Ministry of Health proposes health insurance payment for medical examination and treatment outside the prescribed line

People pay health insurance at Thanh Nhan Hospital ( Hanoi ) - Illustration photo: NAM TRAN

Proposal to pay for outpatient health insurance treatment not in the right line

The Ministry of Health is proposing the drafting of a law amending and supplementing several articles of the Health Insurance Law. Specifically, the ministry proposes amending and supplementing regulations on the scope and level of health insurance coverage, and adjusting the health insurance reimbursement rate for certain cases where medical examination and treatment are not within the appropriate technical and professional scope under the health insurance scheme.

According to the draft, the Ministry of Health proposes an adjustment plan for cases where patients self-examine and treat health insurance at medical examination and treatment facilities that are not at the right technical level at specialized medical examination and treatment facilities and some basic care facilities.

Specifically, in cases where people seek basic medical treatment outside their designated healthcare network (provincial hospitals of level 2 and level 1 - not classified as the final level), the Ministry of Health proposes two options.

Option 1: Health insurance participants will be paid 60% of inpatient costs and 40% of outpatient costs (except for district facilities where 100% inpatient and outpatient costs are covered).

Option 2: maintain current regulations, 100% of inpatient treatment costs and no payment for outpatient examination and treatment costs (except for district facilities which are 100% inpatient and outpatient)

Health insurance benefits are adjusted from line to level, from technical expertise level proposed by the Ministry of Health - Screenshot

Supplementing the list of non-health insurance payments

In the draft, the Ministry of Health proposed a list of treatments for strabismus, myopia and refractive errors of the eye, except for people under 18 years old who will be covered by health insurance.

Previously, the health insurance fund only paid for the treatment of strabismus, myopia and refractive errors of the eyes for children under 6 years old.

In addition, the Ministry of Health proposes not to cover health insurance for the use of replacement medical supplies including artificial eyes, dentures, eyeglasses, and mobility aids in medical examinations, treatment, and rehabilitation.

Previously, the list of items not covered included the use of replacement medical supplies such as prosthetic limbs, artificial eyes, dentures, eyeglasses, hearing aids, and mobility aids in medical examinations, treatment, and rehabilitation, which were not covered by health insurance.

Therefore, those covered by health insurance are only reimbursed for medical supplies such as prosthetic limbs and hearing aids.

The Ministry of Health also maintains the list of cases not covered by health insurance, including: nursing care and convalescence at nursing and convalescence facilities; health check-ups; and pregnancy tests and diagnoses not intended for treatment.

The use of assisted reproductive technologies, family planning services, abortion, and termination of pregnancy are permitted, except in cases where pregnancy must be terminated due to pathological reasons related to the fetus or the mother.

Use of cosmetic services; medical examination, treatment, and rehabilitation in case of disaster; medical examination and treatment of drug addiction, alcohol addiction, or other addictive substances; medical examination, forensic examination, forensic psychiatric examination; participation in clinical trials and scientific research.

In addition, the Ministry of Health proposes amending and supplementing Clause 5 regarding the group that pays for health insurance themselves.

Specifically, the list includes people living, working, or being cared for in charitable or religious organizations and institutions; Vietnamese citizens without identification documents; foreigners residing in Vietnam who do not fall under the categories stipulated in the law; and workers on unpaid leave or with temporarily suspended employment contracts who contribute to the scheme themselves or participate in it as a household.

Source: https://tuoitre.vn/bo-y-te-de-xuat-chi-tra-bao-hiem-y-te-cho-kham-chua-benh-khong-dung-tuyen-20240223164111.htm