The Consolidated Document number 13/VBHN-BYT stipulates the maximum ceiling price range for medical services for diagnosis and treatment not covered by the Health Insurance Fund in state-run medical facilities and provides guidance on applying prices and settling costs for diagnosis and treatment in certain cases.

MINISTRY OF HEALTH -------	SOCIALIST REPUBLIC OF VIET NAM Independence - Freedom - Happiness ---------------
Number: 13/VBHN-BYT	Hanoi, October 10, 2019

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 REIMBURSING HEALTH SERVICE COSTS IN CERTAIN CASES

Circular No. 37/2018/TT-BYT dated November 30, 2018 of the Minister of Health on uniform pricing for health services under health insurance between hospitals of the same level nationwide and guidelines for applying prices and reimbursing costs for health services under health insurance in certain cases, which took effect from January 15, 2018, has been amended and supplemented by

Circular No. 14/2019/TT-BYT dated July 5, 2019 of the Minister of Health amending and supplementing certain articles of Circular No. 37/2018/TT-BYT dated November 30, 2018 of the Minister of Health on uniform pricing for health services under health insurance between hospitals of the same level nationwide and guidelines for applying prices and reimbursing costs for health services under health insurance in certain cases, which took effect from August 20, 2018.

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

Pursuant to the Price Law dated June 20, 2012;

On the basis of the Ordinance on Implementation of Democracy in Communes, Wards, and Towns dated April 20, 2007;

Pursuant to Decree No. 85/2012/NĐ-CP dated October 15, 2012 of the Government on the operational mechanism and financial mechanism for public health service units and prices for health services at public health care 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;

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;

Pursuant to Decree No. 149/2016/NĐ-CP dated November 11, 2016 of the Government amending and supplementing certain articles of 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;

Pursuant to the Government's Decree No. 75/2017/NĐ-CP dated June 20, 2017 stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health;

Pursuant to Decree No. 72/2018/NĐ-CP dated May 15, 2018 of the Government on the basic salary for civil servants, public officials, and members of the armed forces;

Pursuant to Resolution No. 140/NQ-CP dated November 9, 2018 of the Government on the regular meeting of the Government in October 2018;

Based on the opinions of the Ministry of Finance in Circular No. 14818/BTC-QLG dated November 27, 2018;

The Minister of Health hereby promulgates this Circular regulating 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 reimbursing costs for health services in certain cases.[1]

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 guidelines for applying prices and reimbursing 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 health insurance; patients with health insurance cards but seeking medical treatment or using health services outside the health insurance fund reimbursement scope; other relevant agencies, organizations, and individuals.

3. Patients with health insurance cards seeking medical treatment according to the laws on health insurance shall be reimbursed by the health insurance fund for medical expenses according to regulations.

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

a) Units contributing capital, raising funds, joint ventures, or joint operations as stipulated in Article 6 of Decree No. 85/2012/NĐ-CP dated October 12, 2012 of the Government on the operational mechanism and financial mechanism for public health service units and prices for health services at public health care facilities and implementing service prices based on the principle of ensuring sufficient cost recovery and accumulation;

b) Health care facilities operating under a business model funded by loans from public institutions in accordance with Resolution No. 93/NQ-CP dated December 15, 2014 of the Government on certain mechanisms and policies for developing healthcare;

c) Health care facilities invested in under a public-private partnership model as prescribed by the Government's regulations on public-private partnerships.

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

The maximum price range for medical examination and treatment services includes:

1.[2] The maximum price range for medical examination and health check-up services as stipulated in Appendix I attached to this Circular;

2.[3] The maximum price range for medical examination and treatment bed-day services as stipulated in Appendix II attached to this Circular;

3.[4] The maximum price range for technical service and laboratory test prices as stipulated in Appendix III attached to this Circular.

4.[5] Supplementing the notes of some technical services that have been ranked equivalently by the Ministry of Health in the Decisions of the Ministry of Health as stipulated in Appendix IV attached to this Circular.

Article 3. Structure of medical examination and treatment service prices

The maximum prices of medical examination and treatment services stipulated in this Circular are established based on direct costs and salaries to ensure medical examinations, patient care, treatment, and the provision of medical technical services; specifically as follows:

1. Direct costs included in the medical examination price

a) Costs for clothing, hats, masks, sheets, pillows, mattresses, mats, office supplies, gloves, cotton, bandages, alcohol, gauze, saline solution, and other consumables used in diagnostic activities;

b) Costs related to electricity, water, fuel, waste management (solid and liquid), laundry, sterilization of textiles and examination tools, hygiene and environmental sanitation costs, disinfection chemicals and anti-infection materials during medical examinations;

c) Maintenance and repair costs for buildings and equipment, procurement and replacement of assets such as air conditioners, computers, printers, dehumidifiers, fans, tables, chairs, beds, cabinets, lighting fixtures, and other necessary tools and equipment during medical examinations.

2. Direct costs included in the medical examination bed-day service price

a) Costs related to clothing, hats, masks, blankets, pillows, mattresses, mosquito nets, stationery, gloves used in examinations, injections, infusions, cotton, bandages, alcohol, gauze, saline solution, and other consumables serving daily care and treatment (including costs for changing dressings for inpatients, except cases paid outside the bed-day price as stipulated in Clause 4 and Clause 5, Article 7 of this Circular); electrodes, ECG cables, blood pressure cuffs, SPO2 cables used during patient monitoring in intensive care beds.

