|
MINISTRY OF
HEALTH
-------
|
SOCIALIST
REPUBLIC OF VIETNAM
Independence - Freedom – Happiness
---------------
|
|
No. 22/2023/TT-BYT
|
Hanoi, November
17, 2023
|
CIRCULAR
UNIFYING
PRICES OF MEDICAL EXAMINATION AND TREATMENT SERVICES COVERED BY MEDICAL
INSURANCE AMONG HOSPITALS OF THE SAME CLASS ACROSS THE COUNTRY AND GUIDELINES
FOR APPLYING PRICES AND PAYMENT FOR MEDICAL SERVICES IN CERTAIN CASES
Pursuant to Law on Medical Examination and Treatment
No. 40/2009/QH12 dated November 23, 2009;
Pursuant to Law on Prices No. 11/2012/QH12 dated
June 20, 2012;
Pursuant to the Law on Medical Insurance No.
25/2008/QH12 dated November 14, 2008 receiving amendments according to the Law
No. 46/2014/QH13 dated June 13, 2014;
Pursuant to Decree No. 177/2013/ND-CP dated
November 14, 2013 of the Government on elaboration to a number of Articles of
the Law on Prices, which is amended by Decree No. 149/2016/ND-CP dated November
11, 2016 of the Government;
Pursuant to Decree No. 60/2021/ND-CP dated June
21, 2021 of the Government prescribing financial autonomy of public service
providers;
Pursuant to Decree No. 24/2023/ND-CP dated May
14, 2023 of the Government prescribing statutory pay rate for officials, public
employees and armed forces;
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
At the request of the Director of Planning –
Finance Department of the Ministry of Health;
The Minister of Health hereby promulgates a
Circular unifying prices of medical examination and treatment services covered
by medical insurance among hospitals across the country and guidelines for
applying prices and payment for medical services in certain cases.
Article 1. Adjustment scope and
regulated entities
1. This Circular provides regulations on unifying
prices for medical examination and treatment services covered by health insurance
among hospitals of the same class across the country and guidelines for
applying prices and making payment for medical services in certain cases.
2. Price frame and the authority to stipulate
prices for medical services not covered by health insurance shall be instructed
in the Law on Prices, the Law on Medical Examination and Treatment and the Law
on Organization of Local Government and documents for implementation
instructions.
Article 2. Prices for medical
services covered by health insurance
1. Prices for medical examination and consultation
are specified in Appendix I enclosed herewith.
2. Prices for hospital stay are specified in
Appendix II enclosed herewith.
3. Prices for medical procedures and testing are
specified in Appendix III enclosed herewith.
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
5. Prices for medical local anaesthesia excluding
costs of drugs and oxygen used for such services are prescribed in Appendix V
enclosed herewith. The costs of drugs and oxygen paid to social insurance
agencies and the patients shall comply with their actual use and procurement
results.
Article 3. Composition of
prices for medical services covered by health insurance
Prices for medical services specified in this
Circular shall be calculated based upon direct expenses and salaries in order
to ensure the provision of medical examination and treatment; to be specific:
1. Direct expenses included in prices for medical
examination:
a) Expenses incurred on patient clothing, scrubs,
medical cap, surgical mask, bedspread, pillow, mattress, mat, stationery,
medical glove, cotton wool, bandage, alcohol, gauze, brine and other supplies
serving the medical examination.
b) Expenses incurred on electricity, water, fuels,
daily-life waste treatment, medical waste (solid and liquid waste); laundry,
steaming, drying, washing or disinfecting cloth, examination equipments;
expenses incurred on cleaning and ensuring environment hygiene; antiseptic
supplies and chemicals during the examination;
c) Expenses incurred on maintenance and care of
equipment, purchase of assets and tools for replacement such as air
conditioners, computers, printers, dehumidifiers, fans, desks, chairs,
cabinets, lights and other necessary tools during medical examination.
