1. Health insurance covers 100% of some rare and serious diseases that go straight to the advanced level.
The Law amending and supplementing a number of articles of the Law on Health Insurance (HI) has just been passed with 8 new points, including regulations on the level of health insurance when implementing universal health insurance examination and treatment in the direction of not distinguishing administrative boundaries, maintaining the rate of health insurance benefits according to the provisions of the current Law and expanding it to a number of cases.
Patients who have been diagnosed with rare diseases, serious diseases, or diseases requiring high technology on the list issued by the Ministry of Health can go directly to specialized hospitals without needing a referral letter.
2. The hospital has no medicine, health insurance patients get a refund when buying outside
In case the drug covered by the payment scope is a drug on the List of rare drugs issued with Circular No. 26/2019 of the Minister of Health.
Medical equipment to be paid is of type C or D, except for in vitro diagnostic medical equipment, personal specific medical equipment, medical equipment in the list of medical equipment issued by the Minister of Health, which are purchased and sold as ordinary goods according to the provisions of Decree No. 98/2021 of the Government and Decree No. 07/2023 of the Government amending and supplementing a number of articles of Decree No. 98/2021.
According to Article 3 of Circular 22, in case a doctor prescribes a medicine that is on the insurance list but the hospital does not have the medicine at that time and the patient has to buy the medicine from outside, the insurance will refund the patient if certain conditions are met.
The Social Insurance Agency will pay directly to the patient according to the quantity and unit price stated on the invoice purchased by the patient at the pharmaceutical business establishment.
3. Do not divide the list of drugs covered by health insurance by hospital class.
According to the Appendix issued with Circular 20/2022/TT-BYT, drugs in the list of health insurance payments are classified according to hospital class including: Special class, class I, class II, class III and class IV hospitals; Technical professional level includes: Central, provincial, district, and commune levels.
In Circular 37/2024, the Ministry of Health abolished the columns classifying hospitals using drugs; notes on payment rates, payment conditions of drugs... This means that the list of drugs covered by health insurance will not be divided according to hospital class.
At that time, medical examination and treatment facilities are allowed to use all drugs in the list, in accordance with the scope of professional activities, diagnostic and treatment guidelines, regardless of hospital class or technical expertise level.
This regulation will take effect when the Circular promulgating the list of drugs replacing Circular 20/2022 is issued.
4. Pay for medicine at the commune health station
In Circular 37/2024, in Article 16, the Ministry of Health guides a number of cases of drug payment at commune health stations.
- Medical stations examine, prescribe and dispense medicine within the scope of professional activities and technical services approved by competent authorities.
- Medicines are dispensed by health stations according to prescriptions from medical facilities with higher technical expertise.
Accordingly, from January 1, the Health Insurance Fund will pay for medicine for health insurance participants who are managed for chronic diseases at commune health stations.
In case the commune health station has medical practitioners who are mobilized, rotated to examine and treat patients, provide professional support, and provide technical guidance from a higher level of technical expertise according to the assignment or plan of the competent authority or according to the contract; in case of technical transfer according to the contract, in case of remote medical examination and treatment or support for remote medical examination and treatment according to the provisions of law on medical examination and treatment.
5. Supplementing payment conditions for some techniques in cancer diagnosis and treatment
Circular 39/2024 of the Ministry of Health takes effect from January 1 with many new points beneficial to the people.
In particular, regarding the provisions in the revised Lists 1 and 2, the Ministry of Health supplements the payment conditions for the 64-row to 128-row computed tomography (CT) scan service in the direction of expansion for some necessary cases to serve more accurate diagnosis and treatment of diseases (chest/abdominal scan for children under 6 years old; Craniofacial scan for congenital craniofacial malformations...).
The Ministry of Health amends and supplements the payment conditions for PET/CT imaging services when determining recurrence/metastasis for bile duct cancer, testicular cancer, oral cavity cancer, melanoma, neuroblastoma, and stomach cancer.
Supplementing payment conditions for some tumor markers for diagnosing metastatic cancer of unknown primary tumor, SCC quantification (blood), Her 2 gene mutation testing...
