Circular No. 13/2023/TT-BYT stipulates the framework of prices and methods for pricing medical examination and treatment services provided according to demand by state-run medical examination and treatment facilities.

CIRCULAR

REGULATIONS ON THE FRAMEWORK OF PRICES AND METHODS FOR SETTING PRICES OF MEDICAL SERVICES FOR MEDICAL EXAMINATIONS AND TREATMENTS AT THE REQUEST OF PATIENTS PROVIDED BY STATE MEDICAL ESTABLISHMENTS

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

Pursuant to the Law on Prices dated June 20, 2012;

Pursuant to Decree No. 95/2022/NĐ-CP dated November 15, 2022 of the Government stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health;

Pursuant to Decree No. 60/2021/NĐ-CP dated June 21, 2021 of the Government stipulating the financial autonomy mechanism for public service units;

Pursuant to Decree No. 177/2013/ND-CP dated November 14, 2013 of the Government detailing and guiding the implementation of certain provisions of the Law on Prices, which has been amended and supplemented by Decree No. 149/2016/NĐ-CP dated November 11, 2016 of the Government;

Pursuant to Circular No. 25/2014/TT-BTC dated February 17, 2014 of the Minister of Finance stipulating general methods for setting prices of goods and services;

At the proposal of the Director of the Department of Planning and Finance, Ministry of Health;

The Minister of Health issues this Circular to regulate the framework of prices and methods for setting prices of medical services for medical examinations and treatments at the request of patients provided by state medical establishments.

Article 1. Scope of Regulation and Applicability

This Circular stipulates:

Article 1. The framework of prices for medical services for medical examinations and treatments at the request of patients provided by state medical establishments under the Ministry of Health, other ministries, sectors, and localities (hereinafter referred to as medical establishments) is set out in the Appendix attached hereto.

Article 2. Methods for setting prices of medical services for medical examinations and treatments at the request of patients provided by state medical establishments.

Article 2. Types of medical services for medical examinations and treatments at the request of patients

Clause 1. Medical services for medical examinations and treatments at the request of patients provided by state medical establishments include:

Point a) Medical examinations;

Point b) Treatment beds;

Point c) Medical technical services according to the requests of service users.

Clause 2. Medical services for medical examinations and treatments at the request of patients provided by state medical establishments at home shall be implemented in accordance with Circular No. 21/2019/TT-BYT dated August 21, 2019 of the Minister of Health guiding the pilot operation of family medicine activities.

Article 3. Principles for implementing medical services for medical examinations and treatments at the request of patients

Clause 1. These services must comply with the policies of the Party and the laws of the State, meet diverse needs and payment capacities of service users, and be priced based on reasonable costs and accumulation for reinvestment and development, consistent with the socialist-oriented market economy mechanism.

Clause 2. The list of services, their prices, and the capacity to provide such services must be publicly disclosed so that the public and patients can choose to use these services through mutual agreement and voluntary consent between service users and medical establishments, ensuring that patients receive treatment according to officially issued treatment protocols.

Clause 3. Medical establishments providing medical services for medical examinations and treatments at the request of patients must ensure compliance with their functions, tasks, organizational regulations, and operational conditions as prescribed, while also fulfilling assigned functions and tasks.

Clause 4. Medical establishments providing medical services for medical examinations and treatments at the request of patients have the responsibility to manage, utilize, and apply standards and usage norms for state assets in accordance with the laws on management and utilization of state assets.

Clause 5. Medical establishments must separately account for and monitor revenues and expenses, fully reflecting them in accounting books and financial reports; they must allocate and use depreciation of fixed assets in accordance with the laws on management and utilization of state assets; and fulfill all obligations to the State as prescribed by law.

Article 4. Method for Pricing Medical Services on Demand

1. Medical establishments decide to choose one of the two methods specified in Clause 1, Article 5 of Circular No. 25/2014/TT-BTC dated February 17, 2014, issued by the Minister of Finance, which stipulates common pricing methods for goods and services (hereinafter referred to as Circular No. 25/2014/TT-BTC), to build prices for medical services on demand.

2. Medical establishments may establish different service price levels based on specialty, time of service provision, level of expertise of service providers, care and treatment personnel; facility conditions and level of care; quantity and quality of technical services, subject to approval by the competent authority as prescribed in Article 6 of this Circular, within the framework of the price range set out in the annex attached to this Circular.

3. In cases where additional domestic (outside the regular staff of the unit or department providing services on demand) or foreign human resources are hired, the costs incurred shall be included in the service price, including the costs of hiring personnel under contract, food, accommodation, travel, translation, and other reasonable and legitimate expenses related to hiring personnel, based on mutual agreement and voluntary consent of the service user.

