According to the Circular and the Document No 4614/BYT-KHTC guiding the implementation of some contents of the circular issued by the Ministry of Health, from July 1, 2021, the capitation payment method of medical expenses under health insurance will be carried out across the nation. This payment method, implemented in 2021, will be applied for the costs of outpatient medical examination and treatment at all medical facilities nationwide which signed medical examination and treatment under health insurance contracts with insurance agencies from 2019 or earlier.

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

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

However, the capitation scope does not include the costs of medical examination and treatment of the following subjects, diseases and groups of diseases: Expenses for subjects with IDs for military, cipher, police; expenses for transportation of patients with health insurance cards; full costs of medical care sessions under health insurance using the cyclic dialysis technique service or the peritoneal dialysis or peritoneal dialysis service; 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); full costs of medical care sessions under health insurance using haemophilia drugs or blood or blood products for patients diagnosed with haemophilia including codes D60, D67, D68 under the ICD - 10 code set; full costs of medical care sessions under health insurance using anti-rejection drugs for transplant patients; full costs of medical care sessions under health insurance using drugs to treat patients with hepatitis C; and 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.

Illustrative image (source: internet)

Viet Nam Social Security on June 11 issued a plan to organise the implementation of the Ministry of Health’s circular on guiding the capitation payment method of medical expenses under health insurance. The plan sets specific goals of building documents guiding the implementation under the responsibility of Viet Nam Social Security as regulated by the circular; building tools to notify the capitation fund and supervise the implementation of the capitation fund from Viet Nam Social Security to insurance agencies of cities and provinces based on professional software of the sector.

Viet Nam Social Security will also organise training on the implementation of the circular for social insurance agencies at localities; build documents guiding the implementation of the circular; and tools to notify the capitation fund and supervise the implementation of the capitation fund. After getting guidance from the Viet Nam Social Security, social insurance agencies at localities will coordinate with medical facilities to sign additional appendices of their contracts about the capitation payment method.

In order to ensure the circular is implemented from July 1 as regulated, Vietnam Social Security has issued documents guiding localities on the capitation payment method and on organising online training courses on the implementation of the circular before June 30./.