Currently, the issuance of the list and regulations on health insurance (HI) payments for drugs is carried out according to Circular No. 20/2022. After nearly 2 years of implementation, Circular 20 has revealed a number of problems, requiring amendments, supplements, and adjustments to suit the actual situation.
To facilitate patients participating in health insurance and medical examination and treatment facilities, the Ministry of Health has issued Circular No. 37 stipulating principles, criteria for building, updating, recording information, structure of the list and payment instructions for pharmaceutical drugs, biological products, radioactive drugs and markers within the scope of benefits of health insurance participants.
According to MSc. Vu Nu Anh - Deputy Director of the Department of Health Insurance (Ministry of Health), this Circular stipulates the principles of building and updating the drug list, criteria for considering drugs to be included in the list, considering drugs that need to stipulate the rate and conditions for health insurance payment, and considering removing drugs from the list. This will contribute to building and updating the drug list publicly, transparently, regularly and effectively.
The Circular also removes the regulation on dividing the drug list according to hospital class. As a result, medical facilities can use all drugs in the list, in accordance with the scope of professional activities, diagnosis and treatment guidelines, regardless of hospital class or technical expertise level.
This will also encourage facilities to develop expertise and techniques; attract human resources and encourage capacity development of medical staff, especially creating conditions for development of grassroots health care by ensuring fairness in access and payment of health insurance for drugs.
At the same time, it helps limit the number of patients choosing to go to high-tech specialized facilities for medical examination and treatment, reducing the overload at some high-tech specialized facilities.
The Circular also adds new regulations on drug payment guidelines. Specifically, the Health Insurance Fund will pay in accordance with the scope of professional activities and technical service performance capacity, regardless of the hospital class. This will contribute to increasing access to drugs for patients and medical examination and treatment facilities.
The Circular also stipulates payment for some cases where drugs are not indicated or drugs are contraindicated in prescribed documents in emergency cases and there are no other alternative drugs, after consultation.
At the same time, regulations on payment for drugs at commune health stations. This regulation contributes to increasing access to drugs for patients with chronic diseases when being managed and treated at health stations, creating a financial mechanism to encourage the development and improvement of professional capacity of staff at commune health stations.
Another new point of the Circular is the regulation on payment for drugs in special cases. This regulation contributes to creating flexibility in special situations such as natural disasters, wars, catastrophes, the Ministry of Health will promptly issue instructions on payment for health insurance in emergency situations.
Regulations on payment for drugs for chronic diseases when the patient is being treated for another disease. This regulation ensures that health insurance participants have continuous access to and guarantee the right to health insurance payment for drugs.
These new regulations will help supplement the cases covered by the health insurance fund to increase access to drugs, provide flexibility in payment instructions for patients, and create conditions for medical examination and treatment facilities to pay for drug costs that were not previously paid due to the lack of specific instructions. Thereby, contributing to ensuring the rights of health insurance participants, while creating a financial mechanism to promote the development of medical examination and treatment facilities.
To effectively implement Circular 37/2024/TT-BYT, the Ministry of Health requests the Vietnam Social Security and the Departments of Health to promptly disseminate the provisions of Circular No. 37/2024/TT-BYT to the Social Security of provinces and cities and medical examination and treatment facilities under their management;
Medical examination and treatment facilities must research and comply with the provisions of Circular No. 37/2024/TT-BYT from January 1, 2025.