2. Direct expenses included in prices for hospital
stay
a) Expenses incurred on patient clothing, scrubs,
medical cap, surgical mask, blanket, bedspread, pillow, mattress, curtain, mat;
stationery; medical gloves used in examination, injection and infusion, cotton
wool, bandage, alcohol, gauze, brine and other supplies used in daily caring
and treatment (including the expense incurred on changing the dressing of a
surgical wound or incision of in-patient, except for cases in which such
expense is covered in addition to the price for hospital stay as prescribed in
clauses 5, 6 and 7 hereof); electrodes, electrocardiogram, blood pressure
monitor, SPO2 cables in the course of using patient monitors for emergency beds
and intensive care beds.
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
c) Expenses incurred on medicines, whole blood,
standard blood products, intravenous fluids, supplies not mentioned above;
types of syringe used in infusion; inserted tubes, tubes connecting to syringe
pumps or infusion pumps; oxygen supplies, oxygen nasal cannulas, oxygen masks
(except cases in which the medical ventilators are indicated for patients),
which are not included in the prices for hospital stay, shall be paid if the
above-mentioned tools are used during medical examination and treatment.
3. Direct expenses included in the prices for
medical procedures:
a) Expenses incurred on patient clothing, scrubs,
medical cap, bedspread, pillow mattress, mat, cloth; stationery; medicines,
intravenous fluids, chemicals, supplies used and supplies for replacement
during medical procedures;
b) Expenses prescribed in Clause 1b and 1c of this
Article shall arise out of medical procedures as professional required.
4. Salaries included in prices for medical
examination, hospital stay and medical procedures, including:
a) Salaries based upon salary scale, grade or job
title, allowances, contributions as prescribed in respect of public service
providers and statutory pay rate prescribed in Decree No. 24/2023/ND-CP dated
May 14, 2023 of the Government which regulates the statutory pay rate of public
officials, public employees and armed forces;
b) Regular allowances, allowances for surgery and
medical procedures prescribed in Decision No. 73/2011/QD-TTg dated December 28,
2011 of the Prime Minister on regulations on particular allowances provided for
public officials, public employees and labors in public medical facilities and
allowances intended for epidemic prevention.
5. Salaries included in the prices for medical
examination prescribed in clause 4 in this Article which do not include
expenditures covered by state budget and comply with the following regulations:
a) Policies on preferential allowances, attraction
allowances, benefits and other incentives applicable to medical officials,
public employees, employees under employment contracts, and military medical
workers directly performing medical tasks in state-owned healthcare
establishments in areas with extremely difficult socio-economic conditions;
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
c) Specific policies on allowances paid to
officials and public employees working for Huu Nghi hospital, Thong Nhat hospital,
Hospital C – Da Nang affiliated to the Ministry of Health, Central Health
Protection Centers 1, 2, 2B, 3 and 5, Department A11 of Military Central
Hospital 108 and Department A11 of Military Hospital of Traditional Medicine;
d) Policies on job-specific allowances.
6. Payment for expenses for medical examination
prescribed herein by social insurance agencies to the medical facilities and
expenses incurred on medicines, whole blood, standard blood products, chemicals
and medical equipment not included in medical service prices (specified in
particular services) shall be made as prescribed in Article 24 of the Decree
No. 146/2018/ND-CP dated October 17, 2018 of the Government which provides
guidance on measures for implementing some articles of the Law on Health
Insurance which has been amended by Decree No. 75/2023/ND-CP dated October 19,
2023 of the Government.
7. Expenses prescribed in clauses 1, 2, 3 and 4 in
this Article shall be determined based upon technical-economic norms and
expense norms issued by competent authorities, prices for medical service and
average expenses must be practical and consistent with applicable policies,
provided that the average and advance as well as satisfying the service quality
requirement are satisfied.
Economic-technical restrictions shall be used as
the basis for determining prices for medical services but not for the payment
for each type of medical service (except particular cases prescribed in clause
6, Article 5, clause 16, Article 6, clause 8, Article 7 hereof).
Article 4. Rules for
application of medical service prices in medical facilities contracted to
provide medical services covered by health insurance
1. For institutes with patient beds, medical
centers providing medical services that are licensed to serve functions of
hospitals, classed medical centers in districts providing medical services,
apply the prices by hospital of the same class.
