Directive No. 08/BYT-CT on urgent issues in medical examination and treatment facilities

DIRECTIVE

OF THE MINISTER OF HEALTH

On some urgent issues in medical examination and treatment facilities
Medical examination and treatment

In recent years, medical examination and treatment facilities have made positive contributions to the health care事业继续翻译剩余的段落。但是，请注意，您要求的是直接翻译，不包含任何解释或思考过程。以下是直接翻译：

However, there are still many shortcomings in medical examination and treatment facilities due to subjective and objective reasons as follows:

Slow reform in management and operation of medical examination and treatment according to market mechanisms with state regulation.

Insufficient infrastructure and housing. Diagnostic and treatment equipment is both lacking and outdated.

Insufficient attention has been paid to continuous vocational training to improve professional knowledge and management skills.

Healthcare workers face many difficulties in their lives.

The fundamental reason is the lack of about 50% to 60% of funds needed to ensure and stabilize the quality of medical examination and treatment.

To address these shortcomings, the Ministry requires Departments of Health, hospitals with beds, and other medical examination and treatment facilities (referred to collectively as hospitals) to urgently implement six urgent issues as follows:

1. Rectify the collection of partial hospital fees and properly implement health insurance (HI).

1.1. Collection of partial hospital fees:

1.1.1. Currently, the collection of hospital fees still has the following situations:

Incorrectly collecting from different groups: Collecting hospital fees from officials, employees, those with Health Insurance cards, and social policy beneficiaries.

Improperly assessing the contribution capacity of those exempted or partially exempted from hospital fees, neglecting the poor, leading to overcharging and imposing fees beyond their ability to pay.

Multiple collections at various times and places within a hospital, making it difficult to verify correctness, causing inconvenience to patients and reducing their trust in doctors regarding the quality of medical examination and treatment.

1.1.2. To rectify the collection of partial hospital fees, the hospital director must strictly enforce the following regulations:

a. The hospital director is directly responsible for organizing the collection of partial hospital fees. Each hospital must have a document signed by the director specifying the authority, duties, responsibilities, and list of personnel authorized to collect partial hospital fees. The director must convene monthly meetings to review, learn from experiences, and adjust this work.

b. Those eligible for exemption or reduction of partial hospital fees must be reviewed and decided by the director.

c. Stop individual and improper collections by unauthorized personnel, as well as services that violate state and hospital regulations.

d. Collected funds must be accounted for according to Circular No. 4034/KH-TC dated August 1, 1989, issued by the Department of Finance and Accounting under the Ministry of Health, including funds collected through voluntary bed arrangements or on demand.

1.2. Implement HI for mandatory subjects:

1.2.1. Hospitals must sign contracts with HI agencies to provide medical examination and treatment for mandatory HI subjects according to Decree No. 299/HĐBT dated August 15, 1992, and organize good service for those with HI cards.

Current HI contract prices are provisional and will be adjusted to match actual medical examination and treatment costs at hospitals and balance with the contributions of those with HI cards.

1.2.2. The HI agency issuing the card will reimburse the hospital that provided medical examination and treatment to the cardholder. Hospitals must accept patients with HI cards from provinces, centrally-administered cities, sector HI, and Vietnam HI at the same rates they charge for provincial HI. Vietnam HI guides inter-provincial medical examination and treatment and between provinces and Vietnam HI.

1.2.3. When providing medical examination and treatment to patients with HI cards, hospitals may not collect partial hospital fees or any other service charges.

1.2.4. Hospital officials and staff must set an example by contributing to HI as required for mandatory HI subjects; doctors treating hospital officials and staff with HI cards must treat them like other HI subjects, avoiding favoritism and abuse.

2. Rectify the implementation of professional regulations and systems to minimize possible errors and treatment accidents.

2.1. Based on the specific situation of the unit regarding expertise, technical skills, manpower, practical conditions, the hospital's scientific council recommends to the board of directors the weak points and necessary practical conditions to strictly implement professional regulations and systems.

2.2. The hospital director selects priorities to supplement and perfect working conditions based on the scientific council's recommendations. Initially, sterilization and blood transfusion regulations are considered major projects of the hospital.

2.3. Implementing sterilization and blood transfusion regulations requires special equipment. Funding for these two projects is divided into urgent and long-term phases. Urgent funding is submitted for additional support at the direct management level of the hospital.

