Many important changes from 2025

A series of new regulations on health insurance examination and treatment applied from January 1, 2025 will bring many benefits to health insurance participants and improve the quality of medical services at medical examination and treatment facilities.

Health insurance medical examination and treatment: Many important changes from 2025

A series of new regulations on health insurance examination and treatment applied from January 1, 2025 will bring many benefits to health insurance participants and improve the quality of medical services at medical examination and treatment facilities.

From 2025, patients with health insurance will have many advantages.

 

Many advantages when examining and treating health insurance

Previously, the list of drugs covered by health insurance was classified according to hospital class and professional level. However, from January 1, 2025, this regulation was abolished according to Circular No. 37/2024/TT-BYT (Circular 37). Ms. Vu Nu Anh, Deputy Director of the Department of Health Insurance (Ministry of Health) said that Circular 37 abolished the classification of hospitals in the list of drugs covered by health insurance, and also removed the note on the rate and conditions of payment for drugs used for some facilities.

The new regulation allows medical examination and treatment facilities to use the entire list of health insurance drugs, in accordance with the scope of professional activities and diagnostic and treatment guidelines, regardless of hospital level or technical level. This regulation is expected to encourage medical examination and treatment facilities to develop their expertise, attract human resources, and enhance health care capacity at lower levels. At the same time, it will limit the situation of patients flocking to higher levels, reducing overload for central hospitals.

The new regulations in Circular 37 and Circular 39 are expected to improve the rights of health insurance participants, ensure more effective access to medicine, and contribute to improving the quality of medical examination and treatment services at all health care levels.

In addition, Circular 37 adds new regulations on drug payment. Medical examination and treatment facilities are paid by the Health Insurance Fund for drug costs in accordance with the scope of professional activities, capacity to perform technical services, equipment conditions and human resources. The Circular also stipulates cases of payment for drugs that are not indicated or contraindicated in professional documents, but are used in emergency situations or there is no alternative drug after consultation. Flexible regulations in special situations such as natural disasters, catastrophes, and wars are also added.

One of the notable points in the new regulations is the level of health insurance benefits for participants. Accordingly, from January 1, 2025, health insurance participants will have 100% of their medical examination and treatment costs paid by the health insurance fund at primary health care facilities nationwide. For inpatient medical examination and treatment services at basic health insurance facilities, the payment level is also 100%.

In Circular No. 39/2024/TT-BYT issued on November 17, 2024 (Circular 39), the Ministry of Health emphasized the principle of "correct, sufficient and reasonable" in the use of drugs. The Circular adds many new drugs to the list of drugs covered by health insurance, including drugs for the treatment of rare diseases and chronic diseases. The drugs in the list are classified and adjusted to prioritize modern treatment regimens, suitable for clinical practice and treatment needs in Vietnam.

In addition, the drug bidding process is specifically regulated to minimize drug shortages and ensure reasonable drug prices, helping people access high-quality drugs at low costs. The regulation also adds special drugs for children, the elderly and patients with rare diseases. Price support policies for vulnerable groups are also applied.

The health insurance payment process has been improved to reduce the time for processing documents, helping health insurance participants receive benefits more quickly. According to the representative of the Ministry of Health, the new regulations in Circular 37 and Circular 39 are expected to improve the benefits for health insurance participants, ensure more effective access to medicine, and contribute to improving the quality of medical examination and treatment services at all health care levels.

From 2025, patients with rare or serious diseases can be treated directly at specialized medical facilities without having to apply for a referral as before. Cancer, lupus erythematosus, organ transplants, strokes and other serious diseases will be 100% covered by health insurance when patients are treated at higher-level hospitals. This regulation helps shorten treatment time and reduce administrative procedures, while ensuring health insurance benefits for patients.

Get paid when buying medicine outside

According to Circular 22/2024/TT-BYT, from January 1, 2025, if the hospital does not have the necessary medicine or medical equipment in the health insurance list, the patient will be refunded when purchasing medicine or equipment from outside. Refund conditions include: the hospital does not have medicine because it has not selected a supplier or there is no alternative medicine. The patient only needs to provide an invoice for purchasing medicine or equipment at pharmaceutical facilities, then the cost will be paid according to the price listed on the invoice, not exceeding the hospital's prescribed payment level.

One notable point is that the payment of medical examination and treatment costs at private hospitals will also have a major change. From 2025, private medical examination and treatment facilities will be allowed to participate in the health insurance payment process for medical examination and treatment services. However, the payment level will be regulated according to the health insurance examination and treatment price of that technical service as prescribed or approved by the Provincial People's Council for local state medical examination and treatment facilities.

From 2025, when receiving medical examination and treatment on demand, health insurance participants will be paid for the medical examination and treatment costs within the scope of health insurance coverage. The costs exceeding the health insurance coverage will be paid by the patient himself. This is an important improvement in creating conditions for patients to choose medical examination and treatment services on demand, while still ensuring benefits from the health insurance fund.

The new regulations on health insurance from January 1, 2025 are expected to create an important change in the health insurance system in Vietnam. The Government and the Ministry of Health hope that these changes will not only help improve the quality of medical examination and treatment, but also contribute to ensuring the rights of health insurance participants, support the reduction of direct out-of-pocket costs for people, and improve the efficiency of using the Health Insurance Fund.

Source: https://baodautu.vn/kham-chua-benh-bao-hiem-y-te-nhieu-thay-doi-quan-trong-tu-nam-2025-d245482.html