Rules for application of medical service prices in medical facilities contracted to provide medical services covered by health insurance in Vietnam

Rules for application of medical service prices in medical facilities contracted to provide medical services covered by health insurance in Vietnam (Internet image)

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

1. Rules for application of medical service prices in medical facilities contracted to provide medical services covered by health insurance in Vietnam

Rules for application of medical service prices in medical facilities contracted to provide medical services covered by health insurance in Vietnam according to Article 4 of Circular 39/2018/TT-BYT are as follows:

- For institutes with patient beds, medical centers providing medical services that are licensed to serve functions of hospitals, classed medical centers in districts providing medical services, apply the prices by hospital of the same class.

- For health protection and care clinics for public officials in provinces, cities not affiliated to general hospitals in provinces and cities, apply the prices issued by class II hospitals.

- For unclassed medical facilities, army medical clinics, civil-military medical clinics, military infirmaries, infirmaries, private polyclinics and specialty clinics, apply the prices issued by class IV hospitals.

- For regional polyclinics:

+ If licensed to serve functions of hospitals or fall into the cases specified in clause 12, Article 11 of the Decree 155/2018/ND-CP apply the prices issued by class IV hospitals;

+ If only providing emergency medical response and medical services for outpatients, apply the prices issued by class IV hospitals. If permitted by the Department of Health to have patient beds, the price for an outpatient bed shall be equal to 50% of the price for hospital stay of type 3 inpatient bed of class IV hospitals.

An outpatient can only be confined to a bed for maximum 3 days for each medical treatment. Payment for medical examination service is not required if the price for outpatient bed is paid.

- For medical aid stations in communes and towns, medical aid stations in companies, agencies, organizations, schools and civil-military medical aid stations:

+ Apply the medical service prices issued by the medical aid stations in communes. Apply the medical procedure price that is equal to 70% of such price specified in Appendix III.

+ If having patient beds as decided by the Health Department, apply the price which is equal to 50% of the price for hospital stay of type 3 inpatient bed issued by class IV hospitals.

An outpatient can only be confined to a bed for maximum 3 days for each medical treatment. Payment for medical examination service is not required if the price for outpatient bed in commune medical aid stations is paid.

- If a patient has medical insurance but uses required medical services, the payment for medical services covered by health insurance shall be made as prescribed.

2. Instruction on determination of number of times, prices and payment for medical services in particular cases in Vietnam

Instruction on determination of number of times, prices and payment for medical services in particular cases in Vietnam according to Article 5 of Circular 39/2018/TT-BYT as follows:

- If a patient undergoes medical examination in examination department then is transferred to inpatient department for treatment as required by professionals, payment for medical examination shall be made in accordance with clause 3 of Article 5 of Circular 39/2018/TT-BYT.

If a patient is not subject to medical examination in examination department but in clinical department as required by professionals, the payment for such examination is not required.

- For medical facilities providing specialist examination service in clinical departments, examination conducted in examination department and specialist examinations in clinical department will be counted as examination in medical examination department.

A number of times for medical examination will be counted and the price for such examination service will be determined in accordance with regulations in clause 3 in Article 5 of Circular 39/2018/TT-BYT.

- For one-time examination in a single medical facility (such examination can be finished in one day or last for 2 days due to subjective reasons or professional requirements), if the patient is required to undergo more than one specialist examination, the price for the second examination onwards shall be equal to 30% of the price for one-time examination and the maximum price for such -medical examination shall not exceed 2 times the price for one-time examination.

- Patients that show abnormal signs after undergoing examination and taking medicines by medical facility require re-examination in the same day in such medical facility; such examination shall be counted as the second examination in a day. Payment for medical examination shall be made in accordance with regulations in clause 3 in Article 5 of Circular 39/2018/TT-BYT;

- For patients undergoing examination in regional polyclinics then being transferred to hospitals or medical centers of district level for another medical examination, such examination shall be counted as a new examination.

- Medical facilities are required to arrange medical examination tables and allocate staff as required to ensure the examination quality. For examination tables of more than 65 examinations per day, the social insurance agency shall only pay 50% of the examination price from the 66thexamination.

If there are still 65 examinations conducted in one medical examination table in a quarter, the insurance agency shall not pay the price for the 66th examination and onward.

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