There should be specific instructions soon to ensure patient rights when hospitals lack drugs and equipment covered by health insurance.
On October 18, 2024, the Ministry of Health issued Circular No. 22/2024/TT-BYT stipulating cases with health insurance cards that are entitled to payment for medicine and medical equipment costs when hospitals lack medicine and equipment on the health insurance list.
Patients are paid for medicine and medical equipment when the hospital lacks medicine and equipment on the health insurance list.
According to Circular No. 22/2024/TT-BYT, the Ministry of Health stipulates direct payment for medicine and medical equipment costs for people with health insurance cards when going for medical examination and treatment, but at the time of prescribing medicine, there is an indication for use.medical equipment The hospital does not have the medicine or medical equipment and is in the process of selecting a contractor according to the approved contractor selection plan but has not been able to select a contractor.
At the same time, at that time, the medical examination and treatment facility did not have any commercial drugs "containing the active ingredient that the patient was prescribed, or the same active ingredient but with different concentrations or contents or dosage forms or routes of administration and could not be substituted for the prescription for the patient"... Regarding medical equipment, the medical facility did not have the equipment that the patient was prescribed to use and did not have medical equipment to replace it.
Patients with cardshealth insuranceThe cost of medicine and medical equipment is also paid when the patient cannot be transferred to another medical examination and treatment facility due to health condition or illness that does not meet the conditions for transfer; the medical examination and treatment facility where the patient is being treated is in medical isolation or that 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.
The health insurance agency will pay directly to the patient according to regulations and deduct the health insurance costs paid by the medical examination and treatment facility where the patient is treated. Specifically, 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 the rate and payment conditions, the payment rate 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 the case of medical equipment with a payment level regulation, the payment level must not 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 medical examination and treatment facilities where patients have been examined and treated... In cases where drugs and medical equipment have not won bids at medical examination and treatment facilities where patients have been examined and treated, the unit price used as the basis for determining the health insurance card payment level is the result of selecting a valid contractor in order of priority regarding the results of national centralized procurement or the results of price negotiation.
The provisions of Circular No. 22/2024/TT-BYT 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 the Circular but finishes treatment after the effective date of the Circular, the provisions of this Circular shall apply.
Need guidance and pilot implementation soon
The Ministry of Health's issuance of Circular No. 22/2024/TT-BYT is considered as a "loophole plug" for hospitals in the transitional procurement process, with the ultimate goal of meeting the highest demands of patients with health insurance.
This meets the reality in some cases where the hospital does not have enough medicine, there is a supply interruption between two bidding packages, or the number of patients arriving is higher than the actual number, or there is a disease that is not on the drug list, then paying for health insurance patients with treatment medicine is realistic, consistent with social insurance payment.
Recently, there has been a shortage of drugs and supplies in many provinces and cities, including Nghe An. According to regulations, inpatients and outpatients receive medicine at hospital pharmacies and public health facilities. However, in many cases, drugs and supplies are prescribed and indicated but medical facilities do not have a supply, so patients have to buy them out of their own pocket. This situation has caused great disadvantages for patients participating in health insurance... Thus, Circular No. 22/2024/TT-BYT is the solution that the Ministry of Health provides to ensure that patients with health insurance cards do not suffer from a lack of treatment drugs while being examined and treated at public health facilities.
Circular No. 22/2024/TT-BYT has received the approval of many patients participating in health insurance. Ms. NTL, (70 years old), in Vinh city, said: “My family and I often go to hospitals for examination and treatment. Sometimes my family and I still have to go out to buy medicine, IV fluids, sutures... because the hospital does not have them available. I know my rights are affected but I have to accept it. Now the Ministry of Health has issued a new circular setting out 5 conditions for health insurance patients to buy medicine outside during the treatment process to be paid. The rights of patients have been increased, I think it is very good."
According to Circular No. 22/2024/TT-BYT, the patient or the patient's legal representative is responsible for the legality and completeness of the direct payment request file. With this regulation, many patients participating in health insurance are still wondering about the implementation process to get payment.
There must be specific instructions for implementation, to avoid the situation where the invoices of non-public pharmacies and drugstores are not recognized. At that time, patients have to waste time, running back and forth to complete procedures and documents. In addition, State management agencies must have solutions to ensure that there is no abuse or profiteering in prescribing and instructing patients to buy drugs and medical equipment themselves.
Mr. TC, 39 years old, in Nam Dan district
Information from Nghe An Department of Health: To implement Circular No. 22/2024/TT-BYT, the Ministry of Health and Vietnam Social Security need to soon have consensus and guidance for the Department of Health, Social Security of provinces and cities, and medical facilities that have contracts with the Social Security agency. Nghe An Department of Health is waiting for this guidance to study and implement. Currently, there are many concerns, such as the price of drugs and supplies purchased by health insurance patients outside is always higher than the winning bid price of the medical facility; how do doctors prescribe the dosage for patients to buy; many administrative procedures need to be implemented during the payment process...
Before implementing the circular, the Ministry of Health and Vietnam Social Security should pilot a number of drugs, supplies, and equipment at a few medical facilities to avoid future problems.
Dr. Nguyen Huu Le - Deputy Director of Nghe An Department of Health