Health insurance patients get refunds when they have to buy medicine themselves

In case the hospital does not provide it, the refund for health insurance patients when they buy it themselves will be applied for some medicines and medical equipment, applied from January 1, 2025.

Conditions for health insurance patients to be paid for medicine and supplies

The Ministry of Health has just issued Circular 22/2024/TT-BYT regulating direct payment of drug and medical equipment costs for people with health insurance cards, effective from January 1, 2025.

According to this latest guidance, reimbursement of drugs and medical equipment for patients with health insurance when medical facilities do not provide enough drugs and medical equipment.

Health insurance patients who pay for some medicines and medical equipment that the hospital does not provide enough will be refunded.

Specifically, for drugs: only applies to the list of rare drugs issued by the Ministry of Health, and for medical devices, only includes medical devices in groups C - D according to the risk classification of the device. The health insurance fund will not pay when the patient pays for easily replaceable supplies such as: alcohol, gauze, cotton, bandages.

Explaining the reason for only paying for specific drugs and supplies, Ms. Tran Thi Trang, Director of the Department of Health Insurance (Ministry of Health), said that there is currently a Bidding Law, Decree 24, circulars of the Ministry of Planning and Investment and the Ministry of Health guiding the procurement of drugs, equipment and medical supplies. However, these are specific items, so there are situations where medical facilities that have implemented procurement and bidding solutions are still at risk of local shortages of drugs and supplies due to supply disruptions or the absence of participating units.

Drug transfer, shortage correction

To ensure the rights of health insurance participants, the Ministry of Health has proposed solutions. Firstly, in the draft revised and supplemented Health Insurance Law this time, a mechanism for transferring drugs between medical examination and treatment facilities is added in case of shortage of drugs and supplies and the patient cannot be transferred elsewhere.

Ms. Trang explained that, for example, when a tertiary surgical hospital lacks drugs and medical supplies (due to objective factors, unable to make purchases), another tertiary hospital can support the transfer and the payment price is the price that health insurance pays to the tertiary hospital. The hospital with transferred drugs and supplies will summarize the payment records for the social insurance agency using the procurement bidding price.

Thus, timely treatment for patients is still ensured. In case of transferring patients but there is still no medicine due to local shortages or supply disruptions, while drug retail facilities in some places still have it, patients can buy it outside and pay the social insurance agency for the part they had to pay themselves.

According to Ms. Trang, during the policy development process, there were also opinions that instead of patients having to pay directly to the social insurance agency, there should be a mechanism for the hospital to pay the patient, then the hospital pays back to the social insurance agency, to reduce procedures for the patient.

Therefore, the Ministry of Health has proposed to amend Article 31 of the draft Law on Health Insurance this time. If approved by the National Assembly, patients will have two options: pay directly to the medical facility or the medical facility will reimburse the social insurance agency. In case the medical facility does not sign a health insurance contract, the patient must pay directly to the local social insurance agency.

According to the Ministry of Health, the above regulation is only applied to each patient case, not in normal situations of medical facilities. Hospitals are responsible for bidding for public procurement, ensuring adequate supply for patients.

Source: https://thanhnien.vn/tu-2025-benh-nhan-bao-hiem-y-te-duoc-hoan-tien-khi-phai-tu-mua-thuoc-185241030124157904.htm