According to Minister of Health Dao Hong Lan, the health insurance medical examination and treatment route is established to ensure that patients receive treatment appropriate to their health condition.
Cases beyond the treatment capacity of primary hospitals will be transferred to higher-level hospitals, thereby contributing to reducing overload at higher-level hospitals and improving treatment efficiency.
 |
| Illustration photo. |
According to the head of the health sector, the health insurance policy has been implemented since 2016, allowing health insurance participants to receive medical examination and treatment at district and provincial levels nationwide without a referral.
In particular, ethnic minorities and people living in island communes and island districts are also allowed to have inpatient examinations directly at central-level hospitals without having to be transferred.
A notable point is that from July 1, 2025, according to Law No. 51/2024/QH15 - Law amending and supplementing a number of articles of the Law on Health Insurance, health insurance participants with 62 serious and rare diseases will be examined and treated directly at specialized hospitals without a referral letter, and will enjoy 100% of health insurance benefits.
The list of 62 diseases has been announced by the Ministry of Health in Appendix I of Circular 01/2025/TT-BYT, including many dangerous diseases such as pancreatic cancer (ICD-10 code C25), cardiovascular diseases, neurological diseases, genetic diseases, and metabolic disorders.
Specifically, when a patient is diagnosed with one of the 62 diseases mentioned above at the primary health care facility, they can go to specialized hospitals for further treatment without a referral.
In case the patient goes directly to a specialized hospital and is diagnosed with a disease on this list, he/she will also enjoy full health insurance benefits from the first examination.
However, if the patient has other diseases that are not on the list of 62 critical illnesses, the health insurance will only pay according to the benefit level corresponding to those diseases, and special policies such as rare or critical illnesses will not apply.
In addition, from July 1, 2025, the health insurance law also officially expanded the scope of payment for remote medical examination and treatment services, including at home. This is an important step forward to help patients in remote areas, people who cannot move, have the opportunity to access high-quality medical services while still enjoying full health insurance payment.
Regarding the policy to support students participating in health insurance, Minister Dao Hong Lan said that this group belongs to group 4 according to Decree No. 188/2025/ND-CP of the Government . Accordingly, students are supported with at least 50% of the health insurance premium - higher than the support level for households (30%), to reduce the financial burden on families.
In an effort to improve the efficiency of health insurance fund use, the Ministry of Health has just issued a Circular detailing payment for herbal medicines, traditional medicines, medicines combining pharmaceutical ingredients with herbal medicines and herbal medicines within the scope of health insurance coverage.
This Circular takes effect from September 1, 2025, aiming to promote the safe and rational use of traditional medicine, encourage the production of medicine from domestic raw materials, and harmoniously combine modern and traditional medicine.
According to the new regulations, drugs on the list covered by health insurance must have a valid circulation registration certificate, not contain rare animal or plant ingredients (unless legally cultivated), have proof of treatment effectiveness and safety, and be published in reputable scientific journals or have been accepted.
Some special traditional medicines will be exempted from clinical proof if they have been recorded in the Vietnamese Pharmacopoeia or reliable international documents.
Health insurance coverage for these drugs will be based on the scope of indication, the user and the medical facility performing the treatment. If the treatment cost is significantly higher than that of drugs with the same effect, the health insurance coverage may be limited to ensure budget balance.
The Ministry of Health also affirmed that it will continue to review and adjust health insurance policies to ensure legitimate rights for people, improve treatment effectiveness, promote fairness in access to health services and protect the health of all people.
Source: https://baodautu.vn/bo-y-te-noi-gi-ve-de-xuat-bo-giay-chuyen-vien-d400831.html
Comment (0)