2. For health protection and care clinics for
public officials in provinces, cities not affiliated to general hospitals in
provinces and central-affiliated cities, apply the service prices issued by
class II hospitals.
3. For unclassed medical facilities, army medical
clinics, civil-military medical clinics, military infirmaries, infirmaries,
private polyclinics and specialty clinics, apply the prices issued by class IV
hospitals.
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
a) If regional polyclinics are licensed to serve
functions of hospitals or fall into the cases specified in clause 12, Article
11 of the Government’s Decree No. 155/2018/ND-CP dated November 12, 2018 on
amendments to certain articles related to the business and investment
conditions under state management of the Ministry of Health, apply the prices
for medical services issued by class IV hospitals;
b) If only providing emergency medical response and
medical services for outpatients, apply the prices for medical services issued
by class IV hospitals. If permitted by the Department of Health to have patient
beds, the price for an outpatient bed shall be equal to 50% of the price for
hospital stay of type 3 inpatient bed of class IV hospitals. An outpatient can
only be confined to a bed for maximum 3 days for each medical treatment.
Payment for medical examination service is not required if the price for
outpatient bed is paid.
5. For medical aid stations in communes and towns,
medical aid stations in companies, agencies, organizations, schools and
civil-military medical aid stations:
a) Apply the prices for medical services issued by
the medical aid stations in communes.
b) Apply the medical procedure price that is equal
to 70% of such price specified in Appendix III enclosed herewith.
c) If having patient beds as decided by the Health
Department, apply the price which is equal to 50% of the price for hospital
stay of type 3 inpatient bed issued by class IV hospitals. An outpatient can
only be confined to a bed for maximum 3 days for each medical treatment.
Payment for medical examination service is not required if the price for
outpatient bed in commune medical aid stations is paid.
6. Maternity homes: apply the price of medical
services of grade IV hospitals.
For prices for hospital stay: apply the price
which is equal to 50% of the price for hospital stay of type 3 inpatient bed
issued by class IV hospitals.
7. If a patient has medical insurance but uses
required medical services, the payment for medical services covered by health
insurance shall be within the scope of coverage and coverage level according to
the provisions of the Law on Health Insurance and implementation guiding
documents.
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
1. If a patient undergoes medical examination in
examination department then is transferred to inpatient department for
treatment as required by professionals, payment for medical examination shall
be made in accordance with clause 3 of this Article. If a patient is not
subject to medical examination in examination department but in clinical
department as required by professionals, the payment for such examination is
not required.
2. For medical facilities providing specialist
examination service in clinical departments, examination conducted in
examination department and specialist examinations in clinical department will
be counted as examination in medical examination department. A number of
times for medical examination will be counted and the price for such
examination service will be determined in accordance with regulations in clause
3 in this Article.
3. For one-time examination in a single medical
facility (such examination can be finished in one day or last for 2 days due to
subjective reasons or professional requirements), if the patient is required to
undergo more than one specialist examination, the price for the second
examination onwards shall be equal to 30% of the price for one-time examination
and the maximum price for such -medical examination shall not exceed 2 times
the price for one-time examination.
4. Patients that show abnormal signs after
undergoing examination and taking medicines by medical facility require
re-examination in the same day in such medical facility; such examination shall
be counted as the second examination in a day. Payment for medical
examination shall be made in accordance with regulations in clause 3 in this
Article.
5. For patients undergoing examination in regional
polyclinics then being transferred to hospitals or medical centers of district
level for another medical examination, such examination shall be counted as a
new examination.
6. Medical facilities are required to arrange
medical examination tables and allocate staff as required to ensure the
examination quality. For examination tables of more than 65 examinations
per day, the social insurance agency shall only pay 50% of the examination
price from the 66thexamination. If there are still 65 examinations
conducted in one medical examination table in a quarter, the insurance agency
shall not pay the price for the 66th examination and onward.
