Circular No. 02/2017/TT-BYT stipulates the maximum ceiling price range for certain medical examination and treatment services not covered by the Health Insurance Fund in state-run medical facilities and provides guidance on applying prices and settling costs for medical examinations and treatments in some specific cases.

CIRCULAR

REGULATIONS ON THE MAXIMUM FRAMEWORK PRICES FOR HEALTH SERVICES EXCLUDED FROM THE HEALTH INSURANCE FUND REIMBURSEMENT SCOPE IN STATE HEALTH CARE FACILITIES AND GUIDELINES FOR APPLYING PRICES AND PAYING COSTS FOR HEALTH SERVICES IN CERTAIN CASES

Pursuant to the Law on Medical Examination and Treatment No. 40/2009/QH12 dated November 23, 2009;

WHEREAS, Law on Prices No. 12/2012/QH13 dated June 20, 2012;

WHEREAS, Law on Local Administration Organization No. 77/2015/QH13 dated June 19, 2015;

WHEREAS, Government Decree No. 85/2012/NĐ-CP dated October 15, 2012 on the operational mechanism and financial mechanism for public health service units and prices for health services provided by state-owned healthcare facilities;

Pursuant to Decree No. 16/2015/NĐ-CP dated February 14, 2015 of the Government stipulating the self-management mechanism of public service units;

This Circular prescribes procedures for receiving, providing health care for domestic violence victims and statistical reports on domestic violence victims at medical facilities.

BASED ON THE OPINION OF THE MINISTRY OF FINANCE IN Circular No. 15692/BTC-QLG dated November 3, 2016;

THE MINISTER OF HEALTH ISSUES THIS CIRCULAR TO REGULATE THE MAXIMUM FRAMEWORK PRICES FOR HEALTH SERVICES EXCLUDED FROM THE HEALTH INSURANCE FUND REIMBURSEMENT SCOPE IN STATE HEALTH CARE FACILITIES AND TO PROVIDE GUIDELINES FOR APPLYING PRICES AND PAYING COSTS FOR HEALTH SERVICES IN CERTAIN CASES.

Article 1. Scope of Regulation and Applicability

2. Applicability:

THIS CIRCULAR REGULATES THE MAXIMUM FRAMEWORK PRICES FOR HEALTH SERVICES EXCLUDED FROM THE HEALTH INSURANCE FUND REIMBURSEMENT SCOPE IN STATE HEALTH CARE FACILITIES AND PROVIDES GUIDELINES FOR APPLYING PRICES AND PAYING COSTS FOR HEALTH SERVICES IN CERTAIN CASES.

第二条 组织和实施奖励工作的支出水平，如政府第152/2025/NĐ-CP号决定关于分级授权和奖励领域的分权规定

STATE HEALTH CARE FACILITIES; PATIENTS WHO HAVE NOT JOINED THE HEALTH INSURANCE PROGRAM; PATIENTS WITH HEALTH INSURANCE CARDS BUT SEEKING HEALTH SERVICES OR USING HEALTH SERVICES OUTSIDE THE HEALTH INSURANCE FUND REIMBURSEMENT SCOPE; OTHER RELATED AUTHORITIES, ORGANIZATIONS, AND INDIVIDUALS.

3. PATIENTS WITH HEALTH INSURANCE CARDS SEEKING HEALTH SERVICES IN ACCORDANCE WITH LAWS ON HEALTH INSURANCE SHALL FOLLOW THE PRICES OF HEALTH SERVICES UNDER THE HEALTH INSURANCE PROGRAM AS STATED IN Joint Circular No. 37/2015/TTLT-BYT-BTC dated October 29, 2015 OF THE MINISTRY OF HEALTH AND THE MINISTRY OF FINANCE ON UNIFIED PRICES FOR HEALTH SERVICES UNDER THE HEALTH INSURANCE PROGRAM ACROSS NATIONAL PUBLIC HOSPITALS OF THE SAME RANK.

