According to the new regulations in Decree 188/2025/ND-CP of the Government, patients in some cases who buy medicine and medical equipment themselves will be directly paid by the Social Insurance agency for the cost, based on the unit price and the valid quantity.
The Decree clearly stipulates: Payment for drugs is based on the quantity and unit price on the invoice of the pharmaceutical business establishment. If the drug has regulations on the rate or payment conditions, the Social Insurance agency will implement the correct rate and conditions.
Similarly, for medical equipment, payment is based on invoices purchased by patients at medical equipment trading facilities. In case the medical equipment has a specific payment level, the Social Insurance agency will not pay more than that level.
The Decree also clearly states that the unit price of drugs and medical equipment is the basis for determining the payment level not to exceed the winning unit price at the medical examination and treatment facility where the patient is being treated, at the most recent time.
In case the drug or medical equipment has not won the bid at the medical facility where the patient is being treated, the payment level will be determined based on the valid contractor selection results, in order of priority:
Results of national centralized procurement or price negotiation results;
Results of local-level centralized procurement;
Results of selecting the lowest contractor of public health facilities at the same level of technical expertise in the area;
If not in the area, it will be based on the results of other public facilities nationwide.
In addition, the Social Insurance agency also has specific instructions on deducting health insurance payment costs for medical facilities where patients are being treated. Specifically, if the cost of drugs and medical equipment is included in the price of medical examination and treatment services, the Social Insurance agency will deduct the corresponding amount from the cost of health insurance payment for medical facilities. If not included in the price structure, the Social Insurance will not deduct.
The cost of drugs and medical equipment paid directly by the Social Insurance to patients will be included in the expenditure estimate of the medical examination and treatment facility.
The new regulation contributes to creating more favorable conditions for patients, especially in cases where it is necessary to buy medicine and medical equipment outside, while still strictly ensuring payment settlement and control of health insurance fund costs.
