Circular No. 15/2018/TT-BYT dated May 30, 2018 of the Ministry of Health on unifying prices for medical examination and treatment services covered by health insurance among hospitals of the same class across the country and providing guidelines for applying prices and payment for medical services in certain cases

THE MINISTRY OF HEALTH 

Circular No.15/2018/TT-BYT dated May 30, 2018 of the Ministry of Health on unifying prices for medical examination and treatment services covered by health insurance among hospitals of the same class across the country and providing guidelines for applying prices and payment for medical services in certain cases

Pursuant to the Law on Medical Examination and Treatment dated November 23, 2009;

Pursuant to the Law on Prices dated June 29, 2012;

Pursuant to the Law on amendments to the Health Insurance Law dated June 13, 2014;

Pursuant to Decree No.85/2012/ND-CP dated October 15, 2012 of the Government on operation and finance mechanism applied to public medical service providers and prices for medical examination and treatment services of public medical facilities.

Pursuant to Decree No.16/2015/ND-CP dated February 14, 2015 of the Government on autonomy mechanism of public service provide;

Pursuant to Decree No.149/2016/ND-CP dated November 11, 2016 of the Government which amends Decree No.177/2013/ND-CP dated November 14, 2013 of the Government on elaboration and implementation of the Law on Prices;

Pursuant to Decree No.75/2012/ND-CP dated June 20, 2017 of the Government on functions, duties, rights and organizational structure of the Ministry of Health;

Upon the opinions of the Ministry of Finance presented in Official Dispatch N.5834/BTC-QLG dated May 21, 2018;

The Minister of Health promulgates a Circular unifying prices for medical examination and treatment services covered by health insurance among hospitals of the same class across the country and providing guidelines for applying prices and payment for medical services in certain cases.

Article 1. Scope of adjustment and subject of application

1. This Circular unifies prices for medical examination and treatment services (hereinafter referred to as "medical services") covered by health insurance among hospitals of the same class across the country and providing guidelines for applying prices and payment for medical services in certain cases.

2. This Circular applies to medical facilities, entities, organizations and individuals that engage in medical examination and treatment, payment and preparation of final accounts for prices for medical services covered by health insurance.

3. Price frame and the authority to stipulate prices for medical services not covered by health insurance fund shall be instructed in the Law on Prices, 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 issued thereto;

2. Prices for hospital stay are specified in Appendix II issued thereto;

3. Prices for medical procedures are specified in Appendix III issued thereto;

4. Additional notes of some medical procedures presented by the Ministry of Health in its Decisions shall be prescribed in Appendix IV issued thereto.

Article 3. Composition of prices for medical services covered by health insurance

Prices for medical services prescribed herein shall be calculated based upon direct expenses and salaries in order to ensure the medical examination, treatment and care for patients and medical procedures provision, specifically as follows:

1. Direct expenses included in the price 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 equipments, 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, mattress, mat; stationery; medical gloves used in examination 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 cases in which such expense is covered in addition to the price for hospital stay as prescribed in clause 5 and 6 herein); electrodes, electrocardiogram, blood pressure monitor, SPO2 cables in the course of using patient monitors for emergency beds and intensive care beds.

However, expenses incurred on medicines, blood, intravenous fluids, supplies not mentioned above; types of syringe used in infusion; inserted tubes, tubes connecting to syringe pumps or infusion pumps; oxygen, nasal cannula, oxygen mask (except cases in which the patient is required to use medical ventilator) shall not be included in the price for hospital stay and will be paid if above-mentioned tools are used during medical examination and treatment.

b) Expenses prescribed in point b and c in clause 1 in this Article shall arise out of care and treatment services provided to patients as professionally required.

3. Expenses directly included in the price 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 point b and c in clause 1 in this Article shall arise out of medical procedures as professionally required.