4. When providing specialized technical services at home, additional reasonable and legitimate expenses related to the provision of such services (if any) shall be included.

Article 5. Costs and Methods for Determining Costs to Build Prices for Medical Services on Demand

1. Direct Costs:

a) Direct costs for providing services include:

- Medicines, chemicals, medical equipment, consumables, replacement materials (including storage and loss costs as prescribed);

- Electricity, water, fuel, waste processing, environmental sanitation, infection control;

- Maintenance, repair, inspection, calibration of equipment, purchase of tools, equipment directly used for service provision;

- Other direct costs as prescribed.

b) Method for Determining Costs

- The cost of each item mentioned in point a of this clause shall be determined based on consumption norms established and issued by the medical establishment, and reference shall be made to the norms issued or announced by the competent authority (if available).

- Unit prices for various medicines, materials, chemicals, and other direct costs (including value-added tax) are supply prices to the medical establishment, determined according to published prices (if available) or invoice prices as prescribed by law at the time of pricing + (plus) reasonable distribution costs to the medical establishment or winning bid prices as prescribed.

2. Labor Costs:

a) Labor costs include monetary expenses that the medical establishment must pay to workers, including:

- Wages; allowances; contributions according to regulations (including contributions paid by the unit) for civil servants and employees;

- Fees and related expenses for personnel providing services as prescribed;

- Outsourced labor costs, fees for inviting domestic and foreign experts under agreed contracts;

b) Method for Determining Costs

- For services with specified numbers of personnel and times for service provision: the medical establishment bases its decision on consumption norms for labor days according to regulations and actual circumstances of the unit;

- For services without specified numbers of personnel and times for service provision: the unit bases its decision on actual circumstances to establish and issue consumption norms for labor days;

- The unit price for labor days is calculated based on wages, fees, allowances, and contributions according to regulations (including contributions paid by the unit) as per the salary table or labor contract of the unit.

3. Management Costs:

a) Management costs include expenses of the management and operation departments of the medical establishment and indirect expenses for service provision, including:

- Expenses for electricity, water, fuel; telecommunications and postal service charges; information technology rental or management service and software rental; patient security assurance; hygiene, environment, waste processing; other rental and purchase expenses;

- Maintenance, repair, inspection, calibration of assets, procurement of equipment, tools, materials, means, office supplies for the management department, indirect activities, and common activities of the unit;

- Translation and interpretation fees; expenses for purchasing, printing, photocopying documents and publications for professional purposes;

- Uniform, protective clothing, occupational safety and health protection, HIV prevention, vaccination for civil servants, employees, and workers;

- Expenses for communication and brand image promotion as prescribed;

- Fees, taxes, land use fees/rental expenses for business and service operations (if applicable); insurance for medical malpractice, asset insurance; fire prevention and extinguishing expenses; quality management expenses; expenses related to drug and material storage, loss, and disposal; expenses for asset liquidation and disposal as prescribed;

- Training and scientific research expenses; transfer of techniques and advanced professional training;

- Interest on loans (if applicable);

- Other expenses.

b) Method for Determining Costs:

- Costs for materials, chemicals, and other expenses of the management and operation departments are determined as direct costs as prescribed in this Article;

- Units develop plans to allocate management and operation costs to each service in accordance with the actual situation of the unit.

4. Depreciation Costs of Assets include assets exclusively used for service activities on demand and assets shared for both functional tasks and service activities on demand: in accordance with current depreciation regulations.

5. Risk Reserve.

6. Accumulation for Reinvestment, Technical Development, and Anticipated Profit (if applicable).

Article 6. Competence to Approve Specific Prices for Outpatient and Inpatient Services on Demand

1. The approval of specific prices for outpatient and inpatient services on demand at healthcare facilities must comply with pricing methods, be within the competence of the approving authority, and shall not approve service prices lower than or higher than the price range specified in the Appendix attached to this Circular.

2. For outpatient and inpatient services on demand formed from joint venture capital, joint operation capital, and public-private partnership (PPP) projects:

The price of outpatient and inpatient services on demand is the proposed price in the project proposal using state assets for joint ventures or PPP projects approved by the competent authority, including:

a) The Minister of Health approves the project proposals using state assets for joint ventures or PPP projects of units under the Ministry of Health;

b) The Minister or the head of central agencies approves the project proposals using state assets for joint ventures or PPP projects of units under ministries and sectors;

c) The People's Committee of provinces approves the project proposals using state assets for joint ventures or PPP projects of units under their management, except those specified in Points a and b of this Clause.