4. This Circular does not apply to health services in the following cases:

a) UNITS CONTRIBUTING CAPITAL, RAISING FUNDS, JOINT VENTURING, OR COLLABORATING IN ACCORDANCE WITH Article 6 OF Government Decree No. 85/2012/NĐ-CP dated October 12, 2012 ON THE OPERATIONAL MECHANISM AND FINANCIAL MECHANISM FOR PUBLIC HEALTH SERVICE UNITS AND PRICES FOR HEALTH SERVICES PROVIDED BY PUBLIC HEALTH CARE FACILITIES AND IMPLEMENTING PRICES BASED ON THE PRINCIPLE OF COVERING COSTS AND GENERATING SAVINGS.

b) HEALTH CARE FACILITIES OPERATING UNDER A BUSINESS MODEL WITH CAPITAL LOANED BY PUBLIC SERVICE UNITS FOR INVESTMENT AND JOINT INVESTMENT ACCORDING TO Resolution No. 93/NQ-CP dated December 15, 2014 OF THE GOVERNMENT ON SOME MECHANISMS AND POLICIES FOR DEVELOPING HEALTHCARE.

c) HEALTH CARE FACILITIES INVESTED IN ACCORDANCE WITH THE PUBLIC-PRIVATE PARTNERSHIP MODEL AS PER Government Decree No. 15/2015/NĐ-CP dated February 14, 2015 ON INVESTMENT UNDER THE PUBLIC-PRIVATE PARTNERSHIP MODEL.

Article 2. Maximum price range for medical examination and treatment services

1. THE MAXIMUM FRAMEWORK PRICES FOR HEALTH SERVICES INCLUDE:

a) The maximum framework price for medical examination and health check-up services specified in Annex I issued together with this Circular;

b) The maximum framework price for daily bed charges for treatment specified in Annex II issued together with this Circular;

c) THE MAXIMUM FRAMEWORK PRICES FOR TECHNICAL AND LABORATORY SERVICES AS SET OUT IN ANNEX III ATTACHED TO THIS CIRCULAR.

2. THE MAXIMUM FRAMEWORK PRICES REGULATED IN THIS CIRCULAR INCLUDE THE FOLLOWING COSTS:

a) DIRECT COSTS:

- COSTS FOR: MEDICATIONS, INFUSIONS, CHEMICALS, CONSUMABLES, REPLACEMENT ITEMS USED TO PROVIDE HEALTH SERVICES. SPECIFICALLY, FOR CERTAIN TYPES OF MEDICATIONS, INFUSIONS, CHEMICALS, CONSUMABLES, REPLACEMENT ITEMS NOT INCLUDED IN THE PRICES OF HEALTH SERVICES AS STATED IN ANNEX II AND ANNEX III ATTACHED TO THIS CIRCULAR AND BLOOD, BLOOD PRODUCTS: REIMBURSED BASED ON THE ACTUAL AMOUNT USED FOR PATIENTS AND PURCHASE PRICE AS REGULATED BY LAW;

- COSTS FOR ELECTRICITY, WATER, FUEL, WASTE MANAGEMENT, ENVIRONMENTAL SANITATION;

- MAINTENANCE AND REPAIR COSTS FOR EQUIPMENT, PURCHASE OF REPLACEMENT TOOLS AND UTENSILS.

b) SALARY COSTS, INCLUDING:

- SALARY GRADUATION, POSITION, SUBSIDIES, CONTRIBUTIONS ACCORDING TO THE REGIME ESTABLISHED BY THE STATE FOR PUBLIC SERVICE UNITS; EXCEPT FOR EXPENSES AS REGULATED IN Clause 3 of this Article;

- ONGOING SUBSIDIES, SURGERY SUBSIDIES, PROCEDURE SUBSIDIES (HEREINAFTER REFERRED TO AS SPECIAL SUBSIDIES) AS REGULATED IN Decision No. 73/2011/QĐ-TTg dated December 28, 2011 OF THE PRIME MINISTER ON SPECIAL SUBSIDIES FOR PUBLIC HEALTHCARE STAFF AND PERSONNEL AND DISEASE CONTROL SUBSIDIES.

