This Circular amends and supplements Article 5 of Circular No. 05/2015/TT-BYT regarding the reimbursement of costs for traditional herbal medicines, traditional medical ingredients, and decoctions within the scope of health insurance. The document specifies in more detail the items of cost that the health insurance fund will reimburse to healthcare facilities.
적용 범위
Healthcare facilities; Health insurance fund
핵심 사항
- The health insurance fund reimburses costs for traditional herbal medicines, traditional medical ingredients, and decoctions used at healthcare facilities and those self-manufactured and compounded by the facilities (Article 1).
- Costs for raw materials, losses during processing, preservation, excipients for making medicine, electricity water fuel, packaging materials, labor costs, management fees, and depreciation of machinery are reimbursed for traditional medical ingredients (Article 1.2).
- Costs for decocting medicine when healthcare facilities decoct medicine for inpatients and outpatients at their premises are reimbursed by the health insurance fund (Article 1.3b).
- The health insurance fund reimburses management costs and machinery depreciation according to the adjustment schedule of factors constituting the price of health insurance medical services (Article 1.5).
- Healthcare facilities must prepare detailed explanations for any incurred costs outside the provisions to reach consensus with the social insurance agency as the basis for reimbursement (Article 1.6).
🌐 이 문서의 사회적 영향
- Strengthen management and control of drug costs within the scope of health insurance to help save budget funds.
- Improve the quality of medical services by clearly defining the items of cost that are reimbursable.
- Reduce financial burden on citizens when using healthcare services related to traditional herbal medicines and traditional medical ingredients.
❓ 자주 묻는 질문
What costs does the health insurance fund reimburse for healthcare facilities?
The health insurance fund reimburses costs such as raw materials, losses during processing, excipients for making medicine, electricity water fuel, packaging materials, labor costs, management fees, and machinery depreciation.
Under what circumstances must healthcare facilities prepare detailed explanations?
When there are incurred costs outside the provisions of Article 1.6, healthcare facilities must prepare detailed explanations to reach consensus with the social insurance agency.
How does the health insurance fund reimburse management costs and machinery depreciation?
These costs are reimbursed according to the adjustment schedule of factors constituting the price of health insurance medical services.
What responsibilities do healthcare facilities have when self-manufacturing and compounding drugs?
The head of the facility must approve production procedures, quality standards, and prices of drugs self-manufactured and compounded by the facility.
When does this Circular take effect?
This Circular takes effect from March 1, 2021.
전문
CIRCULAR
AMENDMENTS AND SUPPLEMENTS TO ARTICLE 5 OF THE CIRCULAR NO. 05/2015/TT-BYT DATED MARCH 17, 2015 ISSUED BY THE MINISTER OF HEALTH ON THE LIST OF TRADITIONAL MEDICINE DRUGS, DRUGS FROM MEDICINAL MATERIALS, AND HERBS IN TRADITIONAL MEDICINE WITHIN THE SCOPE OF PAYMENT BY THE HEALTH INSURANCE FUND
Pursuant to the Health Insurance Law dated November 14, 2008, amended and supplemented by some articles pursuant to the Health Insurance Law dated June 13, 2014; pursuant to Article of the Health Insurance Law;dated June 13, 2014;
Decree No. Decree No. 146/2018/NĐ-CP dated October 17, 2018 of the Government detailing and guiding methods for implementing certain provisions of the Health Insurance Law; Article of the Health Insurance Law;
Decree No. Decree No. 75/2017/NĐ-CP of the Government dated June 20, 2017 stipulating functions, tasks, powers, and organizational structure of the Ministry of Health; transmission within the scope of payment of the health insurance fund.
At the request of the Director of the Health Insurance Department,
The Minister of Health issues this Circular amending and supplementing Article 5 of Circular No. 05/2015/TT-BYT dated March 17, 2015 issued by the Minister of Health on the List of Traditional Medicine Drugs, Drugs from Medicinal Materials, and Herbs in Traditional Medicine within the scope of payment by the health insurance fund. falls within the payment scope of the health insurance fund.
