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VIETNAM
SOCIAL SECURITY
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THE
SOCIALIST REPUBLIC OF VIETNAM
Independence – Freedom – Happiness
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No: 2392/BHXH-CSYT
V/v guiding Official Dispatch No.
3730/BYT-KCB dated July 03, 2024 of the Ministry of Health
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Hanoi,
July 17, 2024
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To:
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On July 3, 2024, the Ministry of
Health issued Official Dispatch No. 3730/BYT-KCB guiding the resolution of
difficulties in the payment process of health insurance-covered medical cost in
accordance with Circular No. 22/2023/TT-BYT dated November 17, 2023 of the
Ministry of Health. Vietnam Social Security (VSS) transferred Official Dispatch
No. 3730/BYT-KCB for provincial Social Security agencies to study and implement
the following contents:
1. Point 1 of
Official Dispatch No. 3730/BYT-KCB
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2. Point 2 of
Official Dispatch No. 3730/BYT-KCB
For 03 types of medical local
anaesthesia specified in Appendix V attached to Circular No. 22/2023/TT-BYT
(No. 59: Open surgery for ovarian cystectomy or oophorectomy; No. 61:
Exploratory laparotomy and treatment of gynecological conditions; No. 64: Second
Look surgery in ovarian cancer) while waiting for the Ministry of Health to
amend Circular No. 22/2023/TT-BYT, appraisal and payment for these medical
procedures shall temporarily comply with the instructions in Official Dispatch
No. 1163/BHXH-CSYT of Vietnam Social Security.
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3. Point 3 of
Official Dispatch No. 3730/BYT-KCB
Based on the price frame for
Mycobacterium tuberculosis identification and RMP resistance Xpert testing,
guidance on payment in cases where medical establishments are provided with
test cartridges or consumables included in the medical service price as per the
Ministry of Health's Circular No. 7686/BYT-KHTC dated November 29, 2023, the
Vietnam Social Security shall provide guidance on determining the deductible
expenses in the price for cases where medical establishments are provided with
test cartridges[1]. To be specific:
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3.2. In the implementation phase of
Circular No. 15/2018/TT-BYT, Circular No. 39/2018/TT-BYT, Circular No. 13/2019/TT-BYT,
cartridge has been removed because it is currently being covered by the
Tuberculosis Prevention Program. However, there are still costs related to the
test (cartridge). Therefore, the deductible expenses include:
- Trial test: is the depreciation
cost, inspection cost, and proof running cost currently equal to 1/10 of the
total cost of Section I of the service price plan as the basis for the price
proposal in Joint Circular No. 37/2015/TTLT-BYT-BTC), thus including 1/10 of
the cost of the benchmark 1.1 cartridge (equivalent to 211.750 VND)[3]
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The total cost of cartridges
thereby is 233.984 VND.
3.3. Pursuant to Circular No.
22/2023/TT-BYT, deductible costs related to cartridges (tests) include:
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- Cost of cartridge: Unit of
measurement is test, benchmark is 1.0 (equivalent to 690,000 VND).
- Cost of cartridge, cost of trial
test, depreciation cost is included in the internal and external quality
control costs, corresponding to 1/10 and 1/200 of 759.000 VND.
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4. Guidance on
encoding, updating the inventory, and submitting payment requests in accordance
with Decision No. 4750/QD-BYT dated December 29, 2023 of the Ministry of
Health.
4.1 For medical local anaesthesia
mentioned in Clause 1:
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- In the MA_DICH_VU indicator, add
the character "TT" after the common code of the medical procedure
issued with Decision No. 7603/QD-BYT dated December 25, 2018 of the Ministry of
Health (XX.YYYY.ZZZZ_TT) to differentiate medical procedures without prices,
whose costs of drugs and medical supplies used directly for patients based on
actual usage are covered; in the TEN_DICH_VU indicator, add the phrase
"[gây tê]" ("[anesthesia]") after the service name.
The list and codes of medical
procedures are created on the receiving portal for medical establishments to
update in their inventory and submit payment request data.
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- In the medical supplies section,
the actual quantity of medical supplies used for patients is recorded in the
MA_DICH_VU and TEN_DICH_VU indicators as instructed above.
b) Table 2. Detailed indicators of
medications
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4.2. For medical local anaesthesia
mentioned in Clause 2: follow guidance on Decision No. 4750/QD-BYT.
5. Review and
adjust the expenditure from the health insurance fund (recover settled
expenses, reject expenses proposed for payment that do not comply with the
above instructions) for:
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- 03 medical procedures mentioned
in Clause 2 with prices specified in Appendix V attached to Circular No.
22/2023/TT-BYT;
- Cases of Mycobacterium
tuberculosis identification testing and RMP Xpert resistance testing where
cartridges (tests) that are sponsored but have been paid at the price specified
in the Circulars related to price issued by the Ministry of Health.
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[2] Pursuant to Decision No. 3072/QD-BYT temporarily
promulgating technical economic norms as a basis for establishing medical
service prices (attached to Official Dispatch No. 7686/BYT-KH-TC), currently
being recorded as Cartrige.
[3] Pursuant Official Dispatch No. 2450/BVPTU dated August
25, 2023 of the Central Lung Hospital, the price of Xpert testing service
approved in Joint Circular No. 37/2015/TTLT-BYT-BTC is 2.150.000 VND; in 2018,
when drafting Circular 39/2018/TT-BYT, the test price was excluded from the
testing service price, instead included in the cost of consumables for the test
as 10% of 2.150.000 VND, which is 210,000 VND (according to the testing price
plan as the basis for price proposal in Joint Circular No.
37/2015/TTLT-BYT-BTC, 1.925.000 VND out of 2.150.000 VND is for cartridge
cost). In the testing price plan as the basis for price proposal in Circular
No. 15/2018/TT-BYT, Circular No. 13/2018/TT-BYT, the cost of trial test is
231,000 VND (210.000 VND x 1,1). The cost of cartridge thereby is 1.925.000 VND
x 10% x 1,1 = 211.750 VND.
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