Ministry of Health issues circular on payment for technical services covered by health insurance

Many benefits of patients participating in health insurance are enhanced when Circular No. 39/2024/TT-BYT of the Ministry of Health comes into effect.

Many benefits of patients participating in health insurance are enhanced when Circular No. 39/2024/TT-BYT of the Ministry of Health comes into effect.

On November 17, 2024, the Minister of Health issued Circular No. 39/2024/TT-BYT amending and supplementing a number of articles of Circular No. 35/2016/TT-BYT on the list, rates, and payment conditions for medical technical services covered by health insurance.

Many benefits of patients participating in health insurance are enhanced when Circular No. 39/2024/TT-BYT of the Ministry of Health comes into effect.

The new Circular will take effect from January 1, 2025, with many changes to ensure the rights of health insurance participants and overcome difficulties and obstacles in actual implementation.

Accordingly, the concept of “a medical examination” is clarified to mean one outpatient examination or one treatment session (including outpatient, inpatient or day treatment), with the number of treatment days decided by the doctor based on the patient's condition.

Expenses not included in the bed day price, such as paracentesis needles, blood transfusions or pressure ulcer sprays, will be paid based on actual usage.

The maximum number of medical examinations has also been adjusted, limiting payment for examination tables exceeding 65 examinations in 8 hours per day, instead of 65/day as before. In addition, instructions on payment for intensive care unit (ICU) beds, surgical beds and burn beds have also been added to be more specific.

The new circular abolishes human resources and facilities conditions for a number of technical services, aiming to simplify and expand the scope of implementation at lower levels.

Computed tomography (CT) coverage is extended to cases such as chest or abdominal imaging for children under 6 years old, and craniofacial imaging for congenital malformations.

In particular, high-tech services supporting cancer diagnosis and treatment, including PET/CT scans for cancers such as bile duct cancer, oral cavity cancer, or neuroblastoma, are also added.

Tumor marker tests such as CA 125, CA 72-4 and SCC to aid in the diagnosis of metastatic cancer and accurately identify primary tumors are also updated for payment conditions.

Some special techniques have expanded coverage, such as cataract surgery using phaco or femtosecond at the lower level, hemodynamic exploration using the PiCCO method, command hypothermia technique, adsorption hemofiltration using resin filters, and double-lumen endotracheal intubation.

Payment conditions for rehabilitation services are also amended to increase benefits for health insurance participants while still ensuring the fund's ability to pay.

In order for Circular 39/2024/TT-BYT to be effectively implemented, the Ministry of Health requests that the Vietnam Social Security and the Departments of Health promptly disseminate the new content to their affiliated units. At the same time, it requires medical examination and treatment facilities to carefully study the content and properly implement the regulations from January 1, 2025.

This Circular marks an important step forward in improving the quality of medical technical services and the rights of health insurance participants.

The change not only simplifies procedures but also expands access to high-quality medical services, contributing to reducing the burden on upper-level health care and ensuring the financial security of the health insurance fund.

Source: https://baodautu.vn/bo-y-te-ban-hanh-thong-tu-ve-thanh-toan-dich-vu-ky-thuat-thuoc-pham-vi-bao-hiem-y-te-d230508.html