3. For outpatient and inpatient services on demand formed from borrowed capital, raised capital:

a) The Minister of Health approves specific prices for outpatient and inpatient services on demand of units under the Ministry of Health classified as self-governing groups 3 and 4;

b) For units under ministries and sectors: The Minister or the head of central agencies approves the joint venture or PPP project proposals of units under ministries and sectors;

c) The People's Committee of provinces approves specific prices for outpatient and inpatient services on demand of units under their jurisdiction, except those specified in Points a, b, and d of this Clause;

d) The head of public service units under the Ministry of Health approves specific prices for outpatient and inpatient services on demand of units when such units have been classified as self-governing groups 1 and 2 by the competent authority.

4. For outpatient and inpatient service prices on demand that do not use state budget funds and do not fall under the cases stipulated in Clauses 2 and 3 of this Article: The head of the unit shall approve specific prices for outpatient and inpatient services on demand of the unit according to Clause 2 of Article 6 of Decree No. 60/2021/NĐ-CP dated June 21, 2021 of the Government on the financial autonomy mechanism of public service units.

Article 7. Requirements for Healthcare Facilities Providing Outpatient and Inpatient Services on Demand

In addition to meeting requirements regarding infrastructure, medical equipment, and human resources as prescribed by laws on outpatient and inpatient services, healthcare facilities providing services on demand must also meet the following quality standards:

1. For outpatient services:

a) The area for one consultation seat must be equal to or greater than the area specified in National Standard TCVN 4470:2012;

b) Ensure that each doctor or specialist conducting consultations and advice does not exceed 45 people per eight-hour working day.

2. For inpatient bed services: One room for inpatient services on demand must not exceed four beds and must ensure the floor area per bed as specified in National Standard TCVN 4470:2012.

Article 8. Implementation organization

1. Healthcare facilities are responsible for:

a) Establishing a list and prices for outpatient and inpatient services on demand for approval within their competence or submission to the competent authority for approval as prescribed by law;

b) Strictly implementing regulations on medical expertise, particularly the referral of patients for inpatient treatment; transfer between levels, prescription of services, medicines, and medical equipment according to the appropriate treatment protocol, suitable for the patient's condition;

c) Ensuring the number of beds available for outpatient and inpatient services on demand at any given time does not exceed 20% of the average total number of beds in the previous year (excluding beds for outpatient and inpatient services on demand funded through borrowing, raising capital, joint ventures, joint operations, and public-private partnerships (PPP) as stipulated for independent areas for outpatient and inpatient services on demand separate from regular outpatient and inpatient services);

d) Ensuring that a certain proportion of time (at least 70%) is dedicated by specialists and excellent doctors of the unit to outpatient and inpatient services for patients with health insurance cards, those without health insurance cards but not using services on demand, and supporting lower-level facilities;

đ) Declaring prices in accordance with Decree No. 177/2013/NĐ-CP dated November 14, 2013 of the Government detailing and guiding the implementation of certain provisions of the Law on Prices, amended and supplemented by Decree No. 149/2016/NĐ-CP dated November 11, 2016 of the Government and other guiding legal documents;

e) Publicly posting the list and prices of outpatient and inpatient services on demand for patients to know and choose;

g) The establishment of funds from revenue exceeding expenses of outpatient and inpatient services on demand activities must adhere to the following principles:

- Increasing the ratio of fund allocation for Development of Public Services to invest in both regular outpatient and inpatient services and outpatient and inpatient services on demand;

- Allocating and gradually increasing the level of allocation for the Support Fund for Outpatient and Inpatient Services, while establishing regulations to support patients during their outpatient and inpatient services at the facility.

2. Provincial Departments of Health are responsible for:

a) Taking the lead and coordinating with relevant units to guide, inspect, and supervise the implementation of this Circular within their jurisdiction;

b) Directing healthcare facilities under their management to strictly implement professional regulations, and to comprehensively implement measures to improve the quality of outpatient and inpatient services.

Article 9. Implementation Provisions

1. This Circular takes effect from August 15, 2023.

2. Health care facilities that have units or departments providing medical services upon request which were operating before this Circular takes effect shall be responsible for reviewing and must invest in, upgrade physical infrastructure, purchase additional equipment, and recruit personnel to meet the requirements stipulated in Article 7 of this Circular and resubmit price approval before December 31, 2024.

3. In cases where legal regulations and provisions cited in this Circular are amended, supplemented, or replaced, they shall be implemented according to the new legal regulations.

During the implementation process, if there are difficulties or obstacles, it is requested that agencies, organizations, and individuals report them in writing to the Ministry of Health for consideration and resolution./.