Vietnam's Ministry of Health is drafting a new circular to establish principles for developing a list of medical technical services and provide updated guidance on reimbursement of medical technical service fees under the national health insurance scheme.
The proposed circular is intended to address shortcomings identified in the implementation of Circular 35/2016 and its subsequent amendments.
According to Tthe Ministry's Department of Health Insurance, several existing provisions have proven unclear, incomplete or have failed to keep pace with advances in medical science and technology, reported Vietnam.vn.
The Ministry said the reforms are particularly necessary as the growing burden of non-communicable diseases, including cancer and cardiovascular disease, has rendered some existing reimbursement conditions outdated. As a result, certain payment rules have limited benefits for health insurance participants while increasing patients' out-of-pocket medical expenses.
Under the draft circular, the Department of Health Insurance proposes expanding the list of reimbursable medical technical services by introducing clearer provisions on payment conditions, reimbursement rates and benefit levels.
Among the proposed changes is health insurance coverage for PET/CT scans for patients with non-small cell lung cancer and oesophageal cancer. Reimbursement would apply only where a cancer diagnosis has been confirmed and other diagnostic methods have been unable to determine disease staging, recurrence, metastasis or treatment response.
The draft stipulates that reimbursement would be limited to one PET/CT scan per patient every 12 months, with the payment capped at the cost of the procedure.