Article 6. Determination of
number of day for hospital stay, application of price for hospital stay and
payment for such price made by the social insurance agency to medical facility
1. Counting the number of day for inpatient
treatment to be used as a basis for paying hospital stay price:
a) The number of days for inpatient treatment shall
be equal to the discharge date minus (-) the hospitalization date then plus (+)
1: apply to the following cases:
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
- The patient that undergoes medical emergency treatment
in an upper level hospital but still requires inpatient treatment is
transferred to a lower level hospital or to another medical facility.
b) The number of days for inpatient treatment is
equal to the discharge date minus (-) the hospitalization date, apply to the
remaining cases.
c) For the case in which the patient is admitted to
the hospital and is discharged from such hospital on the same day (or
discharged on the following day), such day shall be counted as a treatment day
if the treatment lasts for more than 4 hours but less than 24 hours.
Except the case in which the patient is transferred
directly to the emergency department not through examination department and
undergoes less than 4-hour-treatment (including cases of hospital discharge, hospitalization,
referral or dead) and get the prices for medical examination, medicine
purchase, medical supplies and medical procedures paid by the insurance agency
excluding the hospital stay price per day for emergency beds.
d) For the case in which the patient is admitted
and discharged from the hospital after undergoing less than 04-hour treatment,
such patient shall get the price for medical examination, medicine purchase,
medical supplies and medical procedures paid by the hospital, excluding the hospital
stay price for inpatient bed.
2. If the patient is transferred to 2 different
departments in the same day, each department shall be counted as a half day of
treatment. If the patient is transferred to 3 or more departments in a day, the
price for hospital stay in such day shall be equal to the arithmetic mean of
the highest price for hospital stay in the department with more than
4-hour-treatment and the lowest price for hospital stay in the department with
more than 4-hour-treatment.
3. The price for hospital stay in surgery and burn
department shall be applied within 10 days after the surgery. Such price from
the 11th day onwards will be equal to the price for hospital stay in equivalent
department as prescribed in section 3 in Appendix II hereto.
4. The price for hospital stay shall apply to one
patient confined to a single bed. In case two patients have to share one bed, a
half of the price for hospital stay is paid. If there are 3 or more
patients sharing the same bed, one third of the hospital stay price is paid.
5. The price for hospital stay in Intensive Care
Unit (hereinafter referred to as “ICU”) shall be applied to:
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
b) The case where separate areas or emergency rooms
(with intensive care beds or post-operative beds for patients after special
surgery) which are arranged in the Emergency Department, Anaesthesiology
Department, Pediatrics Department, Neonatology Department, and Infectious
Diseases Department meet the requirements for facilities, equipment, and human
resources specified in the Regulations on emergency, intensive care and poison
prevention issued together with Decision No. 01/2008/QD-BYT;
c) Any patient who is confined to such bed is
suffering illness requiring care, treatment and monitoring in accordance with
regulations on emergency response, intensive care and poison management. For
other cases, apply the hospital stay price per day for emergency beds and other
types of hospital beds as instructed in Appendix II hereto.
6. For clinical departments having emergency beds:
apply the hospital stay price per day for emergency beds prescribed in service
No.2 in Appendix II hereto.
For instance, pediatric departments having
pediatric emergency beds, neonatal departments or special care for premies.
7. For class III and IV hospitals and unclassed
hospitals permitted by competent authorities to perform special surgeries:
apply the highest price for hospital stay in surgery department issued by the
hospital providing such surgery service.
For instance: For hospital A that is licensed for
special surgery, apply the price for hospital stay in surgery department after
type 1 surgery issued by class III hospitals if it is classed III, and apply
the price for hospital stay in surgery department after type 1 surgery if it is
classed IV or unclassed.
8. For cases in which a surgery is classified
according to different criteria applied to different specialist departments
(except Pediatrics) as prescribed in Circular No.50/2014/TT-BYT dated December
26, 2014 of the Minister of Health which prescribes the classification of
surgery, medical procedure and personnel norm applied to such surgery or
medical procedure (hereinafter referred to as “Circular No.50/2014/TT-BYT”):
apply the price for hospital stay in surgery or burn department according to
the lowest graded surgery.
