Deputy Minister of Health Tran Van Thuan has just signed and issued Circular 22/2024/TT-BYT regulating the direct payment of medicine and medical equipment costs for people with health insurance cards (BHYT), which clearly states the conditions, criteria and payment levels...
Regarding direct cost payment, according to the guidance of Circular 22, the Social Insurance agency (SI) will pay directly to the patient according to the following regulations:
For drugs: The basis for calculating the payment level is the quantity and unit price stated on the invoice purchased by the patient at the pharmaceutical business establishment. In case the drug has regulations on payment rates and conditions, the payment rates and conditions shall be implemented;
For medical equipment (including reusable medical equipment): The basis for calculating the payment level is the quantity and unit price stated on the invoice purchased by the patient at the medical equipment trading facility. In case the medical equipment has a payment level regulation, it must not exceed the payment level prescribed for that medical equipment.
The unit price of drugs and medical equipment used as the basis for determining the payment level must not exceed the unit price paid at the most recent time for cases where drugs and medical equipment have won bids at the medical examination and treatment facility where the patient was examined and treated.
In case the medicine or medical equipment has not won the bid at the medical examination and treatment facility where the patient has been examined and treated, the unit price used as the basis for determining the health insurance payment level is the result of the selection of a valid contractor in the following order of priority: Results of centralized procurement at the national level or price negotiation results; Results of centralized procurement at the local level in the area;
And the lowest contractor selection result at the time of payment of public medical examination and treatment facilities at specialized or basic levels or medical examination and treatment facilities at the same technical level in the area;
The lowest contractor selection result at the time of payment of public medical examination and treatment facilities at specialized or basic levels or medical examination and treatment facilities at the same technical level in Hanoi and Ho Chi Minh City.
The Social Insurance Agency shall deduct the health insurance costs paid by the medical examination and treatment facility where the patient is treated as follows:
In case the cost of medicine and medical equipment is included in the price of medical examination and treatment services: Deduction shall be made from the cost of medical examination and treatment services covered by health insurance of the medical examination and treatment facility at the payment level prescribed in Clauses 1 and 2 of this Article;
In case the cost of medicine and medical equipment is not included in the price structure of medical examination and treatment services: No deduction will be made from the cost of medical examination and treatment services covered by health insurance of the medical examination and treatment facility;
The cost of medicine and medical equipment paid directly by the Social Insurance agency to the patient is calculated in the estimate of the medical examination and treatment facility.
