Accordingly, the Circular determines: The capitation fund is the pre-determined amount, which is assigned to the medical facility providing health care covered by health insurance for outpatient examination and treatment for patients with health insurance cards within the capitation range for a certain period of time.

In which, the capitation range for a facility of district-level or lower is full of the outpatient medical expenses within the scope of the insured's benefits.

The capitation scope for provincial and central facilities: Applicable to all establishments with health insurance cards registered for initial medical care and full of the outpatient medical expenses within the capitation scope of the patient who registered for initial medical treatment arising at the establishment.

                  The MoH promulgates a Circular guiding the capitation payment method of medical expenses under health insurance (Illustrative image: internet).

However, the capitation scope does not include the costs of medical examination and treatment of the following subjects, diseases and groups of diseases:

1. Expenses for subjects with IDs for military, cipher, police;

2. Expenses for transportation of patients with health insurance cards;

3. Full costs of medical care sessions under health insurance using the cyclic dialysis technique service or the peritoneal dialysis or peritoneal dialysis service:

4. Full costs of medical care sessions under health insurance using anti-cancer drugs or cancer intervention services for patients diagnosed with cancer, including codes from C00 to 297 and other codes from 00 to D09 in the International Classification of Diseases, Tenth Revision (hereinafter abbreviated to ICD - 10);

5. Full costs of medical care sessions under health insurance using hemophilia drugs or blood or blood products for patients diagnosed with Hemophilia including codes D60, D67, D68 under the ICD - 10 code set;

6. Full costs of medical care sessions under health insurance using anti-rejection drugs for transplant patients;

7. Full costs of medical care sessions under health insurance using drugs to treat hepatitis C for patients with hepatitis C;

8. Full costs of medical care sessions under health insurance using antiretroviral drugs or HIV load testing services of patients with health insurance cards diagnosed with HIV.

The Circular will take effect from July 1, 2021./.