3. SALARY COSTS IN THE MAXIMUM FRAMEWORK PRICES FOR HEALTH SERVICES REGULATED IN Clause 1 of this Article DO NOT INCLUDE EXPENSES AS REGULATED BY THE STATE BUDGET AS STATED IN THE FOLLOWING DOCUMENTS:

a) Decree No. 64/2009/ND-CP dated July 30, 2009 of the Government on policies for medical staff working in areas with extremely difficult economic and social conditions;

b) Government Decree No. 116/2010/NĐ-CP dated December 24, 2010 ON POLICIES FOR OFFICIALS, CIVIL SERVANTS, AND PERSONNEL WORKING IN AREAS WITH DIFFICULT ECONOMIC AND SOCIAL CONDITIONS;

c) Decision No. 46/2009/QĐ-TTg dated March 31, 2009 OF THE PRIME MINISTER ON SPECIAL SUBSIDIES FOR STAFF AND PERSONNEL WORKING AT Hanoi Friendship Hospital, Ho Chi Minh City General Hospital, Da Nang Central Hospital, and Central Units 1, 2, 2B, 3, and 5, Department A11 at Military 108 Central Hospital, and Department A11 at Military Traditional Medicine Institute (HEREINAFTER REFERRED TO AS Decision No. 46/2009/QĐ-TTg) AND Decision No. 20/2015/QĐ-TTg dated June 18, 2015 OF THE PRIME MINISTER ON AMENDMENTS AND SUPPLEMENTS TO CERTAIN PROVISIONS OF Decision No. 46/2009/QĐ-TTg;

d) Point a Clause 8 Article 6 OF Government Decree No. 204/2004/NĐ-CP dated December 14, 2004 ON SALARY REGIMES FOR OFFICIALS, CIVIL SERVANTS, PERSONNEL, AND MILITARY FORCES AND Government Decree No. 76/2009/NĐ-CP dated September 15, 2009 ON AMENDMENTS AND SUPPLEMENTS TO CERTAIN PROVISIONS OF Government Decree No. 204/2004/NĐ-CP dated December 14, 2004 ON SALARY REGIMES FOR OFFICIALS, CIVIL SERVANTS, PERSONNEL, AND MILITARY FORCES.

Article 3. Principles and Authority to Determine Service Fees for Medical Examination and Treatment

Clause 1. The authority specified in Clauses 2 and 3 of this Article shall decide specific service fees for medical examination and treatment at medical facilities under its management, which shall not exceed the maximum ceiling prices set forth in this Circular for such services.

Clause 2. The People's Councils of provinces shall decide specific service fees for medical examination and treatment performed at medical facilities under their local management and shall decide specific service fees or apply service fees for certain cases according to the following principles:

Point a. Hospitals with beds, provincial health centers with functions of medical examination and treatment; district health centers performing both preventive and curative functions that have been ranked: apply the service fee level of equivalent-grade hospitals.

Point b. Medical facilities that have not yet been classified: apply the service fee level of Grade IV hospitals.

Point c. Family doctor clinics, health care units, organizations, schools: apply the service fee level of commune, ward, town health stations.

Clause 3. The Minister of Health shall decide specific service fees for medical examination and treatment performed at medical facilities directly under the Ministry of Health and special-grade and Grade I hospitals under other Ministries, agencies at ministerial level, and government agencies. For healthcare facilities under other Ministries, agencies at ministerial level, and government agencies, the application of service fees for medical examination and treatment shall be as follows:

Point a. Health stations of units, organizations, military-civilian health stations, military-civilian outpatient clinics: Apply the service fee level for medical examination and treatment prescribed for commune, ward, town health stations in the locality.

Point b. Military-civilian health stations: Apply the service fee level for medical examination and treatment prescribed for regional multi-disciplinary outpatient clinics in the locality.

