Health insurance benefits according to professional classification of 48 hospitals

According to the new Law on Medical Examination and Treatment, from January 1, 2025, medical examination and treatment facilities nationwide will be divided into three levels of technical expertise: initial level, basic level and advanced level.

According to the new Law on Medical Examination and Treatment, from January 1, 2025, medical examination and treatment facilities nationwide will be divided into three levels of technical expertise: initial level, basic level and advanced level.

This is an important change that directly affects the health insurance benefits of patients, so they need to pay attention to the level of the medical facility where they register.

It is expected that by January 15, 2025, the Ministry of Health will complete the assessment and announce the results of professional classification of medical facilities nationwide.

The Ministry of Health has just announced the results of the technical classification of 48 hospitals under the Ministry. Accordingly, 4 hospitals are classified as high-tech specialized hospitals, including Bach Mai Hospital, Cho Ray Hospital, Hue Central General Hospital and Ho Chi Minh City University of Medicine and Pharmacy Hospital. In addition, 24 hospitals are classified as specialized hospitals, and the remaining 20 hospitals are classified as basic hospitals, including both specialized and general hospitals.

It is expected that by January 15, 2025, the Ministry of Health will complete the assessment and announce the results of professional classification of medical facilities nationwide.

This classification is based on four groups of competencies: the ability to provide medical examination and treatment services and the scope of professional activities, the ability to participate in medical practice training, the ability to participate in technical support for other facilities, and the ability to conduct scientific research in medicine. Hospitals will self-assess their scores and competent authorities will confirm and evaluate the results.

It is known that according to the new regulations, patients with diseases in the list of 62 rare and dangerous diseases can go directly to specialized hospitals without a referral letter. The level of health insurance benefits for outpatient examination and treatment and medical examination upon request will be adjusted from July 1, 2026.

According to Decree 02/2025/ND-CP and Circular 01/2025/TT-BYT, the level of health insurance benefits for outpatient examination and treatment at basic medical facilities will be specifically regulated.

If a new medical facility is established and licensed, patients will be paid 100% of outpatient medical examination and treatment costs from January 1, 2025.

However, for facilities with a score of 50 to below 70, the health insurance payment will be reduced to 50% from July 1, 2026. Provincial or central facilities will be paid 50% of the benefit from July 1, 2026.

In addition, the new regulations also help reduce administrative procedures and facilitate patients when using health insurance services. Specifically, using citizen identification cards or level 2 electronic identification accounts to replace manual documents will help reduce the time for medical examination and treatment registration, while ensuring accuracy and speed in processing medical records.

Electronic health insurance cards will be integrated into the VNeID application, helping people not need to bring paper health insurance cards when going to see a doctor, saving time and effort.

Decree 02/2025/ND-CP also provides detailed regulations on payment of medical examination and treatment costs at private medical facilities and medical services whose prices have not been approved, to ensure that public and private medical facilities comply with health insurance prices and avoid medical cost abuse.

In addition, public hospitals will need to comply with regulations on health insurance payments for approved technical services that do not have official prices, contributing to protecting patients' rights and creating fairness in the health system.

Source: https://baodautu.vn/quyen-loi-bao-hiem-y-te-theo-phan-cap-chuyen-mon-cua-48-benh-vien-d240018.html