4. Salaries included in prices for medical examination service, hospital stay and medical procedures

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.66/2013/ND-CP dated June 27, 2013 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 procedure 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 count towards the medical service price prescribed in clause 4 in this Article shall not include expenditures covered by state budget which are specified in the following documents:

a) Decree No.64/2009/ND-CP dated July 30, 2009 of the Government on policies intended for public officials, public employees, working in medical facilities located in areas with seriously poor conditions for socio-economic development;

b) Decree No.116/2010/ND-CP dated December 24, 2010 of the Government on policies intended for public officials, public employees and people in armed force working in areas with seriously poor conditions for socio-economic development;

c) Decision No.46/2009/QD-TTg dated March 31, 2009 of the Prime Minister prescribing particular allowances intended for public officials and public employees working in hospitals affiliated to the Ministry of Health such as Huu Nghi Hospital, Thong Nhat Hospital, C Da Nang Hospital, Central Health Protection Department 1, 2, 2b, 3 and 5, Department A11 of 108 Military Central Hospital and Department A11 of Military Traditional Medicines Institute (hereinafter referred to as “Decision No.46/2009/QD-TTg”) and Decision No.20/2015/QD-TTg dated June 18, 2015 of the Prime Minister which amends the former Decision;

d) Point a in clause 8 in Article 6 of Decree No.204/2004/ND-CP dated December 14, 2004 of the Government on salaries of public officials, public employees and armed force and Decree No.76/2009/ND-CP dated September 15, 2009 of the Government which amends the former Decree.

6. Payment for expenses for medical services prescribed herein by the health insurance agency to the medical facility and expenses incurred on medicines, chemicals and medical supplies not included in the medical service price (specified in particular services), blood, and products from blood shall be made as prescribed in clause 3 in Article 11 of Joint Circular No.41/2014/TTLT-BYT-BTC dated November 21, 2014 of the Ministry of Health and Ministry of Finance which provides guidelines for health insurance.

7. Expenses prescribed in clause 1, 2, 3 and 4 in this Article shall be determined based upon economic-technical restrictions and maximum expense issued by a competent authority, prices for medical service and average expenses must be practical and consistent with applicable policies and ensure the average and advance as well as satisfy the service quality requirement. 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 16 in Article 6 and clause 8 in Article 7 hereof). If any inappropriate restriction is found during the implementation, local authorities shall inform the Ministry of Health for consideration and adjustment.

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 cities, apply the prices issued by class II hospitals.

3. For unclassed medical facilities, army medical clinics, civil-military medical clinics, military infirmaries, infirmaries, private polyclinics, apply the prices issued by class IV hospitals.

4. For regional polyclinics affiliated to medical centers or hospital of district level that are arranged under the guidance of the Ministry of Health:

a) if licensed to serve functions of hospitals or permitted to transform into inpatient departments of regional general hospitals in provinces, district hospitals or district medical centers, apply the prices issued by class IV hospitals;

b) if only providing emergency medical response and medical services for outpatients but permitted by the Health Department to have patient beds, apply the prices issued by class IV hospitals. 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 medical service prices issued by the medical aid stations in communes apply the medical procedure price that is equal to 70% of such price issued by class IV hospitals.

b) 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. A patient 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.

Article 5. Determination of number of times, prices and payment for medical services in particular cases.

1. If a patient undergoes medical examination in examination department then is transferred to inpatient department for treatment as required by professionals, such examination can be counted. If a patient is not subject to medical examination in examination department but in clinical department as required by professionals, such examination will not be counted.

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 once 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 66^thexamination. If there is still 65examinations conducted in one medical examination table in a quarter, the insurance agency shall not pay the price for the 66^thexamination 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 is equal to the discharge date minus (-) the hospitalization date: apply to cases in which the patient is permitted to be discharged from the hospital if partially or completely recovering from illness.

b) The number of day for inpatient treatment shall be equal to the discharge date minus (-) the hospitalization date then plus (+) 1: apply to the following cases:

- The seriously-ill patient is undergoing inpatient treatment in a hospital but there is no sign of illness recovery or such illness becomes worse who requires hospital discharge or referral to upper level hospital.

- The patient that undergoes medical emergency treatment in a upper level hospital but still requires inpatient treatment is transferred to a lower level hospital or to another medical facility.

c) For the case in which the patient is admitted to the hospital and is discharged from such hospital in the same day, such day shall be counted as a treatment day if the treatment lasts for more than 4 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 for intensive care.

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 surgeon. Such price from the 11^thday onwards will be equal to the price for hospital stay in equivalent department as prescribed in section 3 in Appendix II issued thereto.