Point c. Hospitals of Grades II, III, IV (including military-civilian hospitals): Apply the service fee level for medical examination and treatment at local medical facilities of the same grade.

Point d. Other medical facilities: Apply the service fee level for medical examination and treatment at Grade IV medical facilities in the locality.

Clause 4. In cases where medical facilities under Ministries, agencies at ministerial level, and government agencies provide technical services not included in the local pricing regulations for medical examination and treatment, such medical facilities must develop a pricing plan and report it to the Ministry of Health for review and decision.

Clause 5. For new technical services as stipulated in Clauses 1 and 2 of Article 69 of the Law on Medical Examination and Treatment and other remaining technical services (excluding those already classified by the Ministry of Health as equivalent in terms of technology and cost) without a maximum ceiling price:

Point a. Medical facilities shall develop and propose service fees to the authority specified in Article 3 of this Circular to temporarily decide on the service fees.

Point b. Every six months (on June 30 and December 31 each year), units and localities shall compile reports to the Ministry of Health for review and supplementary regulation of maximum ceiling prices after reaching consensus with the Ministry of Finance.

c) Procedures and documentation for pricing plans shall comply with laws on pricing.

Article 4. Guidelines for Implementing Examination Fees

1. The necessary direct costs for determining examination fees as stipulated in Point a Clause 2 Article 2 of this Circular include:

a) Costs for gloves, hats, masks, uniforms, sheets, pillows, mattresses, mats, cloth items used by healthcare staff and patients; office supplies such as paper, pens, notebooks, ink, stamps, clips, professional seals, and other office supplies; common consumables like cotton, bandages, alcohol, gauze, syringes, saline solution for washing, and other consumables serving the examination process;

b) Costs for electricity; water; waste disposal; laundry, ironing, sterilization, drying, washing, and disinfection of cloth items and examination tools; sanitation costs, environmental hygiene assurance, sterilization, and infection control in the examination area;

c) Maintenance and repair costs, replacement purchase costs for assets, tools, and equipment such as air conditioners, computers, printers, dehumidifiers, fans, automatic registration systems, tables, chairs, beds, cabinets, lighting fixtures, and sets of tools and equipment serving the examination process.

2. Determination of the number of times and examination fees in certain specific cases:

a) In the case where a patient comes to an outpatient facility for examination and is then transferred for inpatient treatment according to professional requirements, it shall be counted as one examination;

b) In the case where a patient visits an outpatient facility within the same healthcare institution (possibly on the same day or due to objective conditions or professional requirements, unable to complete the examination process on the first day and must continue on subsequent days), if after consulting with one specialty, the patient needs to consult additional specialties, from the second consultation onwards, only 30% of the fee for one examination will be charged, and the maximum payment for examination costs shall not exceed twice the fee for one examination;

c) In the case where a patient comes to an outpatient facility for examination, receives medication for treatment, but later exhibits unusual symptoms and returns to the outpatient facility on the same day for another examination and continues to receive medical attention, this visit shall be considered as the second or subsequent examination in one day. Payment shall be made according to the guidelines set out in Point b of this Clause;

d) In the case where an outpatient facility has specialized clinics within clinical departments, if a patient registers for an examination at the outpatient department and then consults at specialized clinics within the clinical department, it shall be counted as an examination at the outpatient department. The calculation of costs and the number of examinations in this case shall follow the guidelines set out in Point b of this Clause;

e) In the case where a patient enters a clinical treatment ward without registering for an examination at the outpatient department, examination fees shall not be charged;

f) In the case where a patient enters the emergency department without going through the outpatient department, if the treatment time is less than four hours (including discharge, transfer, or death), the patient only needs to pay for examination fees, medication, and technical services, and does not need to pay for inpatient bed fees;

g) For the Outpatient Clinic of the Provincial Health Care Protection Office that is not directly under the Provincial General Hospital: apply the examination fee level of a Class II hospital in the province.

