What types of cancer do not require a referral?

People receive medical examination and treatment at Oncology Hospital, Branch 2 (Thu Duc City) - Photo: DUYEN PHAN

The Ministry of Health has just issued a list of 62 diseases and groups of diseases that can be taken directly to the final specialized medical facility without a referral letter and still enjoy 100% of the health insurance benefits. However, many cancer patients do not know whether their disease requires a referral letter or not.

Still struggling to "extend" the transfer permit

According to Tuoi Tre Online on the afternoon of January 2, at Ho Chi Minh City Oncology Hospital (facility 1), some cancer patients are still struggling to "extend" their transfer papers as they enter 2025.

Mr. THQ (42 years old, living in Binh Duong province) had stage 2 left nasopharyngeal cancer. He went to the hospital for examination that same morning and was asked to return to the province to get a referral.

However, when returning to the local clinic to complete the procedures, the clinic informed that there are now new regulations, those with serious illnesses can go directly to the central hospital for examination and treatment without a referral letter, and still enjoy 100% health insurance benefits.

Afterwards, Mr. Q. called Ho Chi Minh City Oncology Hospital (facility 1) to verify again about the request for a referral paper and was apologized by the staff, informing him that he did not need to do it again if the old paper was still valid within one year from the date of signing (according to new regulations).

In the case of Mr. LMK (33 years old, residing in Khanh Hoa province), on December 31, 2024, the hospital reminded him to extend his transfer certificate within 7 days (from January 2 to January 8) when the new year comes to continue enjoying health insurance benefits during the treatment of tongue cancer.

Mr. K. has health insurance and registered for initial medical examination and treatment at Cam Ranh Regional General Hospital. Around the beginning of November 2024, he went to Ho Chi Minh City Oncology Hospital for examination and discovered that he had cancer. Mr. K. chose to have surgery and continued to apply for a hospital transfer to receive health insurance during the prolonged treatment at this hospital.

Faced with the news that he had to extend his referral paper during the New Year, Mr. K. had to ask an acquaintance working at Cam Ranh Regional General Hospital to help him make a referral paper as required in order to continue treatment and have his health insurance cover some of the costs.

Mr. K. said: “It takes me about 8 hours to get home from Ho Chi Minh City. If I go back to my hometown to get a referral as previously requested, it will take a day of radiation therapy. That will affect my treatment regimen. If the regulations on referrals are 'open' for those with serious illnesses such as cancer, it will be very beneficial for the patient.”

Not all cancers do not require a referral!

A representative of Ho Chi Minh City Oncology Hospital informed that on January 1, 2025, the Ministry of Health issued Circular 01 detailing and guiding the implementation of a number of articles of the Law on Health Insurance.

Specifically, the list of some rare diseases, serious diseases, diseases requiring surgery or using high technology is entitled to 100% of the benefit level according to the provisions in Point a, Clause 4, Article 22 of the Law on Health Insurance for specialized medical examination and treatment facilities (for example: Oncology Hospital) specified in Appendix I.

This Appendix I includes 62 different disease groups, including 10 malignant disease groups with specific conditions and conditions.

Of which, 9 groups of cancers are C25 (pancreatic malignancy); C37 (thymic malignancy); C38 (malignancy of the heart, mediastinum and pleura) (except code C38.4); C41 (malignancy of bone and articular cartilage at other and unspecified locations); C70 (malignancy of the meninges); C71 (malignancy of the brain); C72 (malignancy of the spinal cord, cranial nerves and other parts of the central nervous system); C79.3 (secondary malignancy of the brain and meninges); From C81 to C86 and from C90 to C96 (malignancy of the lymphoid system, hematopoietic system and related tissues) (except code C83.5).

Particularly for the group of malignant diseases in general (from C00 to C97), 2 conditions must be met. That is, the person is under 18 years old, and does not apply to cases that have been diagnosed but do not have specific treatment indications.

Therefore, in the case of Mr. K. and Mr. Q., if they do not belong to the disease groups and meet the above conditions, they need to be transferred to the Oncology Hospital by the primary health care facility (in case it exceeds the capacity of the basic health care facility in the province) or the basic health care facility to enjoy health insurance benefits when receiving outpatient treatment.

Before January 1, 2025, according to the guidance of Decree 146/ND-CP and Circular 40/TT-BYT, "The referral paper is valid until December 31 of that calendar year".

Therefore, upon receiving Circular 01 of the Ministry of Health, which issued instructions in Clause 5, Article 15, stipulating that "Re-examination appointment papers and referral papers issued before the effective date of this Circular shall be used until the expiry date of the paper as prescribed in this Circular. In case the referral paper expires in the calendar year, it shall be valid from January 1, 2025", the hospital has notified and explained to patients whose referral papers in 2024 are still valid to avoid having to re-apply for a new referral paper.

Source: https://tuoitre.vn/nhung-loai-benh-ung-thu-nao-se-khong-can-phai-xin-giay-chuyen-tuyen-20250103142705116.htm