New regulation: Lower level hospitals are allowed to use health insurance drugs like upper level hospitals

According to the new regulations, medical facilities are allowed to use all drugs in the health insurance list in accordance with the scope of professional activities and treatment, regardless of hospital class or technical expertise level.

Pharmacists prepare medicine for patients at Thanh Nhan Hospital (Hanoi) - Photo: NAM TRAN

"Clearing the line" for health insurance drugs

The Ministry of Health has just issued Circular 37 stipulating principles, criteria for developing, updating, recording information, structure of the list and payment instructions for pharmaceutical drugs, biological products, radioactive drugs and markers within the scope of benefits of health insurance participants.

This Circular stipulates the principles for developing and updating the drug list, criteria for considering drugs to be included in the list, considering drugs that need to stipulate the rate and conditions for health insurance payment, and considering removing drugs from the list.

This will contribute to building and updating a public, transparent, regular and effective drug list.

The Circular also removes the regulation on dividing the drug list by hospital class and adds new regulations on drug payment instructions.

Specifically, the health insurance fund will pay in accordance with the scope of professional activities and technical service performance capacity regardless of hospital class.

Medical facilities are allowed to use all drugs in the list, in accordance with the scope of professional activities, diagnostic and treatment guidelines, regardless of hospital class or technical level. This will contribute to increasing access to drugs for patients and medical examination and treatment facilities.

The leaders of the Health Insurance Department assessed that this regulation will encourage facilities to develop their expertise and techniques; attract human resources and encourage the development of the capacity of medical staff. In particular, it will create conditions for the development of grassroots health care by ensuring fairness in access and payment of health insurance for drugs.

At the same time, it helps limit the number of patients choosing to go to high-tech specialized facilities for medical examination and treatment, reducing the overload at some high-tech specialized facilities.

Expanding medicine for health stations, paying for remote medical examination and treatment

The Circular also stipulates payment for some cases where drugs are not indicated or drugs are contraindicated in prescribed documents in emergency cases and there are no other alternative drugs, after consultation.

At the same time, the circular stipulates payment for drugs at commune health stations. The Health Insurance Fund pays for drugs for cases where health insurance participants are managed for chronic diseases at commune health stations. Drugs are dispensed by health stations according to prescriptions from medical examination and treatment facilities with higher technical expertise.

In addition, in cases where the commune health station has a medical practitioner who performs remote medical examination and treatment, or supports remote medical examination and treatment, the health insurance fund will also pay for appropriate medicine.

This regulation contributes to increasing access to medicine for patients with chronic diseases when they are managed and treated at health stations, creating a financial mechanism to encourage the development and improvement of professional capacity of staff at commune health stations.

Another new point of the circular is the regulation on payment for drugs in special cases. This regulation contributes to creating flexibility in special situations such as natural disasters, wars, catastrophes, the Ministry of Health will promptly issue instructions on payment for health insurance in emergency situations.

The Circular takes effect from January 1, 2025.

Source: https://tuoitre.vn/quy-dinh-moi-benh-vien-tuyen-duoi-duoc-su-dung-thuoc-bao-hiem-y-te-nhu-tuyen-tren-20241119103127738.htm