Article 5. Guidelines for Implementing the Service Fee for Daily Bed Treatment

1. The direct costs necessary for determining the maximum daily bed fee as stipulated in point a, Clause 2, Article 2 of this Circular include:

a) Costs related to examination gloves, injection and infusion gloves, patient care gloves, hats, masks, uniforms, blankets, sheets, pillows, mattresses, mosquito nets, quilts, fabric items used by healthcare staff and patients; office supplies such as paper, pens, notebooks, ink, stamps, clips, professional seals, and other office supplies; consumable materials such as cotton balls, bandages, alcohol, gauze, single-use syringes with a capacity of up to 10 ml, medicine extraction needles, saline solution, and other consumables used for daily care and treatment activities;

b) Costs related to electricity; water; waste management; laundry, ironing, sterilization, drying, washing of fabric items and examination tools; cleaning and environmental hygiene maintenance costs; disinfectant and anti-infection materials for ward areas;

c) Maintenance and repair costs, as well as replacement costs for assets, tools, and equipment such as air conditioners, computers, printers, dehumidifiers, fans, tables, chairs, beds, cabinets, lighting fixtures, and other tools and equipment used for patient care and treatment activities.

2. The number of days for inpatient treatment shall be calculated according to the guidelines set forth in Circular No. 28/2014/TT-BYT dated August 14, 2014, issued by the Ministry of Health, detailing the content of the statistical index system for the health sector, specifically:

a) Number of inpatient treatment days = (discharge date - admission date) + 1;

b) In cases where a patient is admitted on one day and discharged on the next day (from 4 hours to less than 24 hours), only one day is counted;

c) In cases where a patient transfers between two departments on the same day, each department counts only half a day. If a patient transfers among three or more departments on the same day, the daily bed treatment fee for that day is calculated based on the average of the highest and lowest bed fees at departments where the patient stayed for over four hours.

3. The postoperative bed fee for surgical and burn patients shall be applied for a maximum of ten days following surgery. From the eleventh day onwards, the daily bed fee for internal medicine patients as specified in Section 3 of Appendix II attached to this Circular, decided upon by the competent authority, shall apply.

4. The daily bed treatment fee is calculated for one person per bed. In cases where two people share one bed, the maximum charge is fifty percent, and if three or more people share one bed, the maximum charge is thirty percent of the daily bed treatment fee determined by the competent authority.

5. The daily bed rate for Intensive Care Unit (ICU) treatment can only be applied in the following cases:

a) For special-class, Class I, or Class II hospitals that have established Intensive Care Units (ICUs), Poison Control Departments, ICU-Poison Control Departments, and these departments meet all conditions for operation as per Decision No. 01/2008/QĐ-BYT dated January 21, 2008, issued by the Ministry of Health regarding emergency care, intensive care, and poison control regulations;

b) In cases where a hospital has not established an ICU but uses some beds in the Emergency Department for intensive care, postoperative beds for special category surgeries, Class I surgeries, and these beds meet the requirements for ICU beds as per Decision No. 01/2008/QĐ-BYT of the Ministry of Health mentioned above;

c) When patients are placed in these beds due to conditions requiring emergency care, intensive care, and poison control, the remaining cases shall be charged the daily bed fee for emergency ICU services as specified in service number 2 of Appendix II of this Circular, decided upon by the competent authority.

6. Apply the daily bed fee for emergency care:

a) For clinical departments with emergency ICU beds within the department (for example, pediatric ICU beds in the Pediatrics Department, neonatal/special care beds for premature infants), the daily bed fee for emergency ICU services as specified in service number 2 of Appendix II of this Circular, decided upon by the competent authority, shall apply;

b) In cases where a patient enters the Emergency Department without registering at the outpatient department: If the treatment time exceeds four hours, the patient only needs to pay for the daily bed fee for inpatient treatment, medication, and technical services as prescribed, without paying for the outpatient consultation fee.

7. In cases where a medical facility adds extra beds beyond the planned number: the corresponding daily bed fee, decided upon by the competent authority, shall apply.

8. In cases where a patient lies on stretchers or foldable beds: temporarily apply the daily bed fee for two-person shared beds, as decided upon by the competent authority, based on the specialty type.

