No restrictions on prescribing insurance drugs at primary health care facilities

From 2025, treatment facilities will be able to prescribe drugs in accordance with their professional capacity, regardless of the treatment level. Lower-level treatment units will have their drugs previously unpaid covered by the insurance fund.

Do not divide the drug list by hospital class

"From 2025, according to new regulations in Circular 37/2024 issued by the Ministry of Health , medical facilities will not prescribe drugs according to hospital class, and will not divide drug lists according to hospital class," said Deputy Minister of Health Tran Van Thuan at a conference on health insurance drugs held this morning, December 5.

From 2025, people with chronic diseases who have their health monitored at primary health care facilities will still be able to use health insurance drugs from higher-level health care facilities.

According to Professor Thuan, with the new regulation mentioned above, medical examination and treatment facilities are allowed to use all drugs in the list, in accordance with the scope of professional activities, diagnostic and treatment guidelines, regardless of hospital class or technical level, except in cases where there are notes on regulations, conditions on medical examination and treatment facilities or technical level or professional requirements on drug use.

This regulation encourages medical examination and treatment facilities to develop their expertise and techniques; attract human resources and encourage the development of medical staff's capacity, especially creating conditions for the development of grassroots health care by ensuring fairness in access and payment of health insurance for drugs.

At the same time, it helps limit the number 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.

Commune health centers prescribe expensive drugs

According to the representative of the Health Insurance Department, from 2025, when applying new regulations supplementing and amending the guidelines for drug payment to enhance drug access, there will be flexibility in payment for health insurance patients, creating conditions for medical examination and treatment facilities to pay for drug costs that were not previously paid due to the lack of specific guidelines. Thereby, contributing to ensuring the rights of health insurance participants, creating a financial mechanism to promote the development of medical examination and treatment facilities.

Thus, when patients return to primary health care, they still receive expensive drugs as prescribed by upper-level doctors.

According to current regulations, there are 1,037 active ingredients of drugs in the list covered by the Health Insurance Fund. Special and first-class hospitals are paid for all drugs in the list. But second-class hospitals are only paid for 991/1,037 active ingredients.

For level 3 and 4 hospitals (district level, medical center), health insurance covers 756 active ingredients of drugs. At commune health stations, there are only 356 active ingredients in the list covered by health insurance.

Source: https://thanhnien.vn/khong-han-che-ke-don-thuoc-bao-hiem-tai-y-te-co-so-185241205120238727.htm