What types of cancer do not require a referral?

People receive medical examination and treatment at Oncology Hospital, Branch 2 (Thu Duc City) - Photo: DUYEN PHAN

The Ministry of Health has just issued a list of 62 diseases and groups of diseases that can be taken directly to the final specialized medical facility without a referral letter and still enjoy 100% of the health insurance benefits. However, many cancer patients do not know whether their disease requires a referral letter or not.

Still struggling to "extend" the transfer permit

According to Tuoi Tre Online on the afternoon of January 2, at Ho Chi Minh City Oncology Hospital (facility 1), some cancer patients are still struggling to "extend" their transfer papers as the year 2025 approaches.

Mr. THQ (42 years old, living in Binh Duong province) had stage 2 left nasopharyngeal cancer. He went to the hospital for examination that same morning and was asked to return to the province to get a referral.

However, when returning to the local clinic to complete the procedures, the clinic informed that there are now new regulations, those with serious illnesses can go to the central level for examination and treatment directly without a referral letter, and still enjoy 100% health insurance benefits.

Afterwards, Mr. Q. called the Ho Chi Minh City Oncology Hospital (facility 1) to verify again about the request for a referral form and was apologized by the staff, informing him that he did not need to do it again if the old form was still valid within one year from the date of signing (according to new regulations).

In the case of Mr. LMK (33 years old, residing in Khanh Hoa province), on December 31, 2024, the hospital reminded him to extend his transfer certificate within 7 days (from January 2 to January 8) when entering the new year to continue enjoying health insurance benefits during the treatment of tongue cancer.

Mr. K. has health insurance and registered for initial medical examination and treatment at Cam Ranh Regional General Hospital. Around the beginning of November 2024, he went to Ho Chi Minh City Oncology Hospital for examination and discovered that he had cancer. Mr. K. chose to have surgery and continued to request a hospital transfer to enjoy health insurance during his prolonged treatment at this hospital.

Faced with the news that he had to extend his referral paper during the New Year, Mr. K. had to ask an acquaintance working at Cam Ranh Regional General Hospital to help him make the referral paper as required in order to continue treatment and have part of it covered by health insurance.

Mr. K. said: “It takes me about 8 hours to get home from Ho Chi Minh City. If I go back to my hometown to get a referral as previously requested, it will take a day of radiation therapy. This will affect my treatment regimen. If the regulations on referrals are 'open' for those with serious illnesses such as cancer, it will be very beneficial for the patient.”

Not all cancers do not require a referral!

A representative of Ho Chi Minh City Oncology Hospital informed that on January 1, 2025, the Ministry of Health issued Circular 01 detailing and guiding the implementation of a number of articles of the Law on Health Insurance.

Specifically, the list of some rare diseases, serious diseases, diseases requiring surgery or using high technology is entitled to 100% of the benefit level as prescribed in Point a, Clause 4, Article 22 of the Law on Health Insurance for specialized medical examination and treatment facilities (for example: Oncology Hospital) specified in Appendix I.

This Appendix I includes 62 different disease groups, including 10 malignant disease groups with specific conditions and conditions.

Including 9 groups of cancers such as C25 (pancreatic malignancy); C37 (thymic malignancy); C38 (malignant tumors of the heart, mediastinum and pleura) (except code C38.4); C41 (malignant tumors of bones and articular cartilage at other and unspecified locations); C70 (malignant tumors of the meninges); C71 (malignant tumors of the brain); C72 (malignant tumors of the spinal cord, cranial nerves and other parts of the central nervous system); C79.3 (secondary malignant tumors of the brain and meninges); From C81 to C86 and from C90 to C96 (malignant tumors of the lymphatic system, hematopoietic system and related tissues) (except code C83.5).

Particularly for the group of malignant diseases in general (from C00 to C97), 2 conditions must be met. That is, people under 18 years old, and does not apply to cases that have been diagnosed but do not have specific treatment indications.

Therefore, in the case of Mr. K. and Mr. Q., if they do not belong to the disease groups and meet the above conditions, they need to be transferred to the Oncology Hospital by the primary health care facility (in case it exceeds the capacity of the basic health care facility in the province) or the basic health care facility to enjoy health insurance benefits when receiving outpatient treatment.

Before January 1, 2025, according to the guidance of Decree 146/ND-CP and Circular 40/TT-BYT, "The referral paper is valid until December 31 of that calendar year".

Therefore, upon receiving Circular 01 of the Ministry of Health, which issued instructions in Clause 5, Article 15, stipulating that "Re-examination appointment papers and referral papers issued before the effective date of this Circular shall be used until the expiry date of the validity of the papers as prescribed in this Circular. In case the referral papers expire in the calendar year, they shall be valid from January 1, 2025", the hospital notified and explained to patients whose referral papers in 2024 are still valid to avoid having to re-apply for a new referral paper.

Source: https://tuoitre.vn/nhung-loai-benh-ung-thu-nao-se-khong-can-phai-xin-giay-chuyen-tuyen-20250103142705116.htm