9. In cases where a Class III, IV hospital, or an unranked hospital approved by the competent authority to perform special category surgeries: apply the highest daily bed fee for surgical patients of the medical facility performing the service.

Example: At Hospital A, which is approved to perform special category surgeries: If the hospital is ranked Class III, it applies the daily bed fee for surgical patients after Class I surgery at a Class III hospital; if the hospital is ranked Class IV or unranked, it applies the daily bed fee for surgical patients after Class I surgery at a Class IV hospital.

10. In cases where a surgery is classified differently (excluding pediatrics) in Circular No. 50/2014/TT-BYT dated December 26, 2014, issued by the Ministry of Health, concerning the classification of surgeries, procedures, and staffing levels for each surgery and procedure (hereinafter referred to as Circular No. 50/2014/TT-BYT): apply the daily bed fee for surgical and burn patients based on the lowest surgery classification.

11. In cases where surgeries are equivalent to those specified in this Circular but have different classifications according to specialties in Circular No. 50/2014/TT-BYT: apply the daily bed fee for surgical and burn patients based on the surgery's classification.

12. In cases where surgeries have not been classified according to the provisions of Circular No. 50/2014/TT-BYT, the payment price for a day in an outpatient ward of category 4 shall be applied corresponding to the hospital level.

13. Apply the bed day treatment price for departments under traditional medicine hospitals, rehabilitation hospitals:

a) Intensive Care Unit (ICU) beds: implement according to the guidance provided in Clause 5 of this Article;

b) Emergency beds: implement according to the guidance provided in Clause 6 of this Article;

c) Beds in oncology and pediatric departments: apply the price of a day in an internal medicine ward of category 1 (as stipulated in Point 3.1 of Appendix II) corresponding to the hospital level;

d) Internal medicine beds in other departments: apply the price of an internal medicine ward of category 2 (as stipulated in Point 3.2 of Appendix II) for patients with spinal cord injuries, cerebrovascular accidents, brain trauma, and apply the price of an internal medicine ward of category 3 (as stipulated in Point 3.3 of Appendix II) corresponding to the hospital level for other diseases.

14. For interdisciplinary cases: apply the lowest specialty price among the corresponding hospital levels.

Article 6. Guidance on Implementing Technical Service Prices and Laboratory Tests

1. The prices of technical services already include the cost of drugs, chemicals, consumable materials, and replacement materials required to perform the service, except for some specific cases noted in detail. Hospitals are not allowed to charge patients additional costs that are included in the service prices.

2. The prices of surgeries and procedures do not include blood and blood product costs if they are used. If used, they will be reimbursed according to the provisions of Circular No. 33/TT-BYT dated October 27, 2014, issued by the Ministry of Health, which sets the maximum price and service costs for determining the price of a full unit of blood and blood products meeting standards.

3. The principle of applying service prices follows the order below:

a) For specific services whose maximum prices are specified in the appendices attached to this Circular: apply the price determined by the competent authority for each service.

b) For technical services not specified with maximum prices in the appendices attached to this Circular and also not classified equivalently in terms of technology and implementation costs: apply the price of services classified equivalently in terms of technology and implementation costs by the Ministry of Health.

c) For surgeries and procedures not specified with maximum prices in Appendix III attached to this Circular and also not classified equivalently in terms of technology and implementation costs: apply the price determined by the competent authority for each type of surgery or procedure at the "other surgeries and procedures" section of each specialty as specified in Appendix III attached to this Circular.

4. Anesthesia costs: since some services may require anesthesia or not when implemented, the anesthesia costs for services issued along with this Circular are defined as follows:

a) The maximum price of surgeries specified in each specialty includes anesthesia costs, except for eye surgeries which do not include anesthesia costs;

b) The maximum price of procedures includes the cost of pre-anesthesia sedative and analgesic drugs but does not include anesthesia costs (except for some specific cases noted in detail);

c) When performing eye surgeries or other procedures requiring anesthesia (performed by an anesthesiologist), the anesthesia service fee (service number 1250 in Appendix III) will be additionally charged when implementing the service.

