Technical expertise classification in medical examination and treatment

One of the most fundamental changes in Circular No. 01/2025/TT-BYT is the transition from the administrative level model to a technical expertise classification model. The health insurance (HI) medical examination and treatment facility system is no longer divided into 04 levels (Central, provincial, district, commune) as before, but is rearranged into 03 levels of professional expertise:

• Initial medical examination and treatment level: Includes health stations, polyclinics, civil-military health stations, and agency/unit health facilities. The main task is primary health management, treatment of common diseases, and mild-level emergencies.
• Basic medical examination and treatment level: Includes general and specialized hospitals (equivalent to the district level and some former provincial-level hospitals). This level performs general and specialized professional techniques at an average level.
• Specialized medical examination and treatment level: Includes leading hospitals, hospitals directly under the Ministry of Health, or hospitals assigned specialized technical tasks (equivalent to the Central level and grade I, special provincial hospitals).

This classification aims to optimize patient flow, helping people access health services appropriate to their pathological condition, avoiding overload for upper-level facilities with mild pathologies.

Regulations on initial health insurance medical examination and treatment registration

Circular 01/2025/TT-BYT clearly stipulates the right to register the place of initial medical examination and treatment (KCB) to fit the 3-level model mentioned above. Specifically:

HI participants have the right to register for initial KCB at facilities belonging to the Initial medical examination and treatment level and the Basic medical examination and treatment level.

For the Specialized medical examination and treatment level, initial registration will be restricted and only applied to a number of specific groups according to Ministry of Health regulations, such as people with meritorious services to the revolution, people aged 80 and over, or cases of chronic diseases requiring regular monitoring at the specialized level that have been approved by competent authorities. This ensures that specialized hospitals focus resources on treating difficult and complex cases.

Direct access and referral mechanism for critical and rare diseases

This is the most humane aspect of the 2025 regulations. Circular No. 01/2025/TT-BYT issues a list of rare diseases, critical diseases, and diseases requiring surgery or the use of high technology, eligible for specific regimes.

Accordingly, patients diagnosed with diseases in this list (e.g., cancer, hemodialysis, Hemophilia, rare autoimmune diseases…) will be allowed to go directly for examination and treatment at specialized medical examination and treatment facilities without a referral letter from lower levels.

In this case, patients are still entitled to 100% of medical examination and treatment costs within the scope of benefits and benefit levels prescribed on the HI card. This regulation helps reduce the burden of administrative procedures, shorten waiting times, and ensure that severely ill patients have timely access to the best treatment methods.

Regulations on referral letters and follow-up appointment letters

To minimize troublesome procedures for patients with chronic diseases, the Circular also details the validity of Referral Letters and Follow-up Appointment Letters.

For cases of chronic diseases and critical diseases requiring long-term treatment, the Referral Letter is valid for the calendar year (until December 31 of that year). Patients do not need to reapply for a referral letter monthly or quarterly as before.

Besides, the integration of Referral Letters and Follow-up Appointment Letters into the electronic environment (such as VNeID or VssID applications) is being synchronously deployed by the Ministry of Health and Vietnam Social Security. When going for a medical examination, people can present these electronic documents, replacing paper documents, helping the reception process take place quickly and more accurately.

BSc. Truong Phan Hong Ha – Center for Support & Continuing Education