9. For surgeries similar to a surgery prescribed
herein as graded by the Ministry of Health but subject to different
classification of surgeries according to different specialist departments
prescribed in Circular No. 50/2014/TT-BYT: apply the price for hospital stay in
surgery or burn department according to the classification of such surgery.
10. For unclassified surgeries prescribed in
Circular No. 50/2014/TT-BYT: apply the price for hospital stay of type 4
surgery issued by the hospital of equivalent class.
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
12. For departments of traditional medicine
hospitals (except hospitals prescribed in clause 11 of this Article) and
rehabilitation hospitals:
a) Hospital stay price per day for ICU beds as
prescribed in clause 5 in this Article;
b) Hospital stay price per day for emergency beds
as prescribed in clause 6 in this Article;
c) Hospital stay price per day for beds in oncology
department, pediatrics department: apply the hospital stay price per day for
type 1 inpatient beds;
d) Hospital stay price per day for hospital beds to
treat one of the diseases of spinal cord injury, stroke, or traumatic brain
injury: apply the hospital stay price per day for type 2 inpatient beds;
dd) Hospital stay price per day for beds in other
departments: apply the hospital stay price per day for type 3 inpatient beds;
13. For medical facilities having inter-department
structure: apply the hospital stay prices per day for inpatient beds in the
departments in which patients are treated corresponding to the hospital
classes. In case a patient is treated for multiple diseases at the same time,
the hospital stay price per day in the department in which the patient is
treated mainly will be applied.
14. In case of patient overload, the medical
facility is permitted to lay out more beds than the designed one in order to
serve the patients and gets the cost for additional beds paid by the social
insurance agency in accordance with regulations in clause 16 in this Article.
15. For patients lying on stretchers or folding
beds, apply 50% of the hospital stay price per day for beds in each specialist
department in consistent with regulations in Appendix II hereto.
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
a) The number of bed used in a quarter (year) shall
be equal to the total days of inpatient treatment in a quarter (year) divided
(:) by total day in a quarter (365 days in a year), in which the number of days
on which the patient(s) receive(s) inpatient treatment shall be calculated in
the following principles: every 2 days of inpatient hospital stay on a
stretcher, folding bed or bed shared by two patients shall be converted into 1
day of inpatient hospital stay, and every 3 days of inpatient hospital stay on
a bed shared by 3 or more patients shall be converted into 1 day of inpatient
hospital stay;
b) In case the actual number of beds used in a
medical facility in a quarter is less than or equal to 120% of the number of
beds assigned: 100% of total price for the bed use shall be paid according to
the actual number of days that the beds are used and the prescribed hospital
stay price per day;
c) In case the actual number of beds used in a
medical facility in a year is more than 120% of the number of beds assigned in
the year:
- For medical facilities whose hospital beds are
assigned before 2015, such medical facilities and social insurance agencies may
agree on the method for determination of quarterly actual bed occupancy rate
(hereinafter referred to as “bed occupancy rate”) shall be equal to (=) the
actual number of beds used in a quarter divided (:) by the actual number of
beds used in 2015 and multiplied by 100%.
- In case the bed occupancy rate (including the
above-mentioned method for determination):
+ is less than or equal to 130%, the health
insurance agency shall pay the medical facility 100% of total price for the bed
use according to the actual number of days that the beds are used and the
prescribed hospital stay price per day;
+ is more than 130% but not exceed 140%, the health
insurance agency shall pay the medical facility 97% of total price for the bed
use according to the actual number of days that the beds are used and the
prescribed hospital stay price per day;
+ is more than 140% but not exceed 150%, the health
insurance agency shall pay the medical facility 95% of total price for the bed
use according to the actual number of days that the beds are used and the
prescribed hospital stay price per day;
+ is more than 150%, the health insurance agency
shall pay the medical facility 90% of total price for the bed use according to
the actual number of days that the beds are used and the prescribed hospital
stay price per day.
