On the morning of January 2, the Ministry of Health held a national conference to implement Circular No. 01/2025/TT-BYT dated January 1, 2025 of the Minister of Health detailing and guiding the implementation of a number of articles of the Law on Health Insurance.
According to Ms. Tran Thi Trang - Director of the Department of Health Insurance, Ministry of Health - one of the important contents of the Circular is to promulgate a list of some rare diseases, serious diseases, diseases requiring surgery or using high technology with 100% benefit level according to the scope, the patient's rights are to go directly to a specialized medical examination and treatment facility, without having to have a referral form to a medical examination and treatment facility, including a list of 62 diseases and groups of diseases that are examined and treated at a specialized medical examination and treatment facility; a list of 167 diseases and groups of diseases that are examined and treated at a basic medical examination and treatment facility; a list of 141 diseases and groups of diseases that are transferred to a medical examination and treatment facility within 1 year from the date of signing the transfer form instead of the transfer form being no longer valid at the end of the calendar year.
"This is a particularly meaningful regulation in improving the quality of medical examination and treatment so that patients can access and promptly treat a number of diseases that require specialized expertise that basic and initial facilities are not qualified to implement, contributing to reducing procedures for transferring medical examination and treatment facilities for patients, reducing costs of moving and transporting patients, saving costs that need to be implemented at lower levels just to transfer patients to higher levels and other costs related to patients' relatives during the care and treatment process, contributing to reducing out-of-pocket expenses of households related to medical examination and treatment, and at the same time contributing to the effective use of the health insurance fund" - Ms. Trang emphasized.
At the same time, it stipulates the list of diseases, groups of diseases and cases that are initially transferred for management and enjoy benefits of drugs and medical equipment according to the professional instructions of higher technical facilities. This regulation both ensures the rights of patients to be managed, monitored and use new, quality drugs and medical equipment and the grassroots health system has better conditions for technical development.
According to the Department Director, this Circular also stipulates the cases of residence and procedures for medical examination and treatment under health insurance when changing the place of residence or temporary residence to ensure the rights of students during summer vacation, workers during family leave...
Accordingly, health insurance participants are entitled to 100% of the benefits when examining and treating at primary and basic health insurance medical examination and treatment facilities other than the place of initial health insurance medical examination and treatment registration, regardless of administrative boundaries.
Regarding the regulations on initial health insurance registration, it is mainly at the initial level, partly at the basic level, limiting registration at the specialized level, contributing to strengthening health insurance at the grassroots health care level.
Regulations on transferring health insurance medical examination and treatment facilities for health insurance participants to make them more convenient for patients and reform procedures, making them easier to apply. These are important regulations for organizing management, medical examination and treatment under health insurance. The regulations are inherited on the basis of the provisions of Circular No. 40 and have been revised to comply with the new provisions of the Law on Medical Examination and Treatment and the Law on Health Insurance.
Circular of the Ministry of Health No. 01/TT-BYT and effective from January 1, 2025, detailing and guiding the implementation of a number of articles of the Law amending and supplementing a number of articles of the Law on Health Insurance, including regulations on a number of diseases that do not require a referral.
The Circular issued with a list of some rare diseases, serious diseases, diseases requiring surgery or using high technology are entitled to 100% of the benefits according to regulations.
Patients are entitled to benefits after being diagnosed by a medical facility with a disease in this list of 62 diseases. Compared to the old list, the new list has 20 more diseases.
