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

Người dân thanh toán BHYT tại Bệnh viện Thanh Nhàn (Hà Nội) - Ảnh minh họa: NAM TRẦN — 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 to develop a Law amending and supplementing a number of articles of the Law on Health Insurance. In particular, the Ministry proposes to amend and supplement a number of regulations on the scope of benefits, levels of health insurance benefits and adjust the rate of health insurance payments for a number of cases that do not meet the technical expertise level for medical examination and treatment under health insurance.

According to the draft, the Ministry of Health proposes an adjustment plan for cases where patients seek medical examination and treatment under health insurance at a level not appropriate to their technical expertise at specialized medical examination and treatment facilities and some basic care facilities.

Specifically, in the case of people seeking medical treatment outside the basic level (level 2 and level 1 provincial hospitals - not classified as 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 paid).

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)

Mức hưởng bảo hiểm y tế được điều chỉnh từ tuyến, hạng sang cấp chuyên môn kỹ thuật Bộ Y tế đề xuất - Ảnh chụp màn hình — Health insurance benefits are adjusted from line, level to technical professional level proposed by the Ministry of Health - Screenshot

Add the list of non-health insurance payment

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 pay health insurance for the use of replacement medical supplies including artificial eyes, dentures, eyeglasses, and mobility aids in medical examination, treatment, and rehabilitation.

Previously, the list of non-covered items included the use of replacement medical supplies including artificial limbs, artificial eyes, dentures, eyeglasses, hearing aids, mobility aids in medical examination, treatment and rehabilitation that were not covered by health insurance.

Thus, health insurance participants are only covered for medical supplies such as prosthetic limbs and hearing aids.

The Ministry of Health also maintains the cases that health insurance does not cover, including: nursing and convalescence at nursing and convalescent facilities; health check-ups; tests and pregnancy diagnosis not for treatment purposes.

Use of assisted reproductive techniques, family planning services, abortion, except in cases where pregnancy must be terminated due to pathological causes of the fetus or the mother.

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

In addition, the Ministry of Health proposed to amend and supplement Clause 5 on the group of self-paying health insurance.

Specifically, adding people living, working, being raised and cared for in organizations, charitable and religious establishments; Vietnamese people without identification papers; foreigners living in Vietnam who are not subjects specified in the law; employees on unpaid leave or temporarily suspending their labor contracts who pay by themselves or participate as a household.

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