, standard blood products, chemicals, and medical equipment are not included in the service price (specifically noted at the services) according to the payment principles specified in Article 24 of Decree 146/2018/ND-CP amended and supplemented by Decree 75/2023/ND-CP.

(7) Costs specified in (1), (2), (3), and (4) are determined on the basis of economic - technical norms and cost norms issued by competent authorities, the prices of cost factors, and cost levels that are realistic and reasonable according to current regimes and policies, ensuring average and advanced calculation and meeting service quality requirements.

Economic-technical norms are the basis for establishing prices for medical examination and treatment services and are not used as a basis for payment for each specific medical examination and treatment service (except for some special cases specified in Clause 6, Article 5, Clause 16, Article 6, and Clause 8, Article 7 of Circular 22/2023/TT-BYT).

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