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
dd) For the case in which the medical facility puts
reformed, extended or new construction items or works into operation without
any approval for additional patient beds from competent authorities, the Health
Department and social insurance agency shall mutually agree that the number of
additional patient beds in this area shall count towards the designed number of
bed approved by competent authorities for the purpose of making payment in
accordance with regulations in this clause.
17. The hospital stay after the
“phacoemulsification cataract surgery” shall apply the price for “Hospital stay
in surgery and burn department” of type 3 respectively according to the hospital
class of the Appendix II issued together with this Circular.
Article 7. Application of
prices, conditions and payment for particular medical procedures
1. Medical procedures:
a) For specific medical procedures with prices
prescribed in appendix hereto: apply the prices as specified.
b) For medical procedures without prices prescribed
in appendix issued thereto but graded according to procedures with equivalent
technique and costs for performance, apply the prices of procedures with
equivalent technique and cost for performance by the Ministry of Health.
c) If one medical procedure is provided in
different specialist departments, the applicable price for such procedure shall
be the price issued by the department requiring such procedure.
2. For medical procedures which have been approved
by competent authorities such as ministries, central government authorities for
facilities under central management and Health Department for facilities under
local management, except care services included in the hospital stay price and
services included in expenses incurred on other services but have no prices;
medical procedures provided as assigned but fail to continue to operate due to
the illness situation or physical status of the patient, payment shall be made
according to the number of medicines and supplies given to the patient and the
purchase price as regulated by law.
3. For multiple interventions in one surgery,
payment shall be made according to the price of the most complicated or most
expensive surgery. Prices of other mandatory medical procedures that are not
included in the above-mentioned surgery process shall be:
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
b) Equal to 80% of price of additional surgeries if
that technique requires a different surgical team to perform;
c) In case of performing additional procedures, 80%
of their prices shall be paid;
4. For the service called “changing the dressing of
a wound or surgical incision no more than 15cm in length”:
a) Payment shall be made for the patient undergoing
inpatient treatment in the following cases: infected wound or incision;
infiltration of blood into skin lesions with areas over 6 cm2; wound covered by
gauze; wound with fluid leaking at the bottom of drain tube; multi wounds or
incisions; or two or more cuts required in one surgery;
a) The payment shall not be made for changing
dressing in the following cases: endoscopy surgery, changing dressing of a
surgical incision, normal wound or changing umbilical bandage for newborns.
5. For the service called “changing dressing of a
surgical incision from over 15 to 30 cm in length” in patient treatment, apply
the price for medical procedures in the following cases:
a) Infected incision, gastrointestinal fistula,
bile duck leak, urine incontinence;
b) Incision that get infected after the surgery
(such as peritonitis, osteitis or abscess), incision after surgical gut,
urinary, biliary or ascites surgery;
c) Incision after a surgery requiring two or more
cuts;
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
6. For immunological compatibility test performed
at 37 Celsius degrees and supplemented with anti-globulin serum (indirect
Coombs test), payment shall be made according to the price for the service
called “Compatibility reaction using anti-globulin serum for human” numbered
1340 or 1341 in Appendix III enclosed herewith.
7. Payment and final accounts for medical
procedures such as radiography, digital radiography (for diagnosis), 32-slice
CT Scanner for diagnosis which is numbered 42 or 43 in Appendix III enclosed
herewith, ultrasound (service numbered 1, 2 in Appendix III enclosed herewith),
Magnetic Resonance Imaging (MRI) (service numbered 67, 68 in Appendix III
enclosed herewith) shall be made periodically by health insurance agencies to
medical facilities as follows:
a) The maximum cases guaranteed by the social
insurance agency according to the price prescribed herein shall be equal to (=)
the average case according to pricing norm divided (:) by 8, then multiplied by
(x) the working hours of the facility, by total days of work in a quarter, by
the number of machine used in such facility in a quarter and finally multiplied
by 120%;
b) The pricing norm (the number of
case/machine/working day (8 hours)): 48 cases for ultrasound, 58 for
radiography and digital radiography, 29 for 32-slice CT Scanner and 19 for MRI;
c) If the number of cases requiring payment is
smaller than the maximum number prescribed in point a in this clause, the
social insurance agency shall make payment according to actual cases and prices
specified herein;
d) If the number of cases requiring payment is more
than the maximum number prescribed in point a in this clause, the social
insurance agency shall make payment according to prices specified herein for
the number of cases stated in point a in this clause. With regard to cases
exceeding the maximum number of case prescribed in point a in this clause, the
social insurance agency shall make payment based upon the price not including
salaries, specifically as follows:
- For ultrasound (diagnosis): pay 55% of the
prescribed price;
- For radiography and digital radiography:
pay 85% of the prescribed price;
- For 32-slice CT scanner: pay 95% of the
prescribed price.
