Those who self-examine and treat patients outside the designated medical facility will enjoy 100% health insurance from July 1.

The 2024 Law on Health Insurance expands benefits for people who seek medical examination and treatment at a place other than their initial registration, that is, go to a hospital in the wrong area or at a different level, but are still paid 100% of the cost in some cases.

Point 4, Clause 17, Article 1 of the new Law on Health Insurance (effective from July 1) stipulates that health insurance participants who self-examine and treat at a facility other than the initial registration facility, or do not comply with regulations on patient transfer (also known as self-examination and treatment at a facility other than the designated facility or level), will be paid 100% of the benefit by the health insurance fund in the following cases:

- Medical examination and treatment at basic or specialized facilities in cases of definitive diagnosis and treatment of certain rare diseases, serious diseases, diseases requiring surgery or using advanced techniques as prescribed by the Minister of Health .

- Ethnic minorities and poor households living in areas with difficult socio -economic conditions, areas with especially difficult socio-economic conditions, people living in island communes and island districts when receiving inpatient treatment at specialized facilities.

- Medical examination and treatment at primary care facilities.

- Inpatient treatment at basic facilities.

- Medical examination and treatment at basic and specialized facilities that, before January 1, 2025, have been identified by competent authorities as district level.

- Inpatient examination and treatment at specialized facilities that, before January 1, 2025, have been identified by competent authorities as provincial level.

- Medical examination and treatment at any medical facility in case of emergency.

The Ministry of Health currently stipulates that people with 62 serious and rare diseases requiring surgery or advanced techniques can go directly to specialized hospitals for examination and treatment without having to go through procedures to transfer to a medical facility (formerly called referral).

In the list, the most common are malignant tumors, metabolic disorders, congenital malformations... For example, people with pancreatic malignancies (code C25), thymic malignancies (C37), meningioma (C70), brain malignancies (C71), neonatal diabetes (P70.2)... are entitled to benefits immediately during the medical examination and treatment session with a confirmed diagnosis of the disease. Heart failure patients with stage 3 and stage 4 diagnosis are also promoted directly to intensive care...

However, not everyone diagnosed with any malignant tumor (cancer) is eligible for this policy. Accordingly, people with diseases in the malignant tumor group (with codes from C00 to C97) who meet the following 2 conditions will be promoted directly to the specialized level without having to go through the prescribed referral procedures (also known as bypassing the line):

- People under 18 years old.

- Not applicable to cases that have been diagnosed but do not have specific treatment indications.

- For diabetes, patients who are directly promoted to the intensive level must meet a number of conditions: Insulin-dependent patients (code E10.7) have complications of grade 2 foot ulcers or have stage 3 or higher chronic kidney disease or have at least 2 of the following complications: cardiovascular, eye, nerve, blood vessel. Non-insulin-dependent patients (code E11.7) have complications of grade 2 foot ulcers or have stage 3 or higher chronic kidney disease.

Ms. Tran Thi Trang, Director of the Department of Health Insurance (Ministry of Health), said that the Ministry is reviewing to add some rare and serious diseases to this list.

According to Ms. Trang, these rare and serious diseases must "deserve to be promoted to a higher level from the beginning, ensuring that people receive timely treatment", meeting practical needs.

Some medical facilities also reflect that some diseases in this list at the previous level (such as basic, initial level) can be treated, the drafting agency will balance and adjust, the goal is to avoid overload or push patients to higher levels, as well as ensure balanced use of the Health Insurance Fund.

Currently, the Vietnamese health care system is divided into 3 levels: initial (usually commune health stations, general clinics), basic (district-level hospitals, provincial specialized hospitals or provincial general hospitals, some central hospitals), and specialized (mostly central-level general/specialized hospitals, some provincial general or specialized hospitals).

HA (according to Vietnamnet)

Source: https://baohaiduong.vn/nhung-truong-hop-tu-di-kham-chua-benh-trai-tuyen-duoc-huong-100-bao-hiem-y-te-tu-1-7-415287.html