Health insurance payment at private medical facilities: Patients pay the difference in service price themselves.

According to the latest guidance of the Ministry of Health, from July 1, 2025, payment of medical examination and treatment costs under health insurance at private medical facilities will be uniformly applied according to Decree No. 188/2025/ND-CP of the Government detailing and guiding the implementation of a number of articles of the Law on Health Insurance.

People make payment procedures for medical examination and treatment costs. (Photo: DO THOA)

The Ministry of Health has just issued Official Dispatch No. 6872/BYT-BH to Vietnam Social Security to guide the implementation of Decree No. 188/2025/ND-CP of the Government detailing and guiding the implementation of a number of articles of the Law on Health Insurance, including instructions on payment for health insurance examination and treatment services at private medical examination and treatment facilities.

According to the reflection of Vietnam Social Security, before July 1, 2025, payment for health insurance medical examination and treatment services at private medical examination and treatment facilities shall be implemented according to the provisions of Clause 11, Article 27 of Decree No. 146/2018/NDCP, amended and supplemented in Clause 6, Article 1 of Decree No. 02/2025/ND-CP (expired from July 1, 2025).

Meanwhile, at Point b, Clause 2, Article 39 of Decree No. 188/2025/ND-CP stipulates: "For private medical examination and treatment facilities, the Health Insurance Fund shall pay the cost of medical examination and treatment covered by health insurance based on the price of medical examination and treatment services in the list paid by the Health Insurance Fund, prescribed or approved by competent authorities according to the provisions of law on medical examination and treatment for State medical examination and treatment facilities in the area according to the principles prescribed in Points a, b, c and d, Clause 2, Article 47 of this Decree..." effective from July 1, 2025.

Article 47 of Decree No. 188/2025/ND-CP takes effect from August 15, 2025.

Therefore, Vietnam Social Security requests the Ministry of Health to provide guidance on payment of health insurance examination and treatment costs at private medical examination and treatment facilities during the period from July 1, 2025 to August 14, 2025.

Responding to this issue, the Ministry of Health cited information at Point b, Clause 2, Article 39 of Decree No. 188/2025/ND-CP stipulating that, for private medical examination and treatment facilities, the Health Insurance Fund shall pay for medical examination and treatment costs based on the price of medical examination and treatment services on the list paid by the Health Insurance Fund, prescribed by competent authorities according to the provisions of law on medical examination and treatment, or approved for State medical examination and treatment facilities in the area.

The difference between the price of medical examination and treatment services at private medical examination and treatment facilities and the price of medical examination and treatment services on the list paid by the Health Insurance Fund shall be paid by the patient himself/herself.

Decree No. 188/2025/ND-CP also clearly states that in case a private medical examination and treatment facility applies the payment level for medical examination and treatment costs of the Health Insurance Fund according to this regulation, it shall be implemented as follows:

Intensive medical examination and treatment facilities are paid according to actual prices but not higher than the highest price of that medical examination and treatment service of the same specialized medical examination and treatment facility of the State in the province or of the basic medical examination and treatment facility of the State in the province in case there is no price of the specialized medical examination and treatment facility of the State in the province;

Basic medical examination and treatment facilities are paid at the actual price but not higher than the highest price of that medical examination and treatment service of the same basic medical examination and treatment facility of the State in the province. In case the basic medical examination and treatment facility of the State in the province does not have a price for that medical examination and treatment service, the maximum payment is equal to the lowest price of that technical service of the specialized medical examination and treatment facility of the State in the province;

The initial medical examination and treatment facility is paid at the actual price but not higher than the highest price of that medical examination and treatment service of the same initial medical examination and treatment facility of the State in the province.

In case the State's primary medical examination and treatment facility in the province does not have a price for that medical examination and treatment service, the maximum payment shall be equal to the lowest price of that medical examination and treatment service of the State's primary medical examination and treatment facility in the province;

In case the price of such medical examination and treatment service has not been regulated or approved by a competent authority for a State medical examination and treatment facility in a province, the private medical examination and treatment facility shall be paid according to the principles prescribed in points a, b and c of this clause according to the price of such medical examination and treatment service approved by a competent authority for a State medical examination and treatment facility in one of the neighboring provinces.

In case the State medical examination and treatment facility in the bordering provinces does not have the price of that medical examination and treatment service, payment shall be made according to the price of that medical examination and treatment service approved by the competent authority for the State medical examination and treatment facility in another province nationwide.

The Ministry of Health said that Point b, Clause 2, Article 39 above refers to Points a, b, c, d, Clause 2, Article 47 of Decree No. 188/2025/ND-CP as the principle of application (so as not to have to repeat the content of Clause 2, Article 47). Therefore, the implementation of payment for health insurance examination and treatment costs at private medical examination and treatment facilities shall comply with the effect of Clause 2, Article 39 of Decree No. 188/2025/ND-CP from July 1, 2025.

DO THOA

Source: https://nhandan.vn/thanh-toan-bao-hiem-y-te-tai-co-so-y-te-tu-nhan-nguoi-benh-tu-chi-tra-phan-chenh-lech-gia-dich-vu-post914616.html