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:

a) specially-classed hospitals, class I and II hospitals that already established the ICU, Department or center of poison management, department of intensive care and poison management and departments or centers eligible for operation according to Decision No.01/2008/QD-BYT dated January 21, 2008 of the Minister of Health on regulations on medical emergency response, intensive care and poison management (hereinafter referred to as “Decision No.01/2008/QD-BYT”).

b) medical facilities without ICU but having beds in Emergency Department and Anaesthesiology Department used for intensive care; beds for postoperative care after special surgery that meets facility requirements for intensive care prescribed in 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 price for hospital stay in intensive care and emergency medicine department and in other departments as instructed in Appendix II issued thereto.

6. For clinical departments having beds for intensive care and emergency medicine, for instance, pediatric departments having beds for pediatric intensive care and emergency medicine, neonatal departments or special care for premise: apply the price for hospital stay for intensive care and emergency medicine prescribed in service no.2 in Appendix II issued thereto.

7. For class III and IV hospitals and un-classed 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 I surgery of issued by class III hospitals if it is classed III and apply the price for hospital stay in surgery department after type I surgery if it is classed IV or un-classed.

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”), apply the price for hospital stay in surgery or burn department according to the lowest graded surgery.

9. For surgeries equivalent 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, apply the price for hospital stay in surgery or burn department according to the classification of such surgery specified in Circular No.50.

10. For unclassified surgeries prescribed in Circular No.50, apply the price for hospital stay of type 4 surgery issued by the hospital of equivalent class.

11. For class I medicine hospitals affiliated to the Ministry of Health, apply the price for hospital stay in equivalent departments issued by class I hospitals, not the price issued by specialist hospitals affiliated to the Ministry of Health in Hanoi and Ho Chi Minh City.

12. For departments of medicine hospitals (except hospitals prescribed in clause 11 in this Article) and rehabilitation hospitals:

a) apply the price for hospital stay in ICU as prescribed in clause 5 in this Article;

b) apply the price for hospital stay in the intensive care and emergency medicine department as prescribed in clause 6 in this Article;

c) apply the price for hospital stay of type 1 inpatient bed with regard to patients undergoing treatment in oncology and pediatrics;

d) apply the price for hospital stay of type 2 inpatient bed with regard to patients receiving treatment for spinal cord injury, stroke and traumatic brain injury;

dd) apply the price for hospital stay of type 3 inpatient bed with regard to patients receiving treatment in other departments;

13. For medical facilities in the form of inter-departmental structure, apply the price for hospital stay in the lowest graded specialist department equivalent to the class of the hospital

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 price for hospital stay according to each specialist department in consistent with regulations in Appendix II issued thereto.

16. Quarterly payment and final accounts for the hospital stay price by the social insurance agency to the medical facility shall be made as follows:

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 days in a quarter (365 days in a year), in which days of inpatient treatment shall be calculated in the following principle: 2 days lying in the stretcher, folding bed or bed shared by two patients shall be counted as one day of inpatient treatment and 3 days lying in the bed shared by 3 or more patients shall be counted as one day of inpatient treatment.

b) In case the beds used in a medical facility in a quarter is less than or equal to 120% of the assigned one, 100% of prices for bed use shall be paid according to the number of day for hospital stay and the prescribed price.

b) In case the beds used in a medical facility in a year is more than 120% of the assigned one, such medical facility and the social insurance agency shall reach an agreement on payment as follows:

- The quarterly bed occupancy rate (hereinafter referred to as bed occupancy rate) shall be equal to (=) the number of bed used in a quarter divided (:) by the number of beds used in 2015 (the year preceding the year in which patients are permitted to use their health insurance in the hospital that is not the one registered in their insurance card) and multiplied by 100%. In case the bed occupancy rate determined according to the above-mentioned method:

+ is less than or equal to 130%, the health insurance agency shall pay the medical facility 100% the price for bed use according to the number of day for hospital stay and the prescribed price.

+ is more than 130% but not exceed 140%, the health insurance agency shall pay the medical facility 97% of the price for bed use according to the number of day for hospital stay and the prescribed price.

+ is more than 140% but not exceed 150%, the health insurance agency shall pay the medical facility 95% of the price for bed use according to the number day for hospital stay and the prescribed price.

