Payment of outpatient medical examination costs under health insurance according to classification of medical examination and treatment facilities

On January 6, 2025, the Ministry of Health held an online conference to implement Decree No. 02/2025/ND-CP of the Government, amending and supplementing a number of articles of Decree No. 146/2018/ND-CP detailing and guiding the implementation of the Law on Health Insurance.

Payment of outpatient medical examination costs under health insurance according to classification of medical examination and treatment facilities

On January 6, 2025, the Ministry of Health held an online conference to implement Decree No. 02/2025/ND-CP of the Government, amending and supplementing a number of articles of Decree No. 146/2018/ND-CP detailing and guiding the implementation of the Law on Health Insurance.

This Decree takes effect from January 1, 2025, marking an important step forward in reforming the health insurance system, aiming to protect public health and ensure the rights of insurance participants.

Deputy Minister of Health speaking at the Workshop. Photo: Tran Minh

Decree 02/2025/ND-CP was issued to implement the requirements of the Law on Health Insurance No. 51/2024/QH15 and the provisions of the Law on Medical Examination and Treatment 2023.

The goal of these regulations is to build a health insurance system that is synchronous, timely, reasonable and convenient for patients. Along with that, the amendments and supplements in the decree not only improve the quality of health care but also protect the rights of people in the process of using health services.

One of the notable points of this Decree is the detailed regulations on the roadmap and level of health insurance benefits for outpatient medical examination and treatment.

Ms. Tran Thi Trang, Director of the Department of Health Insurance, Ministry of Health, said that basic medical examination and treatment facilities will be paid for outpatient medical examination and treatment costs from the health insurance fund with different benefits depending on the classification of the facility.

Specifically, newly licensed facilities will be paid 100% of outpatient medical examination and treatment costs from January 1, 2025. For medical examination and treatment facilities with a score of 50 to less than 70, the payment level will be reduced to 50% from July 1, 2026. Provincial and central medical facilities will be paid 50% of the benefit level by the health insurance fund from July 1, 2026.

This regulation not only helps ensure fairness in the allocation of health insurance resources but also increases access to health care services for patients, especially those participating in health insurance in suburban or remote areas.

Another important improvement is the regulation on medical examination and treatment on demand. Health insurance participants will be paid within the scope of health insurance benefits. However, if patients choose services beyond the scope of insurance, they will have to pay the difference.

In particular, medical facilities must publicly disclose this cost difference and clearly inform patients before treatment. This regulation will help patients be more proactive in choosing treatment methods, while minimizing disputes over costs and protecting patients' legal rights.

In order to reduce administrative procedures and facilitate patients, Decree 02/2025/ND-CP stipulates the use of citizen identification cards or level 2 electronic identification accounts to replace manual documents when going to medical examination and treatment.

Using these electronic means helps reduce the time for medical examination and treatment registration, while ensuring accuracy and speed in processing medical records.

In addition, additional regulations on the application of electronic health insurance cards and integration into the VNeID application will create maximum convenience for health insurance participants in using medical services without having to carry a paper insurance card, helping to minimize inconvenience and save time.

An important issue in protecting the rights of health insurance participants is the payment of medical examination and treatment costs at medical facilities. Decree 02/2025/ND-CP provides detailed regulations on health insurance payment for private medical examination and treatment facilities and medical services whose prices have not been approved by competent authorities.

This is to ensure that public and private medical facilities comply with the prescribed prices, avoiding abuse and increasing medical examination and treatment costs for people.

At the same time, state hospitals and public health facilities must comply with regulations on insurance payments for approved technical services that do not yet have official prices. This not only protects the rights of patients but also creates fairness in the application of technical services among medical facilities.

In order for the provisions of Decree 02/2025/ND-CP to be effectively implemented, according to Deputy Minister of Health Tran Van Thuan, the Ministry of Health has requested the Vietnam Social Security and health departments nationwide to urgently disseminate these provisions to medical examination and treatment facilities. Medical facilities need to proactively research and properly implement the provisions of the decree from January 1, 2025, ensuring that patients will enjoy full health insurance benefits quickly and conveniently.

The amendments and supplements in Decree 02/2025/ND-CP not only benefit health insurance participants but also contribute to the overall development of Vietnam's health system.

The new regulations will help people easily access high-quality medical services, save costs and ensure full insurance benefits. At the same time, medical facilities will also have a more transparent and effective payment and management system, contributing to improving the quality of medical examination and treatment.

With these reforms, the Government and the Ministry of Health have demonstrated a strong commitment to improving the quality of health services, protecting public health and creating a fair and effective health insurance system. These steps promise to bring positive changes to the health care system and ensure maximum benefits for health insurance participants in the future.

Source: https://baodautu.vn/thanh-toan-chi-phi-kham-ngoai-tru-bao-hiem-y-te-theo-phan-loai-co-so-kham-chua-benh-d239280.html