For home medical examination and treatment, health insurance still pays but avoids abuse

Lệ Hà |

Home medical examination is a humane policy, supporting patients with difficulty in moving to access health care. However, it is necessary to closely monitor to avoid abusing the health insurance fund.

Dr. Tran Thai Son - Deputy Head of General Planning Department, Bach Mai Hospital said: From July 1, 2025, it is the official time to apply a series of new breakthrough policies in the amended Law on Health Insurance (HI) in 2024.

The important highlight is that people will be examined and treated at home, remotely and have their expenses paid by the Health Insurance Fund. This is the first time that health insurance has paid for home and remote medical examination and treatment services, including medicine, medical supplies and reasonable transportation costs in cases where emergency or inpatient treatment is required.

Analyzing this regulation, Dr. Tran Thai Son said: This is a humane step forward, creating favorable conditions for the elderly, people with chronic diseases, people with disabilities or residents living in remote areas to access quality healthcare services without barriers on geographical distance or finance.

The implementation of this policy is also in line with the trend of developing digital healthcare, promoting digital transformation in the healthcare sector, while reducing the burden on upper-level medical examination and treatment facilities.

"This is a profoundly humane policy, especially meaningful for patients who have difficulty moving due to old age, paralysis, epidemics or other objective conditions that make them unable to go directly to medical facilities. However, to promote the real effectiveness of this policy and avoid being abused and losing the health insurance fund, it is necessary to have close coordination between relevant agencies and a system of clear and specific guidance documents.

Under the permitted conditions, people should still prioritize medical examination and treatment at large medical facilities such as Bach Mai Hospital - which has full modern equipment, a team of in-depth specialists and interdisciplinary coordination to ensure accurate diagnosis and comprehensive treatment. Home-based examination services should be considered a support solution in cases that are really necessary to maintain continuous treatment, limit the risk of serious disease progression requiring hospitalization - this not only affects the health of patients but also puts great pressure on the health system", Dr. Tran Thai Son analyzed.

Also according to BSCKII. Tran Thai Son, many people wonder if they will receive health insurance when coming to Bach Mai Hospital for outpatient treatment? Dr. Son explained that not everyone is paid for health insurance when going to this central hospital for examination.

Bach Mai Hospital is a high-tech hospital, classified as a central hospital before January 1, 2025. According to the new regulations of the Ministry of Health in Circular No. 01/2025/TT-BYT, to enjoy health insurance benefits when receiving outpatient examination, patients need to belong to one of the following three groups:

1. Having a valid referral letter: Patients need to have a referral letter from a lower-level medical examination and treatment facility ( basically issued initially) and ensure it is still valid according to regulations.

2. There is a re-examination appointment form issued by Bach Mai Hospital itself: This appointment form must be prepared by Bach Mai Hospital and is still valid at the time of examination.

3. Macular diseases are on the list of 62 diseases and special groups of diseases: These diseases are listed in Appendix 1 attached to Circular 01/2025/TT-BYT, including rare diseases, serious diseases, diseases requiring surgery or using high-tech services. However, patients need to pay special attention: if there is no note "receiving benefits right at the examination with disease determination results", they will only receive health insurance after having other facilities to diagnose and determine the disease and having related records.

Therefore, to ensure health insurance benefits when examining at Bach Mai Hospital, patients should bring prescriptions, discharge papers or medical records from facilities that have previously examined and treated them, Dr. Tran Thai Son emphasized.

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