For a long time, there has been a shortage of medicine and medical equipment at many medical facilities, leading to a situation where patients, even though they participate in health insurance, do not enjoy benefits and have to pay out of pocket to buy medicine and medical equipment for treatment.
Patients who have to buy medicine and medical equipment outside will be paid for by social insurance. Illustrative photo
To protect the rights of patients participating in health insurance, the Ministry of Health has just issued a Circular on regulations on direct payment of medicine and medical equipment costs for people with health insurance who go for medical examination and treatment. Accordingly, the Social Insurance Agency will pay directly to patients according to the following regulations:
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;
For medical equipment (including reusable medical equipment), the basis for calculating the payment level is the quantity and unit price stated on the invoice purchased by the patient at the medical equipment trading facility. In case the medical equipment has a payment level regulation, it must not exceed the payment level prescribed for that medical 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...
The Ministry of Health also specifies payment conditions in detail. Specifically, at the time of prescribing drugs and ordering the use of medical equipment, the following conditions must be met: There are no drugs or medical equipment due to the bidding process but no contractor has been selected.
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 different concentrations or contents or dosage forms or routes of administration and cannot be replaced for prescription for the patient; There is no medical equipment that the patient is prescribed to use and there is no medical equipment to replace it; It is not possible to transfer the patient to another medical examination and treatment facility; It is not possible to transfer medicine and medical equipment between medical examination and treatment facilities according to the provisions of law.
Or the prescribed and indicated drugs and medical equipment must be in accordance with the scope of expertise of the medical examination and treatment facility and the cost of medical examination and treatment covered by health insurance has been paid at one of the medical examination and treatment facilities nationwide; The prescribed and indicated drugs and medical equipment must be within the scope of benefits of the health insurance participant.
This Circular takes effect from January 1, 2025. The provisions of this Circular apply to cases where patients enter medical examination and treatment facilities with a treatment end date after the effective date of this Circular.
Direct payment procedures according to Decree No. 146/2018/ND-CP.
The documents for direct payment request include: Photocopies (with original for comparison) of health insurance card; ID card; Hospital discharge papers, medical examination form or medical examination book of the medical examination or treatment requesting payment; and invoices and related documents.
Submit application and resolve directly:
Patients or their relatives directly submit their application to the Social Insurance agency at the district level where they reside.
The district-level social insurance agency is responsible for receiving the patient's payment request and issuing a receipt. If the request is not complete according to regulations, it will provide instructions for additional information; Within 40 days from the date of receiving the complete request for payment, it must complete the health insurance assessment and pay the medical examination and treatment costs for the patient or the patient's relatives. In case of non-payment, a written response must be given stating the reason.
Source: https://www.baogiaothong.vn/nguoi-benh-phai-mua-ngoai-thuoc-trang-thiet-bi-y-te-se-duoc-bhxh-chi-tra-192241019200403682.htm
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