Supplementing the group of subjects covered by the State budget for health insurance

The Government has issued Decree 75/2023/ND-CP amending and supplementing a number of articles of Decree No. 146/2018/ND-CP dated October 17, 2018 of the Government detailing and guiding measures to implement a number of articles of the Law on Health Insurance.

Decree 75/2023/ND-CP adds a group of subjects whose health insurance is paid by the State budget, including people in safe zone communes and revolutionary safe zones during the resistance war against French colonialism and American imperialism, currently residing in safe zone communes whose information has been updated in the national population database.

In addition, the decree supplements Clause 5 in Article 4 of Decree 146/2018/ND-CP on the group receiving State budget support for health insurance premiums, including: ethnic minorities living in communes in areas 2, 3, and extremely disadvantaged villages in ethnic minority and mountainous areas in the period 2016-2020, but these communes are no longer on the list of communes in areas 2, 3, and extremely disadvantaged villages in ethnic minority and mountainous areas in the period 2021-2025 according to the Prime Minister's decision.

At the same time, the decree amends and supplements the rights of medical examination and treatment facilities in implementing health insurance medical examination and treatment contracts, specifically:

Exercise the rights under Article 42 of the Law on Health Insurance and regulations of law on medical examination and treatment;

Be provided with timely information when the health insurance appraisal information system detects an increase in health insurance medical examination and treatment costs compared to the average cost of medical examination and treatment facilities of the same class, same level, same specialty to promptly review, verify, and implement appropriate adjustment solutions.

The Decree also amends the principle of payment based on service prices. Accordingly, the cost of medical examination services, the cost of hospital bed days, and the cost of technical and testing services used for patients within the scope of benefits and the level of benefits of health insurance participants are paid according to the actual quantity used for patients and the price according to current regulations.

The cost of drugs, chemicals, and medical supplies not included in the price of medical examination and treatment services covered by health insurance or used in technical services for which the price of medical examination and treatment under health insurance has not been issued and has been used for patients within the scope of benefits and the level of benefits of health insurance participants shall be paid according to the actual quantity used and the purchase price according to the provisions of the law on bidding.