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
For instance: Medical facility A owns 3 machines
for radiography currently in operation and works for 9 hours/day (1-hour-extra
work per day) and works on Saturdays, as well as having 78 working days in
total 92 days of quarter III in 2018;
The maximum number of cases guaranteed by the
social insurance agency according to the price for radiography service
prescribed herein shall be calculated as follows: (58:8) x 9 x 3 x 78 x 120% =
18.322,2 cases.
If total number of cases of radiography requiring
payment by the social insurance agency in quarter III of 2018 is smaller or
equal to 18.322, the social insurance agency shall make payment according to
the price prescribed herein.
If the number of cases requiring payment as
requested by the Health Department is more than 18.322, 20.000 for instance,
the social insurance agency shall make payment for 18.322 cases according to
the price prescribed herein and pay 85% of the prescribed price for 1.678
remaining cases (equal to 20.000 minus 18.322).
8. Regulations in clause 8 in this Article, clause
6 in Article 5 and clause 16 in Article 6 hereof shall apply to payment made by
the social insurance agency to the medical facility, not for determination of
the expenses payable of the patient.
9. During natural disasters or epidemic, the social
insurance agency shall pay the medical facility according to the price and
number of service provided but not based upon payment regulations in clause 8
in this Article, clause 6 in Article 5 and clause 16 in Article 6 hereof.
10. Pediatric procedures that are performed on
adults or medical procedures performed for pediatric patients but having the
same name as those for adults but having no specific prices, apply medical
procedure prices according to the list in this Circular and those for
technically and financially equivalent procedures. Medical procedures only
available in pediatrics but performed for patients over 16 years old, apply
medical procedure prices as those prescribed for pediatrics.
Article 8. Expenses not
included in medical service prices covered by state budget
1. Ministries and central government authorities
shall make a consolidated report to the Ministry of Finance, Health Departments
of provinces and centrally-affiliated cities which is then submitted to
People's Committees of provinces for funding provision in consistent with state
budget allocation and regulations on resources for amendments to the salary
policy with regard to:
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
b) Funding from state budget for amendments to the
policy on salary in accordance with regulations in force and the statutory pay
rate prescribed in Decree No.66/2013/ND-CP dated June 27, 2013 of the
Government on statutory pay rate of public officials, public employees and
armed force.
2. If revenues of the public service provider
partially self-covering its recurrent expenditures as assigned by competent
authorities or public services provider guaranteed by the State fail to meet
its recurrent expenditures and ensure sustainable operation, the deficit shall
be financed by state budget for the purpose of ensuring labor benefits and
normal operation of such service provider in accordance with regulations on
decentralization of budget management.