2.4. Promote the movement of safe and rational drug use and treatment according to the "Clinical Practice Guidelines" issued by the Ministry of Health. Reorganize the pharmacy department to ensure drug supply for poor patients, HI patients, and social policy beneficiaries, and organize drug sales for patients who pay hospital fees.

3. Improve patient care quality:

3.1. The hospital director, with the cooperation of the head nurse, arranges manpower based on the specific situation of the unit, establishes care procedures, and organizes their implementation so that patients receive care according to their illness type and nursing classification.

3.2. Nursing staff must change and implement comprehensive patient care methods rather than dividing tasks by service such as injections, bandaging...

Each nurse is assigned the responsibility to comprehensively care for a number of patients, and depending on their technical expertise, they may receive additional technical assistance from more skilled nurses.

3.3. The head nurse of the hospital shall regularly review the working conditions of nurses and technicians to continuously propose recommendations to the hospital director for directing relevant departments to provide conditions for nurses to implement professional regulations and systems, particularly sterilization regulations, disinfection regulations, and blood transfusion regulations.

3.4. Operating rooms, delivery rooms, emergency resuscitation rooms, postoperative rooms, and burn treatment rooms shall not allow family members to care for patients. Patients in these rooms and patients requiring level three nursing care must be cared for and fed by nurses.

4. Sanitation and Orderliness:

4.1. The hospital director shall direct the head nurse to coordinate with relevant departments and wards to develop plans to ensure sanitation within the hospital and provide conditions for implementing sanitation plans.

4.2. The head nurse of the hospital and the ward head nurse shall daily allocate time to inspect and remind about deficiencies in maintaining environmental sanitation, room orderliness, kitchen hygiene, and food consumption.

4.3. Nurses and technicians are responsible for the hygiene of patients, patient beds, technical rooms, floor cleaning, corridors, latrines, urinals, and public area hygiene within the hospital.

4.4. Hospital staff must set an example in adhering to and maintaining sanitation and orderliness, while also mobilizing and educating patients to comply with ward rules.

5. Enhancing Service Attitude and Ensuring Patient Rights.

5.1. Paying part of the hospital fee is the responsibility and voluntary contribution of patients who fall under the category of paying part of the hospital fee to ensure the quality of their treatment. Patients pay the amount to the person designated by the hospital to collect fees, with the receipt noting "voluntary payment of hospital fee."

For mandatory health insurance, if patients seek medical examination or treatment without a health insurance card, they must pay the full hospital fee.

5.2. Strictly prohibit doctors, nurses, and hospital staff from selling medicine to patients in outpatient clinics or hospital rooms. Patients purchase medicine according to the instructions of the Department Head and organized by the hospital pharmacy department.

5.3. The hospital organizes a nutrition department based on service mechanisms and provides dietary regimens. Eliminate unhygienic and disorderly snack stalls and services within the hospital and its gates.

5.4. All doctors and hospital staff must elevate kindness in their interactions and service to patients, strictly implementing regulations regarding the responsibilities of doctors and healthcare workers. They should earnestly follow President Ho Chi Minh's teachings: "Doctors are like kind mothers."

6. Improving the Lives of Hospital Employees.

The hospital director must cooperate with the hospital union chairman to strengthen efforts to improve the living standards and enhance the professional skills of hospital employees, ensuring security, order, and hygiene within the hospital.

7. Implementation organization:

7.1. Directors of hospitals, based on the content of this directive, considering the characteristics and situation of their units, draft supplementary actions for the "1993 Action Plan on Urgent Issues of Hospitals," organize learning sessions, discussions, implementation, and achieve effectiveness within the hospital. These are plans that the Ministry of Health will evaluate and assess hospitals at the end of 1993.

7.2. The Health Management Department, the Ministry of Health's Inspectorate, and related departments, provincial and municipal health bureaus are tasked with monitoring, assisting, inspecting, auditing, evaluating, and reporting the results of implementation to the Ministry and competent authorities.

7.3. Provincial People's Committees and municipalities directly under the Central Government shall allocate funds and direct provincial health bureaus and hospitals to implement this directive of the Ministry of Health.

During the implementation process, if there are difficulties, units and localities must report to the Ministry (Health Management Department) for timely supplementation and amendment.