5. In cases where multiple interventions are performed during the same surgery, reimbursement shall be made based on the most complex and highest-priced technical service, and other technical services arising during the same surgery shall be reimbursed as follows:

a) At 50% of the price of the arising technical services if the same surgical team performs them;

b) At 80% of the price of the arising technical services if another surgical team must perform them;

c) For arising procedures, reimburse 100% of the price of the arising service.

6. Regarding bandage change services:

a) The service "Change bandage for wounds or incisions ≤15 cm long": only reimbursable for inpatients in the following cases: infected wounds/incisions; wounds with fluid or blood leakage in skin avulsion or open skin areas larger than 6 cm; wounds with gauze packing; leg wounds with drainage tube leakage; multiple wounds/incisions; or after one surgery but with two or more incisions; not applicable for bandage changes in endoscopic surgeries, routine wound/incision bandages, newborn umbilical cord bandages;²; the wound has been packed with gauze; the drainage from the wound on the limb is profuse; multiple wounds/surgeries; or after one surgery but requires two incisions or more; this does not apply to changing dressings for the following cases: laparoscopic surgery, changing dressing for surgical wounds, routine wounds, changing umbilical cord dressings for newborns;

b) The service "Change bandage for incisions longer than 15 cm to 30 cm" for inpatients applies in the following cases:

- Infected incisions, gastrointestinal fistulas, bile duct fistulas, urinary fistulas;

- Incisions after infectious surgeries (peritonitis or osteomyelitis or abscesses), incisions after surgeries on digestive tract, urinary system, bile ducts, or abdominal ascites;

- Incisions after one surgery but with two or more incisions;

- In cesarean section surgeries: this price can be applied but not more than three times.

c) For "change bandage for wounds longer than 15 cm to 30 cm": implement according to the price specified in this Circular.

7. Blood group determination service (ABO system) in blood transfusions for tests numbered 1300, 1301, 1302 as specified in Appendix III of this Circular:

a) Blood group typing in the laboratory when issuing whole blood and blood components:

- Blood group determination for patients: reimbursed once according to the price of service number 1302 specified in Appendix III of this Circular (since the maximum price of service 1302 already includes the cost of two ABO blood group determinations on the same blood sample or two samples from the same patient using serum and red blood cell methods);

- ABO blood group determination for blood units or blood product units: reimbursed once according to the price of service number 1300 specified in Appendix III of this Circular;

- In case a patient receives multiple units of blood or blood products at the same time, starting from the second unit of blood or blood product, for each additional unit issued, an additional payment will be made once for the ABO blood group typing service of a unit of blood bag according to the price of service number 1300 specified in Appendix III of this Circular. In this case, it is not necessary to determine the ABO blood group of the patient since the patient has already been determined the ABO blood group when receiving the first unit of blood or blood product.

b) Blood group typing at the bedside:

- For ABO blood group typing at the bedside when the patient receives whole blood transfusion or red cell mass or white cell mass: payment will be made once according to the price of service number 1300 specified in Appendix III of this Circular;

- For ABO blood group typing at the bedside when the patient receives plasma product or platelet mass: payment will be made once according to the price of service number 1301 specified in Appendix III of this Circular;

- In case a patient receives multiple units of blood or blood products at the same time, starting from the second unit of blood or blood product, for each additional whole blood unit or red cell mass or white cell mass issued, an additional payment will be made once for the bedside blood group typing service according to the price of service number 1302 specified in Appendix III of this Circular. In this case, it is not necessary to determine the ABO blood group of the patient since the patient has already been determined the ABO blood group when receiving the first unit of blood or blood product;

- The prices of ABO blood group typing services from numbers 1300, 1301, 1302 specified in Appendix III of this Circular are uniformly applied to all methods such as test tube, slide, or paper-based methods.

