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1. Latest prices for health insurance-covered medical examination and treatment services.
The latest prices for health insurance-covered medical examination and treatment services are stipulated in Article 2 of Circular 22/2023/TT-BYT as follows:
- The fees for medical examinations and consultations are regulated in Appendix I.
- The daily hospital bed service fee is regulated in Appendix II.
- The prices for technical services and tests are regulated in Appendix III.
- Additional notes on certain technical services as stipulated in Appendix IV.
- The price of technical services performed using local anesthesia does not include the cost of medications and oxygen used for the service as stipulated in Appendix V. The cost of medications and oxygen will be reimbursed to the social insurance agency and the patient based on actual usage and the results of the unit's procurement bidding.
2. Structure of health insurance-covered medical examination and treatment services
According to Article 3 of Circular 22/2023/TT-BYT, the price of medical examination and treatment services covered by health insurance is based on direct costs and salaries to ensure medical examination and treatment, specifically as follows:
(1) Direct costs included in the price of medical examination services:
- Costs for clothing, hats, masks, bed sheets, pillows, mattresses, mats, stationery, gloves, cotton, bandages, alcohol, gauze, saline solution, and other consumable supplies used in medical examinations;
- Costs for electricity; water; fuel; disposal of domestic and medical waste (solid and liquid); washing, ironing, steaming, drying, rinsing, and sterilizing linens and examination instruments; costs for sanitation and environmental hygiene; supplies and chemicals for disinfection and infection control during medical examinations:
- Costs for maintaining and repairing the building and equipment, purchasing replacements for assets, tools, and instruments such as: air conditioners, computers, printers, dehumidifiers, fans, tables, chairs, beds, cabinets, lighting fixtures, and other necessary tools and equipment used in medical examinations.
(2) Direct costs included in the daily hospital bed service price:
- Costs for clothing, hats, masks, blankets, sheets, pillows, mattresses, curtains, mats; stationery; gloves used in examinations, injections, infusions; cotton, bandages, alcohol, gauze, saline solution for rinsing and other consumable supplies for daily care and treatment (including costs for changing wound or surgical dressings for inpatients, except for cases reimbursed outside the daily bed service price stipulated in Clauses 5 and 6 of Article 7 of Circular 22/2023/TT-BYT); electrodes, ECG cables, blood pressure cuffs, SPO2 cables during the use of patient monitors for emergency and intensive care beds.
- The costs stipulated in points b and c of Clause 1, Article 3 of Circular 22/2023/TT-BYT are for the care and treatment of patients according to professional requirements.
- Specifically, the costs of medicines, whole blood, blood products meeting standards, intravenous fluids, medical equipment (excluding the supplies mentioned above); various types of syringes, needles, and drug dispensing needles used in injections and infusions; feeding pumps; infusion sets, tubing, and connecting tubes for electric syringe pumps and infusion machines used in injections and infusions; oxygen, oxygen breathing tubes, and oxygen masks (except in cases where the patient is prescribed mechanical ventilation) are not included in the daily hospital bed service price structure and will be reimbursed based on actual usage for the patient.
(3) Direct costs included in the price of technical services:
- Costs for clothing, hats, masks, sheets, pillows, mattresses, mats, linens; stationery; medicines, intravenous fluids, chemicals, consumables, and replacement materials used in the process of providing technical services;
- The costs stipulated in points b and c of Clause 1, Article 3 of Circular 22/2023/TT-BYT are for the provision of technical services as required by professional standards.
(4) Salary costs included in the price of medical examination services, hospital bed services and technical services, including:
- Salaries based on rank, position, allowances, and contributions as prescribed by the State for public non-business units, and the basic salary level stipulated in Decree 24/2023/ND-CP;
- On-call allowance, surgical and procedural allowance according to Decision 73/2011/QD-TTg.
(5) Salary costs in the price of medical examination and treatment services stipulated in Clause 4, Article 3 of Circular 22/2023/TT-BYT do not include expenses under the regime guaranteed by the state budget as prescribed by law as follows:
- Preferential allowances, attraction allowances, subsidies, and other incentives for medical staff, contract workers, and military medical personnel directly engaged in medical professional work at state-owned medical facilities in areas with particularly difficult socio -economic conditions;
- Attraction allowance, long-service allowance, certain subsidies and travel expense payments for officials, civil servants, and employees receiving salaries in the armed forces (People's Army and People's Police) working in areas with particularly difficult socio-economic conditions;
- Special allowance regime for officials and employees working at Friendship Hospital, Thong Nhat Hospital, Da Nang C Hospital under the Ministry of Health , Central Health Protection Departments 1, 2, 2B, 3 and 5, Department A11 of Central Military Hospital 108 and Department A11 of the Military Traditional Medicine Institute;
- Specific allowances based on occupation or job.
(6) Payment of medical examination and treatment costs between social insurance agencies and medical examination and treatment facilities according to the service prices stipulated in this Circular and costs of medicines, whole blood, blood products meeting standards, chemicals, medical equipment not included in the service price (specifically noted in the services) according to the payment principles stipulated in Article 24 of Decree 146/2018/ND-CP which has been amended and supplemented by Decree 75/2023/ND-CP.
Note: The costs specified in points 1, 2, 3, and 4 are determined based on economic and technical norms, cost norms issued by competent authorities, the prices of cost elements, and the actual and reasonable cost levels according to current regulations and policies, ensuring average and advanced levels that meet service quality requirements.
Economic and technical norms serve as the basis for establishing the price of medical examination and treatment services and should not be used as a basis for payment for each specific medical examination and treatment service (except for some specific cases stipulated in Clause 6, Article 5, Clause 16, Article 6, and Clause 8, Article 7 of Circular 22/2023/TT-BYT).
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