Article 1. Amends and supplements Article 5 of Circular No. 05/2015/TT-BYT dated March 17, 2015 issued by the Minister of Health on the List of Traditional Medicine Drugs, Drugs from Medicinal Materials, and Herbs in Traditional Medicine within the scope of payment by the health insurance fund as follows:
"Article 5. Payment for drug costs, herbs, decoctions used at healthcare facilities and drugs prepared and compounded by healthcare facilities
1. General principle: The health insurance fund shall pay for drug costs, herbs, decoctions used at healthcare facilities and drugs prepared and compounded by healthcare facilities based on the actual quantity used for patients, purchase price of the facility in accordance with the laws on bidding, loss expenses as prescribed by the Minister of Health, and other expenses (if any) ensuring compliance with the scope of benefits and entitlement levels as stipulated by the Health Insurance Law and guiding documents.
2. For herbs:
a) In cases where healthcare facilities purchase medicinal materials to prepare and compound herbs, the health insurance fund shall pay for medicinal material costs according to the purchase price of the healthcare facility and the following costs:
- Loss expenses during preparation, storage, weighing (if any);
- Auxiliary material costs for preparing medicines;
- Preparation and compounding costs including electricity, water, fuel;
- Packaging material costs (if any);
- Labor costs;
- Management costs and depreciation costs of machinery;
b) In cases where healthcare facilities purchase herbs from supplying units, the health insurance fund shall pay according to the purchase price of the herbs and loss expenses during storage, weighing (if any).
3. For decoctions containing herbs listed in the attached list of herbs in this Circular, the health insurance fund shall pay for the following costs:
a) Herb costs as stipulated in Clause 2 of this Article;
b) Decoction costs when healthcare facilities perform decoction at their premises for inpatient and outpatient treatment according to Circular No. 13/2019/TT-BYT dated July 5, 2019 of the Minister of Health amending and supplementing certain articles of Circular No. 39/2018/TT-BYT dated November 30, 2018 of the Minister of Health on unified pricing of medical services under health insurance between hospitals of the same level nationwide and guidance on applying prices and paying costs for medical services under health insurance in certain cases;
c) Packaging costs (if any) when healthcare facilities do not perform decoction at their premises for patients.
4. For drugs prepared and compounded by healthcare facilities:
a) The health insurance fund shall pay based on product cost, including:
- Medicinal material costs according to the purchase price of the healthcare facility or herb costs as stipulated in Clause 2 of this Article. Medicinal materials and herbs must be included in the list of traditional medicine herbs attached to this Circular;
- Losses (if applicable);
- Costs of pharmaceutical excipients and materials for preparation;
- Preparation and compounding costs including electricity, water, fuel;
- Packaging costs;
- Material, chemical, auxiliary material costs for quality control activities before testing according to Circular No. 13/2018/TT-BYT dated May 15, 2018 of the Minister of Health on the quality of medicinal materials and traditional medicine drugs (if any);
- Testing costs according to Circular No. 13/2018/TT-BYT dated May 15, 2018 of the Minister of Health on the quality of medicinal materials and traditional medicine drugs;
- Labor costs;
- Management costs and depreciation costs of machinery;
b) The head of the healthcare facility shall be responsible for approving production procedures, quality standards, and drug prices prepared and compounded by the facility, and unify with the social insurance agency that has signed a health insurance service contract with the facility as the basis for payment.
5. For management costs and machinery depreciation costs as stipulated in point a Clause 2 and point b Clause 4 of this Article, the health insurance fund shall pay according to the adjustment schedule of factors constituting the price of medical services under health insurance and apply simultaneously with the price of medical services under health insurance between hospitals of the same level nationwide issued by the Ministry of Health.
6. In cases where there are additional costs outside the provisions of Clauses 2, 3, and 4 of this Article, the healthcare facility shall prepare a detailed explanation to unify with the social insurance agency that has signed a health insurance service contract with the facility as the basis for payment. In cases where the healthcare facility cannot reach an agreement with the social insurance agency, subordinate healthcare facilities under ministries and sectors shall report to the Ministry of Health, and subordinate healthcare facilities under provincial health departments shall report to the provincial health department for consideration and resolution.
Article 2. Effective Date
This Circular takes effect from March 1, 2021.
Article 3. Reference Provisions
In cases where referenced documents in this Circular are replaced or amended, they shall be applied according to the replacing or amending documents. During implementation, if there are difficulties or obstacles, please reflect them in writing to the Ministry of Health for consideration and resolution.
During the implementation process, if there are difficulties or obstacles, it is requested that agencies, organizations, and individuals report them in writing to the Ministry of Health for consideration and resolution./.
DEPUTY MINISTER
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