8. For immunological compatibility testing at 37°C using anti-human globulin serum (indirect Coombs test) in blood transfusion: payment will be made according to the price of the "Compatibility reaction with human anti-globulin" service with number 1358 or 1359 specified in this Circular.

Article 7. Implementation Organization

1. The budget shall ensure funding according to the current budget allocation level for:

a) Expenditures according to the regulations stipulated in the documents mentioned in Clause 3, Article 2 of this Circular;

b) In cases where the financial resources of the unit cannot ensure regular operations, the unit may be classified by the competent authority as a public service unit that self-finances part of its regular expenses or a public service unit whose regular expenses are fully financed by the state budget.

2. Responsibilities of the Ministry of Health:

a) Assign the Planning and Finance Department to take the lead, coordinate with relevant units to organize the implementation, inspection, interim review, and final assessment of this Circular nationwide;

b) Coordinate with the Ministry of Finance to review and adjust the maximum price range of medical examination and treatment services specified in the appendices attached to this Circular when supplementing factors forming the price according to the schedule, adjusting economic and technical norms, or changes in costs of factors forming the price.

3. Responsibilities of the Health Departments:

a) Take the lead and coordinate with relevant units to organize the implementation, inspection, interim summary, and final conclusion of the execution of this Circular within their jurisdiction;

b) Take the lead and coordinate with the Provincial Department of Finance to report to the People's Committee of the province to submit to the People's Council of the province for consideration and decision on the service fee and the implementation date according to Clause 2, Article 9 of this Circular for medical examination and treatment facilities under local management authority.

Article 8. Reference Provisions

In case the referenced documents in this Circular are replaced or amended, they shall be implemented according to the replacement document or the amended document.

Article 9. Implementation Provisions

1. This Circular takes effect from June 1, 2017.

2. The competent authority deciding the price level stipulated in Clause 2, Article 3 of this Circular shall decide the price level and implementation date for medical examination and treatment facilities as follows:

a) Medical examination and treatment facilities classified by the competent authority as self-financing units for regular expenses or self-financing units for regular expenses and investment: the implementation date starts from June 1, 2017;

b) Medical examination and treatment facilities classified by the competent authority as self-financing units for part of regular expenses or units whose regular expenses are fully financed by the state budget: the implementation date is in August, October, or December 2017 and must be implemented in 2017.

3. The following documents cease to be effective from January 1, 2018:

a) Joint Circular No. 14/TTLB dated September 30, 1995, of the Ministry of Health, Ministry of Finance, Ministry of Labor, Invalids and Social Affairs, and the Government Price Control Board guiding the implementation of partial hospital fees;

b) Joint Circular No. 03/2006/TTLT-BYT-BTC-BLDTBXH dated January 26, 2006, of the Ministry of Health, Ministry of Finance, and the Ministry of Labor, Invalids and Social Affairs supplementing Joint Circular No. 14/TTLB dated September 30, 1995, of the Ministry of Health, Ministry of Finance, Ministry of Labor, Invalids and Social Affairs, and the Government Price Control Board guiding the implementation of partial hospital fees;

c) Joint Circular No. 04/2012/TTLT-BYT-BTC dated February 29, 2012, of the Ministry of Health and the Ministry of Finance promulgating the maximum price range for some medical examination and treatment services in state-owned healthcare facilities;

d) Circular No. 04/2013/TT-BYT dated January 21, 2013, of the Minister of Health guiding the approval and application of medical examination and treatment service prices for state-owned medical examination and treatment facilities under the management of other ministries and sectors.

Article 10. Transitional Provisions

For patients undergoing treatment at medical examination and treatment facilities before the implementation date of the prices prescribed in this Circular and discharged or completed outpatient treatment after the implementation date of the prices prescribed in this Circular: they will continue to apply the prices prescribed by the competent authority before the implementation date of the prices prescribed in this Circular until discharge or completion of outpatient treatment.

In the course of implementation, if there are difficulties or obstacles, units and localities are requested to report in writing to the Ministry of Health for consideration and resolution./.