Self-purchase of medicine and medical equipment: Patients will soon receive direct payment from social insurance

Health insurance participants will be paid for the cost of self-medication - Illustration: DUONG LIEU

Specifically, the circular stipulates cases of drugs and medical equipment within the scope of payment, payment conditions, payment levels, and payment records and procedures.

Regarding payment conditions, the circular clearly states that at the time of prescribing drugs and indicating the use of medical equipment, the following conditions must be ensured:

Firstly , there are no medicines or medical equipment because the contractor selection process is in progress according to the approved contractor selection plan.

At the same time, at the medical examination and treatment facility, there is no commercial medicine containing the active ingredient that the patient is prescribed or the same active ingredient but with a different concentration, content, dosage form, or route of administration and cannot be substituted for the prescription for the patient.

With medical devices, it is when the medical device that the patient is prescribed to use is not available and there is no medical device to replace it.

Second , do not transfer patients to other medical examination and treatment facilities in one of the following cases:

- The patient's health condition and illness are determined to be ineligible for transfer.

- The medical examination and treatment facility where the patient is being examined and treated is under medical isolation according to the provisions of the law on prevention and control of infectious diseases.

- The medical examination and treatment facility where the patient is being examined and treated is a specialized medical examination and treatment facility.

Third , it is not possible to transfer drugs and medical equipment between medical examination and treatment facilities according to the provisions of law.

Fourth , prescribed and indicated drugs and medical equipment must be in accordance with the scope of expertise of the medical examination and treatment facility and have been covered by health insurance at one of the medical examination and treatment facilities nationwide.

Fifth , prescribed and indicated drugs and medical equipment must be within the scope of benefits of health insurance participants.

According to the circular, the social insurance agency will pay directly to the patient according to the regulations. For example, for drugs, the basis for calculating the payment level is the quantity and unit price stated on the invoice purchased by the patient at the pharmaceutical business establishment. In case the drug has regulations on payment rates and conditions, the payment rates and conditions shall be implemented.

This Circular takes effect from January 1, 2025. In case a patient enters a medical examination and treatment facility for examination and treatment before the effective date of this Circular but finishes treatment after the effective date of this Circular, the provisions of this Circular shall apply.

What do patients do to get their costs paid?

According to Decree No. 146/2018/ND-CP, to directly pay medical examination costs between the social insurance agency and health insurance participants, patients need to prepare a request for direct payment.

The file includes photocopies of documents (with originals for comparison) such as health insurance cards, identity cards as prescribed; hospital discharge papers, medical examination forms or medical examination books of the medical examination or treatment for which payment is requested; and invoices and related documents.

Patients or relatives or legal representatives as prescribed directly submit applications to the district-level health insurance agency where they reside.

District-level health insurance is responsible for receiving documents, making records of receiving documents and providing full instructions.

Within 40 days from the date of receipt of the complete payment request, the health insurance assessment must be completed and the medical examination and treatment costs for the patient must be paid. In case of non-payment, a written response must be given stating the reason.

Source: https://tuoitre.vn/tu-mua-thuoc-thiet-bi-y-te-nguoi-benh-sap-duoc-bhxh-chi-tra-truc-tiep-20241019155455305.htm