What are the cases considered appropriate referrals in medical examination and treatment covered by health insurance in Vietnam?

What are the cases considered appropriate referrals in medical examination and treatment covered by health insurance in Vietnam? (Internet image)

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

1. What are the cases considered appropriate referrals in medical examination and treatment covered by health insurance in Vietnam?

According to Article 11 of Circular 40/2015/TT-BYT, the cases considered appropriate referrals in medical examination and treatment covered by health insurance in Vietnam are as follows:

- Each holder of health insurance card who registered for initial medical services at health facilities of communes or polyclinics or hospital of districts may get medical services at health stations of communes, polyclinics or hospitals of districts in the same province.

- Each holder of health insurance card who registered for initial medical services at a health facility of commune may take a referral to a hospital of district, including grade I, II hospitals of district and hospitals of traditional medicine of province (if the hospital of district has no department of traditional medicine).

- Each holder of health insurance card may take a referral from a hospital of district, including grade I, grade II hospital and polyclinic hospital, specialized hospital, specialized institute, specialized center of province, to a specialized center of province or polyclinic hospital, specialized hospital, specialized institute of province at the same level or lower level.

- Emergency cases:

+ A patient shall be given emergency treatment at any health facilities. The doctor or physician assistant receiving the patient shall assess the emergency conditions and record in medical record.

+ After emergency treatment, the patient shall be admitted as an inpatient to the receiving facility or referred to another health facility for continuing treatment at the specialist requirements or referred to the original facility upon his/her rehabilitation.

- In case the referred patient has another disease already, or a disease that is diagnosed apart from the disease specified in the outward referral form, the receiving facility shall give treatment to those diseases within its capacity.

2. What are the uses of outward referral forms and follow-up appointment forms in medical services in Vietnam?

Article 12 of Circular 40/2015/TT-BYT stipulates using outward referral forms and follow-up appointment forms in medical services as follows:

- If a patient is referred to another heath facility, he/she is only required an outward referral form made by the heath facility that directly makes the referral.

- In case a patient arrives at a heath facility other than his/her initiating heath facility and he/she is referred to another health facility, he/she is only required an outward referral form of the heath facility that directly makes the referral.

- With regard to patients having health insurance cards that suffer from diseases, groups of disease and those eligible for using the outward referral form prescribed in Appendix 1 issued with Circular 40/2015/TT-BYT, their outward referral forms shall be valid until December 31 of such calendar year. In case where a patient mentioned above, at the end of December 31 of the year, still be an inpatient in the health facility, his/her outward referral form only be valid until the end of such impatient treatment.

List of diseases, disease groups and cases for which referral papers are used in the calendar year:

Nguyen Ngoc Que Anh

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