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1. Latest price of health insurance examination and treatment services
The latest prices for health examination and treatment services under health insurance are stipulated in Article 2 of Circular 22/2023/TT-BYT as follows:
- Prices for medical examination and consultation services are specified in Appendix I.
- Bed day service price according to regulations in Appendix II.
- Technical service and testing prices are as prescribed in Appendix III.
- Add notes of some technical services as prescribed in Appendix IV.
- The price of technical services performed by anesthesia does not include the cost of drugs and oxygen used for the service as prescribed in Appendix V. The cost of drugs and oxygen will be paid to the social insurance agency and the patient based on actual usage and the results of the unit's procurement bidding.
2. Structure of health insurance examination and treatment services
According to Article 3 of Circular 22/2023/TT-BYT, the price of health examination and treatment services under health insurance is built on the basis of direct costs and salaries to ensure medical examination and treatment, specifically as follows:
(1) Direct costs included in the price of medical examination services:
- Costs of clothes, hats, masks, sheets, pillows, mattresses, mats, stationery, gloves, cotton, bandages, alcohol, gauze, saline solution and other consumables for medical examination;
- Costs of electricity; water; fuel; treatment of domestic waste, medical waste (solid, liquid); washing, ironing, steaming, drying, washing, sterilizing fabrics, examination instruments; costs of cleaning and ensuring environmental hygiene; supplies, chemicals for disinfection and anti-infection during medical examination:
- Costs for maintenance and repair of houses, equipment, purchase of replacement assets, tools and instruments such as: air conditioners, computers, printers, dehumidifiers, fans, tables, chairs, beds, cabinets, lighting, other necessary kits and tools during the medical examination process.
(2) Direct costs included in the price of hospital bed service:
- Costs of clothes, hats, masks, blankets, sheets, pillows, mattresses, curtains, mats; stationery; gloves used in examination, injection, infusion, cotton, bandages, alcohol, gauze, saline solution and other consumables for daily care and treatment (including costs for changing wound dressings or surgical incisions for inpatients, except for cases paid outside the daily bed service price specified in Clause 5 and Clause 6, Article 7 of Circular 22/2023/TT-BYT); electrodes, ECG cables, blood pressure cuffs, SPO2 cables during the use of patient monitors for emergency and intensive care beds.
- The costs specified in Point b and Point c, Clause 1, Article 3 of Circular 22/2023/TT-BYT serve the care and treatment of patients according to professional requirements.
- The costs of drugs, whole blood, blood products that meet standards, infusion fluids, medical equipment (in addition to the above-mentioned supplies); all types of syringes, needles, needles used for injection and infusion; feeding pumps; infusion lines, connecting tubes, connecting wires for electric syringes, infusion machines used for injection and infusion; oxygen, oxygen breathing tubes, oxygen breathing masks (except for cases where patients are prescribed to use mechanical ventilation) are not included in the price structure of hospital bed-day services and are paid according to actual use for the patient.
(3) Direct costs included in technical service prices:
- Costs of clothes, hats, masks, sheets, pillows, mattresses, mats, fabric items; stationery; medicine, infusion, chemicals, consumables, replacement materials used in the process of performing technical services;
- The costs specified in Point b and Point c, Clause 1, Article 3 of Circular 22/2023/TT-BYT serve the implementation of technical services according to professional requirements.
(4) Salary costs included in the price of medical examination services, hospital bed day services and technical services, including:
- Salary, rank, position, allowances, contributions according to the regime prescribed by the State for public service units and basic salary prescribed in Decree 24/2023/ND-CP;
- Permanent allowance, surgery and procedure allowance according to Decision 73/2011/QD-TTg.
(5) Salary costs in the price of medical examination and treatment services prescribed in Clause 4, Article 3 of Circular 22/2023/TT-BYT do not include expenses under the regime guaranteed by the state budget according to the following legal provisions:
- Preferential allowances, attraction allowances, subsidies and other incentives for medical officers, civil servants, contract workers and military medical officers and staff directly performing medical professional work at State medical facilities in areas with particularly difficult socio-economic conditions;
- Attraction allowance, long-term service allowance, some subsidies and payment of travel expenses for cadres, civil servants, public employees and salary earners in the armed forces (people's army and people's police) working in areas with particularly difficult socio-economic conditions;
- Special allowance regime for officers and civil servants working at Friendship Hospital, Thong Nhat Hospital, Da Nang C Hospital under the Ministry of Health, Central Health Protection Departments 1, 2, 2B, 3 and 5, Department A11 of 108 Central Military Hospital and Department A11 of the Military Traditional Medicine Institute;
- Special allowances according to profession or job.
(6) Payment of medical examination and treatment costs between social insurance agencies and medical examination and treatment facilities according to service prices prescribed in this Circular and costs of drugs, whole blood, standard blood products, chemicals, medical equipment not included in service prices (specifically noted in services) according to the payment principles prescribed in Article 24 of Decree 146/2018/ND-CP as amended and supplemented by Decree 75/2023/ND-CP.
Note: The costs specified in 1, 2, 3 and 4 are determined based on economic and technical norms, cost norms issued by competent authorities, prices of cost factors, actual and reasonable cost levels according to current policies and regulations, ensuring averageness, progress, and meeting service quality requirements.
Economic and technical norms are the basis for establishing prices for medical examination and treatment services and cannot be used as a basis for payment for each specific medical examination and treatment service (except for some special cases specified in Clause 6, Article 5, Clause 16, Article 6 and Clause 8, Article 7 of Circular 22/2023/TT-BYT).
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