The Ministry of Health has just issued Circular 22/2024/TT-BYT regulating the direct payment of drug and medical equipment costs for people with health insurance cards.
Dr. Vuong Anh Duong, Deputy Director of the Department of Medical Examination and Treatment Management (Ministry of Health), said that the shortage of drugs and medical supplies in medical facilities in recent times is due to many different subjective and objective reasons.
According to a survey of more than 600 hospitals, about 30% of the rare drugs that hospitals are lacking are not on the list of rare drugs covered by health insurance. In the coming time, the Ministry of Health will continue to find solutions to address issues that Circular 22 does not fully cover.
Raising the issue of whether patients may have to pay the difference if they buy medicine outside, Ms. Tran Thi Trang - Director of the Department of Health Insurance (Ministry of Health) - affirmed: This Circular is only to resolve situations, in case of shortage of medicine and medical equipment, so no one wants to apply it, but it must be issued to have a legal basis to handle these situations in order to partly ensure the rights of health insurance participants.
Accordingly, the Ministry of Health is proposing that instead of patients having to pay directly to the Social Insurance agency, there should be a mechanism for hospitals to pay patients, then the hospitals pay back to the Social Insurance agency, to reduce procedures for patients," said Ms. Trang.
The Director of the Health Insurance Department emphasized that when prescribing for patients, medical examination and treatment facilities and medical practitioners need to advise and guide patients to understand the direct payment regulations so that they can buy medicine and supplies and be paid by the Social Insurance agency later according to regulations.
Terms of payment of direct costs
According to the guidance of Circular 22, the Social Insurance agency pays directly to patients according to the following regulations:
For drugs: The basis for calculating the payment level is the quantity and unit price stated on the invoice purchased by the patient at the pharmaceutical business establishment. In case the drug has regulations on payment rates and conditions, the payment rates and conditions shall be implemented;
For medical equipment (including reusable medical equipment): The basis for calculating the payment level is the quantity and unit price stated on the invoice purchased by the patient at the medical equipment trading facility. In case the medical equipment has a payment level regulation, it must not exceed the payment level prescribed for that medical equipment.
The unit price of drugs and medical equipment used as the basis for determining the payment level must not exceed the unit price paid at the most recent time for cases where drugs and medical equipment have won bids at the medical examination and treatment facility where the patient was examined and treated.
In case the medicine or medical equipment has not won the bid at the medical examination and treatment facility where the patient has been examined and treated, the unit price used as the basis for determining the health insurance payment level is the result of the selection of a valid contractor in the following order of priority:
Procurement and price negotiation results: The results of the national centralized procurement or price negotiation, together with the results of the local centralized procurement in the area, will be announced. At the same time, the results of the selection of the lowest bidder at the time of payment of the specialized and basic public medical examination and treatment facilities or medical examination and treatment facilities of the same technical level in the area will also be announced.
In particular, the results of selecting the lowest bidder at the time of payment of public medical examination and treatment facilities in Hanoi and Ho Chi Minh City will be made public.
Direct payment documents and procedures: Direct payment documents include photocopies (with originals for comparison) such as health insurance cards, identity cards, hospital discharge papers, medical examination forms or medical examination books, invoices and related documents.
The patient or their relatives (or legal representative) will directly submit the application to the district-level Social Insurance agency where they reside. The district-level Social Insurance agency is responsible for receiving the application, issuing a receipt, and providing additional instructions if the application is incomplete.
Health insurance payment process: To be paid for health insurance, the buyer must present to the Social Insurance agency a valid prescription and medical supplies prescribed by a doctor as the basis for payment. The Social Insurance agency will receive the application and pay directly to the patient within 40 days. In case of non-payment, the Social Insurance agency must respond in writing and state the reason.
Effective date of the Circular: This Circular will take effect from January 1, 2025. For cases where patients enter medical examination and treatment facilities for examination and treatment before the effective date of this Circular but end treatment after the effective date of this Circular, the provisions of this Circular will be implemented.
