At the workshop to disseminate Circular No. 37/2024/TT-BYT dated November 16, 2024 of the Minister of Health and to seek opinions on the List of pharmaceutical drugs, biological products, radioactive drugs and markers within the scope of benefits for health insurance participants (Circular 37/TT-BYT/2024) recently organized by the Ministry of Health, some medical facilities still have concerns about some regulations related to health insurance payment for cancer treatment drugs.
According to a representative of Hung Vuong General Hospital, Phu Tho province, Circular 37/TT-BYT/2024, effective from January 1, 2025, stipulates that medical facilities must have oncologists to use chemotherapy drugs to treat cancer, or medical facilities that have oncologists but do not have a certificate in cancer treatment, after completing surgery for the patient, will have to transfer the patient to another facility for chemotherapy treatment.
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| Health insurance patients receive medicine at the hospital. (Illustration photo. Photo: Do Thoa) |
Therefore, the Hospital is concerned about this regulation. In the above case, the medical facility can completely consult online with the upper level hospitals to provide appropriate treatment for the patient, or the medical facility can invite the doctor directly to consult the patient.
Regarding this content, sharing at the workshop, Ms. Vu Nu Anh, Deputy Director of the Department of Health Insurance, Ministry of Health said that the regulation is dividing into 2 types: cancer treatment drugs and non-cancer treatment drugs.
Circular 37 has been expanded in the form of medical facilities with oncology departments or specialized departments for cancer treatment, which have approved technical cancer treatment services, have the right to use cancer treatment drugs and be paid for by health insurance. However, cancer treatment drugs will be used according to the specific rates and conditions in the list of drugs within the scope of benefits for health insurance participants.
Ms. Nu Anh said that with nearly 80 cancer treatment active ingredients in the list of drugs covered by health insurance, medical facilities also need to base on the conditions noted in the list of drugs to use and pay for health insurance.
Regarding the form of remote medical examination and treatment, Ms. Tran Thi Trang, Director of the Department of Health Insurance, Ministry of Health said that if medical facilities have a professional cooperation contract with each other, doctors at higher levels consult and prescribe medicine for patients, and doctors at lower levels use appropriate medicine for patients as prescribed, they will still be paid by health insurance.
In case of inviting doctors directly to medical facilities to consult and treat patients, the Circular does not provide specific details, so the Department of Health Insurance will continue to research and include instructions in the following instructions.
At the workshop, Mr. Le Van Phuc, Head of the Health Insurance Policy Implementation Department, Vietnam Social Security, also acknowledged some of the problems raised by medical facilities. For example, the scope of drug payment is still implemented according to the Drug List issued with Circular 20/2022/TT-BYT.
However, according to this regulation, if a medical facility has an approved list of chemotherapy services, will this service be paid for by health insurance with or without chemotherapy or will only the infusion technique be paid for?
The use of chemicals must be accompanied by conditions such as whether the chemicals are used in level 2 or level 3 hospitals. These issues will also be updated by the authorities in the following instructions.
Information at the workshop said that by November 15, the Department of Health Insurance had received dossiers of 75 drugs with new proposed additions with 25 groups of effects. Of these, the most were cancer treatment drugs, targeted therapy with high costs accounting for nearly 1/3.
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| At the workshop, some medical facilities still had concerns about some regulations related to health insurance payment for cancer treatment drugs. |
According to Prof. Dr. Tran Van Thuan, Deputy Minister of Health, in recent years, drugs have always been an important component and always accounted for a large proportion of the total cost of medical examination and treatment under health insurance. Currently, the promulgation of the list and regulations on health insurance payment for drugs is being implemented according to Circular No. 20/2022/TT-BYT dated December 31, 2022 of the Minister of Health promulgating the list and rates, payment conditions for pharmaceutical drugs, biological products, radioactive drugs and markers within the scope of benefits of health insurance participants.
After nearly 2 years of implementation, Circular No. 20/2022/TT-BYT also revealed a number of problems, requiring amendments, supplements, and adjustments to suit the actual situation.
In order to have a clear, public and transparent legal basis for the development and updating of the list of health insurance drugs, on November 16, 2024, the Minister of Health issued Circular No. 37/2024/TT-BYT stipulating the principles, criteria for development, updating, recording information, list structure and payment instructions for pharmaceutical drugs, biological products, radioactive drugs and markers within the scope of benefits of health insurance participants.
Medical examination and treatment facilities are allowed to use all drugs in the list, in accordance with the scope of professional activities, diagnosis and treatment guidelines, regardless of hospital class or technical level. In particular, except for cases with notes on regulations, conditions on medical examination and treatment facilities or technical level or professional requirements on drug use.
This regulation will encourage medical examination and treatment facilities to develop their expertise and techniques; attract human resources and encourage the development of the capacity of medical staff, especially creating conditions for the development of grassroots health care by ensuring fairness in access and payment of health insurance for drugs, contributing to limiting the situation of patients choosing to go to medical examination and treatment facilities with high technical expertise, reducing the overload situation at some medical examination and treatment facilities with high technical expertise.
Accordingly, Circular 37 has added new regulations and amended a number of regulations on drug payment instructions to ensure compliance with the Law on Medical Examination and Treatment and increase access to drugs, provide flexibility in payment instructions for patients, and create conditions for medical examination and treatment facilities to pay for drug costs that were not previously paid due to the lack of specific instructions. Thereby, contributing to ensuring the rights of health insurance participants, while creating a financial mechanism to promote the development of medical examination and treatment facilities.
It is expected that in the first quarter of 2025, the Ministry of Health will develop and issue a Circular on the list of drugs to replace Circular No. 20/2022/TT-BYT, focusing on reviewing and updating regulations on drug use according to hospital class and technical expertise level to match the technical expertise level as prescribed in the Law on Medical Examination and Treatment 2023./.
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