Article 9. Implementation
1. Responsibilities of the Ministry of Health:
a) The Department of Planning and Finance is
required to play the role of an liaison agency to reach an agreement with
relevant units affiliated to the Ministry of Finance on timely considering and
adjusting prices for medical services when supplementing price forming elements
according to the roadmap or when the State adjusts the salary policy,
economic-technical restrictions or expenses of price formation elements; play
the role of a liaison agency to cooperate with relevant entities in conducting
inspection, preliminary review and extensive review of implementation of this
Circular nationwide.
b) The medical service management department shall
take responsibility to play the role of a liaison agency and cooperate with
relevant units in instructing medical facilities to continue to strictly comply
with professional regulations and ensure the consistency in methods for
improving the service quality; inspect, patrol and supervise professional works
regarding the direction for using services, medicines and supplies or assigning
patients to undergo inpatient treatment and other professional works;
c) The Department of Health Insurance shall take
responsibility to play the role of an intermediary agency and cooperate with
units, Ministry Inspectorate and relevant entities in inspecting and
supervising or instructing the Health Department, supervisory authorities of
ministries to inspect and supervise medical facilities, entities and
organizations relating to the implementation of this Circular;
d) The Ministry Inspectorate shall preside over and
cooperate with relevant units in conducting inspection or instructing the
Health Department and medical management authorities affiliated to ministries
to patrol medical facilities, entities and organization relating to the
implementation of this Circular.
2. Responsibilities of Vietnam Social Security:
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
b) Submit reports to the Ministry of Health every
month, 3 months, 6 months and 12 months and instruct social insurance agencies
of all levels to notify People's Committee of provinces and cities, Health
Department and medical management authorities affiliated to relevant ministries
of overuse of services, medicines or supplies and improper direction for
inpatient treatment given to patients.
3. Responsibilities of the Department of Health:
a) Preside over and cooperate with relevant
entities in inspecting, supervising, preliminarily and extensively reviewing
the implementation of this Circular in the localities under management;
b) Instruct medical facilities under local
management to continue to strictly comply with professional regulations and
ensure the consistency in adopting methods for improving the service quality;
c) Notify competent authorities for assigning
patient beds and deciding the number of staff in medical facilities under local
management so as for them to have enough beds and personnel to satisfy civil
medical requirements as well as improving medical service quality.
4. Responsibilities of medical facilities:
a) Use the funding in consistent with expenses
incurred on maintenance and purchase of instruments for replacement that are
included in the prices for medical services and prices for a hospital stay (for
specially-classed hospitals, class I and II hospitals, the expenses shall be
equal to 5% of the service price; as for class III and IV hospitals and
unclassed hospitals, the expenses shall be equal to 3% of the service price) to
repair, reform and expand the medical examination areas and treatment
departments; purchase the following tools for replacement: tables, chairs,
cabinets, beds, stroller, air conditioners, fans, light heaters, fan heaters,
computers, sets of instruments for general examination and specialist examination;
blankets, bedspreads, pillows, mattresses, mat, and other goods or supplies in
pursuit of ensuring professional, hygiene and safety conditions for patients
and improving the service quality;
b) Strictly comply with regulations on medical
expertise, especially instructions on inpatient treatment given to patients;
referral and direction for using services, medicines and supplies as regulated;
c) Develop economic-technical norms, price plans,
price proposals and report them to the supervisory agency to send them to the
Ministry of Health for consideration and regulation of prices for the following
cases:
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
- Medical procedures whose prices have not been
regulated by the Ministry of Health (including services that have been
permitted by the Ministry of Health but have not been classified as technically
and financially equivalent).
Article 10. Terms of reference
In case any of the documents cited in this Circular
is superseded or amended, the newest document shall apply.
Article 11. Implementation
provisions
1. This Circular comes into force from the day on
which it is signed.
2. The following documents cease to be effective
from the effective date of this Circular:
a) Circular No. 39/2018/TT-BYT dated November 30,
2018 of the Minister of Health;
b) Circular No. 13/2019/TT-BYT dated July 05, 2019
of the Minister of Health;
Article 12. Transitional
provisions
...
...
...
Please sign up or sign in to your
TVPL Pro Membership to see English documents.
2. The Vietnam Social Security and medical
facilities do not make retroactive payments for cases where the two parties
have reviewed and agreed on payment data for services in the Appendix V issued
together with this Circular before this Circular takes effect.
Difficulties that arise during the implementation
of this Circular should be reported in writing to the Ministry of Health for
consideration and settlement./.
PP. MINISTER
DEPUTY MINISTER
Le Duc Luan