New regulations on health insurance referrals, not everyone can go to Bach Mai Hospital

Hà Lê |

New regulations on health insurance referrals clearly state the cases that can be transferred to Bach Mai Hospital.

According to Assoc. Prof. Dr. Nguyen Tuan Tung - Deputy Director of Bach Mai Hospital, health insurance (HI) participants in Hanoi can be transferred to Bach Mai Hospital if the initial medical examination and treatment facility does not have sufficient professional capacity or falls under cases prescribed by law.

Circular No. 01/2025/TT-BYT stipulates that patients are transferred between health insurance medical examination and treatment facilities in accordance with professional procedures. Patients can be transferred from the initial medical examination and treatment facility to a basic level medical examination and treatment facility, from basic level to specialized level when the disease condition exceeds professional capacity or according to treatment requirements.

In case the basic level medical examination and treatment facility of the locality is not capable of meeting the needs, patients can also be transferred directly from the initial medical examination and treatment facility to a specialized level medical examination and treatment facility such as Bach Mai Hospital.

Patients who have been treated stably at upper-level hospitals can be transferred to lower-level hospitals for continued treatment and monitoring. For some chronic diseases, patients are transferred to the initial health insurance medical examination and treatment registration facility for long-term management according to regulations.

Thus, initial health insurance medical examination and treatment facilities, health centers, basic-level hospitals and health insurance medical examination and treatment facilities in Hanoi can all make referral letters to Bach Mai Hospital if they exceed their professional capacity.

Circular No. 01/2025/TT-BYT also promulgates appendices regulating the list of diseases eligible for medical examination and treatment at specialized levels, the list of diseases eligible for referral papers valid for one year and the list of diseases transferred to the initial medical examination and treatment facility for management.

Regarding the validity period of referral letters, in case of transfer according to professional requirements, referral letters to medical examination and treatment facilities are valid for 10 working days from the date of signing. Particularly, people with diseases or belonging to disease groups specified in Appendix III of Circular No. 01/2025/TT-BYT are allowed to use referral letters valid for 01 year from the date of signing. If the letters expire while the patient is still being treated, the referral letters will still be valid until the end of the treatment period.

Notably, from March 30, 2026, based on Clause 4, Article 40 of Decree No. 90/2026/ND-CP stipulating a fine of 10-15 million VND for the act of not transferring emergency patients to appropriate medical examination and treatment facilities when the patient's condition exceeds professional capacity or is outside the scope of professional activities of the facility.

If the patient fully meets the conditions for referral but the medical examination and treatment facility does not perform the referral, depending on the nature and severity of the violation, this unit may be handled according to the provisions of law on medical examination and treatment and administrative penalties in the field of health.

Hà Lê
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