+ is more than 150%, the health insurance agency shall pay the medical facility 90% of the price for bed use according to the number of day for hospital stay and the prescribed price.

d) For the case in which the medical facility is always overloaded due to subjective reasons such as extension of administrative boundaries and an increase in number of initial registration of medical services, the Health Department shall take responsibility to send a report to People s Committee of provinces for considering and increasing patient beds as well as job positions for medical service quality assurance.

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.

Article 7. Application of prices, conditions and payment for particular medical procedures

1. Medical procedures

a) For specific procedures with prices prescribed in appendix issued thereto, apply the prices 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 new medical procedures prescribed in clause 1 and 2 in Article 69 of the Law on Medical Examination and Treatment and other procedures (except procedures that are graded according to procedures with equivalent techniques and costs for service provision by the Ministry of Health) that have no price stipulated, the medical facility shall develop a price frame, propose the service price and send a report to the Ministry of Health for consideration and decision on price.

3. For medical procedures having lists of services 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; 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 laws.

4. For multiple interventions in one surgery, payment shall be made according to the price of the most complicated surgery or the surgery with the highest price and prices of other medical procedures required that is not included in the medical formalities for above-mentioned surgery shall be paid:

a) equal to 50% of the price of such surgery if the technique is implemented by the surgeons performing such surgery;

a) equal to 80% of the price of such surgery if the technique is implemented by other surgeons;

c) equal to 80% of the incurred service if such service is the medical procedure.

5. For the service called “changing the dressing of a wound or surgical incision no more than 15cm in length”, 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; 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

6. 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;

d) For caesarean section, the maximum applicable price shall not exceed 3 times the price for above-motioned services

7. 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

8. 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, ultrasound (service numbered 1, 2 in Appendix I), Magnetic Resonance Imaging (MRI) (service numbered 67, 68 in Appendix III) 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

c) 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

- For MRI: pay 97% of the prescribed price

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 has 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).

9. Regulations in clause 8 in Article 7 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.

10. 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 and clause 16 in Article 6 hereof.

Article 8. Expenses not included in medical service prices covered by state budget

1. Ministries, central government authorities shall make a consolidated report to the Ministry of Finance, Health Department of provinces and centrally-affiliated cities which is then submitted to People s Committee of provinces for funding provision in consistent with state budget allocation and regulations on resources for amendments to the salary policy with regard to:

a) expenditures prescribed in documents stated in clause 5 in Article 3 hereof

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. Implementationorganization

1. Responsibilities of the Ministry of Health:

a) The Department of Planning and Finance is required to:

- play the role of an intermediary agency to reach an agreement with relevant departments 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 an intermediary 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 an intermediary agency and cooperate with relevant departments and entities 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 departments, 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 departments and entities 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:

a) Implement this Circular and instruct social insurance agencies of all levels to timely make payment in accordance with regulations in force and regulations herein to medical facilities. If any service price is found improper during the implementation, the Vietnam Social Security shall submit a written request to the Ministry of Health for consideration and adjustment.

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 improve 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 un-classed 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, etc 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.

Article 10. Reference provisions

If documents stated herein are replaced or amended, amended or replaced documents shall prevail.

Article 11. Implementation provisions

1. This Circular takes effect on July 15, 2018.

2. Joint Circular No.37/2015/TTLT-BYT-BTC dated October 29, 2015 of the Ministry of Health – Ministry of Finance which unifies prices for medical examination and treatment services among hospital of the same class across the country and guiding documents prescribed herein will expire from July 15, 2018.

Article 12. Transitional provisions

For patients undergoing treatment in medical facilities before the date of application of service prices prescribed herein and are discharged from hospital or finish the outpatient treatment after the date of application of such price, apply the service price regulated by competent authorities before the date of application of the service price prescribed herein until the date of discharge or the end date of outpatient treatment.

Any question arising in the course of implementation, entities and local authorities shall send a written report to the Ministry of Health for consideration and handling.

For the Minister

The Deputy Minister

Pham Le Tuan

APPENDIX I

PRICE FOR MEDICAL EXAMINATION SERVICE
(Issued together with Circular No.15/2018/TT-BYT dated May 30, 2018 of the Ministry of Health)

Unit: Dong