To:

- Departments of Health of provinces or central-affiliated cities;
- Hospitals and institutes having patient beds affiliated to Ministry of Health;
- Health facilities affiliated to Ministries;

Minister of Health has recently promulgated the Decision No. 4210/QD-BYT dated September 20, 2017 providing for output data standards and formats used in management, assessment and payment for medical services covered by health insurance. The Appendix 01 which is used as reference for cases of special coinsurance percentages has been mentioned in the descriptions of the entry No. 14 “TYLE_TT” and the entry 15 “THANH_TIEN” at Table 3 (Entries relating to medical technical services and medical supplies covered by health insurance fund) enclosed with the abovementioned Decision.

Ministry of Health hereby supplements the Appendix 01 – Guidance on certain cases of special coinsurance percentage (The Appendix enclosed herewith) to the abovementioned Decision.

When receiving this document, concerned units are required to promptly organize the implementation of this document and send reports on difficulties that arise during the implementation of this document to the Ministry of Health (via the Health Insurance Department) for consideration./.

BY ORDER OF MINISTER PP. DIRECTOR OF HEALTH INSURANCE DEPARTMENT
DEPUTY DIRECTOR




Dang Hong Nam

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APPENDIX 01

GUIDANCE ON CERTAIN CASES OF SPECIAL COINSURANCE PERCENTAGE
(Enclosed with the Official Dispatch No.     /BYT-BH dated    /11/2017 by Ministry of Health)

STT

Cases

Code of group of medical services

Unit price

Quantity

Coinsurance percentage

Amount

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...

(TEN_DICH_VU)

(MA_NHOM)

(DON_GIA)

(SO_LUONG)

(TYLE_TT)

(THANH_TIEN)

(1)

(2)

(3)

...

...

...

(5)

(6) = (3) x (4) x (5)/100

(7)

1

Two patients sharing a hospital bed

15

90,000

1

50

...

...

...

If two patients share a bed, total cost of bed shall be equal to 50% of the primary cost of bed; the patient shall not pay the remaining 50% amount. Therefore, Quantity = 1; coinsurance percentage = 50; Amount = Quantity*unit price*coinsurance percentage/100

2

Three patients or more sharing a hospital bed

15

90,000

1

30

27,000

If three patients, or more, share a bed, total cost of bed shall be equal to 30% of the primary cost of bed; the patient shall not pay the remaining 70% amount. Therefore, Quantity = 1; coinsurance percentage = 30; Amount = Quantity*unit price*coinsurance percentage/100

...

...

...

From the second examination to the fourth examination

13

20,000

1

30

6,000

When taking the second, third or fourth examination, total cost of medical examination shall be equal to 30% of the primary cost, and the patient shall not pay the remaining 70% amount. Therefore, Quantity = 1; coinsurance percentage = 30; Amount = Quantity*unit price*coinsurance percentage/100

4

For the fifth examination

...

...

...

20,000

1

10

2,000

When taking the fifth examination, total cost of medical examination shall be equal to 10% of the primary cost, and the patient shall not pay the remaining 90% amount. Therefore, Quantity = 1; coinsurance percentage = 10; Amount = Quantity*unit price*coinsurance percentage/100

5

Using the second technical service in the one surgery (performed by the same surgical team)

8

2,460,000

...

...

...

50

1,230,000

When using the second technical service in the one surgery (performed by the same surgical team), total cost of such medical service shall be equal to 50% of the primary cost, and the patient shall not pay the remaining 50% amount. Therefore, Quantity = 1; coinsurance percentage = 50; Amount = Quantity*unit price*coinsurance percentage/100

6

Using the second technical service in the one surgery (performed by another surgical team)

8

2,460,000

1

80

...

...

...

When using the second technical service in the one surgery (performed by another surgical team), total cost of such medical service shall be equal to 80% of the primary cost, and the patient shall not pay the remaining 20% amount. Therefore, Quantity = 1; coinsurance percentage = 80; Amount = Quantity*unit price*coinsurance percentage/100