Do not stop health insurance medical examination and treatment contracts with private medical facilities

Patients visit a private hospital in Nghe An province. Photo: Ta Chuyen/VNA

Explaining this issue, Mr. Le Van Phuc - Deputy Head of the Department in charge of the Health Insurance Policy Implementation Department (Vietnam Social Insurance) said that in Official Dispatch 5163/BHXH-CSYT, dated November 17, 2017, sent to the social insurance of provinces and cities to guide on signing contracts and paying for health insurance medical examination and treatment costs in 2018, this unit only requested private medical facilities to supplement missing documents according to the provisions of Joint Circular No. 41/2014/TTLT-BYT-BTC of the Ministry of Health and Finance.

Specifically, private medical facilities that continue to sign health insurance medical examination and treatment contracts in 2018 must have an additional Decision on technical professional classification and apply prices according to the equivalent public hospital class as prescribed in Clause 6, Article 4 of Joint Circular No. 37/2015/TTLT-BYT-BTC regulating the unification of prices for health insurance medical examination and treatment services among hospitals of the same class nationwide.

Mr. Le Van Phuc said that according to the provisions of the Law on Health Insurance, in order for the Social Insurance agency to sign a contract and pay for health insurance medical examination and treatment costs, the medical facility must be classified to determine the payment price and technical expertise to serve as a basis for determining the health insurance benefits of patients when they receive medical examination and treatment at a place other than the original registration place.

For medical facilities, being ranked and classified is also the legal basis for performing technical services, using drugs and referring patients. Requirements for signing health insurance medical examination and treatment contracts are specified in Joint Circular No. 41/2014 of the Ministry of Health and Ministry of Finance.

Clause 2, Article 7 of this Circular clearly states: Medical facilities signing health insurance medical examination and treatment contracts must have a hospital classification decision from a competent authority (if any); for non-public medical examination and treatment facilities, there must be a technical professional classification decision from a competent authority.

Circular on classifying private hospitals has not been issued yet.

According to Mr. Phuc, in fact, up to now, the Ministry of Health has not yet issued a Circular guiding the classification and technical expertise for private hospitals. The delay in issuance has caused difficulties for social insurance agencies and private hospitals in determining payment rates and health insurance benefits for patients.

Currently, there is no Circular guiding the classification of private hospitals. Photo: VNA/Vietnam+

For example, with the same hospital scale, some localities apply prices equivalent to grade 3 and temporarily classify them as district level, while other localities apply prices equivalent to grade 2 and temporarily classify them as provincial level.

In particular, when applying the regulation on medical examination and treatment through district level, there was a situation where private hospitals were temporarily classified as equivalent to grade 2 public hospitals at provincial level but requested to be demoted to grade 3, district level.

Vietnam Social Security has made many recommendations to the Ministry of Health to soon issue a Circular guiding the classification and referral of private hospitals to resolve these problems.

Thus, the request of Vietnam Social Security for social insurance agencies of provinces and cities to review medical examination and treatment facilities that do not meet the conditions to request additional documents to sign contracts is in accordance with the provisions of the Law on Health Insurance, the guiding documents of the Ministry of Health and the Ministry of Finance in implementing the Law.

The solution to the current problem is that the Ministry of Health needs to promptly issue specific guidelines on hospital ranking criteria and technical expertise for private hospitals, or at least have temporary standards as a basis for evaluation, ranking and determining technical expertise for all private medical facilities participating in health insurance examination and treatment./.

According to Vietnamplus.vn