Health insurance patients are paid for medicine and medical equipment when hospitals are in shortage.
The Ministry of Health has just issued Circular 22/2024/TT-BYT stipulating that cases with health insurance cards are entitled to payment for medicine and medical equipment costs when hospitals lack medicine and equipment on the health insurance list.
Specifically, the Ministry of Health regulates direct payment of drug and medical equipment costs for people with health insurance cards when going for medical examination and treatment, but at the time of prescription, there is an indication to use medical equipment that the hospital does not have the drug or medical equipment for which the hospital is in the process of selecting a contractor according to the approved contractor selection plan but the contractor cannot be selected.
At the same time, at that time, the medical examination and treatment facility did not have any commercial medicine containing the active ingredient prescribed to the patient or the same active ingredient but with a different concentration or content or dosage form or route of administration and could not substitute it for the prescription for the patient.
For medical equipment, the medical facility does not have the equipment that the patient is prescribed to use and does not have medical equipment to replace it.
Patients with health insurance cards are also paid for medicine and medical equipment costs when they cannot be transferred to another medical examination and treatment facility due to their health condition or illness not allowing them to be transferred; the medical examination and treatment facility where the patient is being treated is in medical isolation or the facility is a specialized medical examination and treatment facility.
In addition, patients with health insurance cards are also paid directly for the cost of drugs and medical equipment when it is not possible to transfer drugs and medical equipment between medical examination and treatment facilities according to the provisions of law; the types of drugs and medical equipment prescribed and indicated for use must be consistent with the scope of expertise of the medical examination and treatment facility and within the scope of benefits of health insurance participants.
Social insurance agency pays directly to patients
According to the Ministry of Health, the Social Insurance agency will pay directly to the patient according to regulations. Specifically, for drugs, the basis for calculating the payment level is the quantity and unit price recorded on the invoice purchased by the patient at the pharmaceutical business establishment.
In case the drug has regulations on payment rates and conditions, payment rates and conditions shall be implemented.
For medical equipment (including reusable medical equipment), the basis for payment is the quantity and unit price stated on the invoice purchased by the patient at the medical equipment trading facility.
In case of medical equipment, the payment level is regulated not to exceed the payment level prescribed for that equipment.
The unit price of drugs and medical equipment used as the basis for determining the payment level must not exceed the unit price paid at the most recent time for cases where drugs and medical equipment have won bids at the medical examination and treatment facility where the patient was examined and treated.
In case the medicine or medical equipment has not won the bid at the medical examination and treatment facility where the patient has been examined and treated, the unit price used as the basis for determining the health insurance payment level is the result of the selection of a valid contractor in order of priority based on the results of national centralized procurement or the results of price negotiation...
The Social Insurance Agency shall deduct the health insurance costs paid by the medical examination and treatment facility where the patient is treated.
These regulations take 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.
In recent times, shortages of drugs and supplies have occurred in some provinces and cities. According to regulations, inpatients and outpatients receive drugs at hospital pharmacies and medical facilities. However, in many cases, drugs and supplies are prescribed and indicated but are not available at medical facilities, so patients have to buy them out of their own pocket.