For drug, blood, infusion fluid, and certain medical supplies (excluding those mentioned above); types of syringes, needles, lancets used in injections, infusions, feeding pumps; infusion tubes, connectors, syringe pump cables, infusion machine cables used in injections, infusions; oxygen gas, oxygen breathing tubes, oxygen masks (except cases where patients are prescribed mechanical ventilation services) are not included in the bed-day price structure and are reimbursed based on actual usage for patients.

b) Costs as stipulated in Point b and Point c, Clause 1 of this Article serving patient care and treatment according to professional requirements.

3. Direct costs included in the medical technical service price

a) Costs related to clothing, hats, masks, sheets, pillows, mattresses, mats, textiles; stationery; drugs, infusion fluids, chemicals, consumables, replacement materials used during the provision of medical services and techniques;

b) Costs as stipulated in Point b and Point c, Clause 1 of this Article serving the provision of medical technical services according to professional requirements.

4. Salary costs included in the medical examination, bed-day, and medical technical service prices, including:

a)[6] Basic salary grade, position allowances, contributions under state regulations for public institutions and the basic salary level as stipulated in Decree No. 38/2019/ND-CP dated May 9, 2019 of the Government regarding the basic salary level for civil servants, public officials, and military personnel.

b) Overtime allowance, surgical and procedural allowance as stipulated in Decision No. 73/2011/QD-TTg dated December 28, 2011 of the Prime Minister regarding special allowances for civil servants, public officials, and workers in public healthcare facilities and epidemic prevention allowances.

5. Salary costs in the service prices stipulated in Clause 4 of this Article do not include expenses covered by the state budget as stipulated 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) Decree No. 116/2010/ND-CP dated December 24, 2010 of the Government on policies for civil servants, public officials, and personnel receiving salaries in the armed forces working in areas with extremely difficult economic and social conditions;

c) Decision No. 46/2009/QD-TTg dated March 31, 2009 of the Prime Minister on special allowances for staff working at the Vietnam Friendship Hospital, Thong Nhat Hospital, Da Nang Central Hospital, Central 1, 2, 2B, 3, and 5 Preventive Medicine Departments, and Department A11 of the 108 Military Central Hospital and Department A11 of the Military Central Traditional Medicine Hospital (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 amending and supplementing some articles of Decision No. 46/2009/QD-TTg;

d) Point a, Clause 8, Article 6 of Decree No. 204/2004/ND-CP dated December 14, 2004 of the Government on salary systems for civil servants, public officials, and military personnel and Decree No. 76/2009/ND-CP dated September 15, 2009 of the Government amending and supplementing some articles of Decree No. 204/2004/ND-CP dated December 14, 2004 of the Government on salary systems for civil servants, public officials, and military personnel.

Article 4. Principles and Authority to Determine Service Fees for Medical Examination and Treatment

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

2. The People's Council of the province shall decide specific service fees for medical examination and treatment carried out at healthcare facilities under local management, and shall decide specific service fees or implement service fee rates for certain cases according to the following principles:

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 rate of equivalent-grade hospitals;

b) Healthcare facilities that have not been classified: apply the service fee rate of Grade IV hospitals;

c) For multi-disciplinary clinics in areas:

- In cases where they are granted a license to operate as a hospital or fall within the provisions stipulated in Clause 12, Article 11 of Decree No. 155/2018/ND-CP dated November 12, 2018 of the Government amending and supplementing certain regulations related to investment conditions under the Ministry of Health’s jurisdiction: apply the service fee rate of Grade IV hospitals;

- In cases where they only perform emergency services, outpatient medical examination and treatment: apply the service fee rate of Grade IV hospitals. For cases where the Department of Health decides on bed retention: apply a service fee rate equal to 50% of the daily ward fee for Grade III internal medicine wards of Grade IV hospitals. The maximum number of days for reimbursement is 03 days/person/treatment session. No payment for medical examination will be made if bed retention has already been paid.

d) Commune Health Stations, Ward Health Stations, Town Health Stations

- Medical examination service fee rate: apply the service fee rate of commune health stations. Technical service fee rates equal 70% of the technical service fee rates listed in Appendix III;

- For commune health stations decided by the Department of Health to retain beds: apply a service fee rate equal to 50% of the daily ward fee for Grade III internal medicine wards of Grade IV hospitals.

3. The Minister of Health shall decide specific service fees for medical examination and treatment carried out at healthcare facilities directly under the Ministry of Health and special-grade hospitals, Grade I hospitals under central ministries and agencies. For other healthcare facilities under central ministries and agencies, the implementation of service fee rates for medical examination and treatment shall be as follows:

a) For health stations of organizations, units, military-civilian health stations, military-civilian medical clinics: apply the service fee rate for medical examination and treatment prescribed for commune, ward, town health stations of the locality.

b) For military-civilian health posts: apply the service fee rate for medical examination and treatment prescribed for multi-disciplinary clinics in areas of the locality.

c) For Grade II, III, IV hospitals (including military-civilian hospitals): apply the service fee rate for healthcare facilities of the same grade in the locality.

d) For other remaining healthcare facilities: apply the service fee rate for Grade IV healthcare facilities in the locality.

4. In cases where healthcare facilities under central ministries and agencies provide technical services not included in the prescribed service fee rates for medical examination and treatment of the locality, such healthcare facilities must develop pricing plans and report to the Ministry of Health for consideration and decision.

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 regarding technical equivalence and cost of implementation) without prescribed maximum ceiling prices:

a) Healthcare facilities shall develop and propose service fee rates to the competent authority specified in Article 4 of this Circular for temporary determination of service fee rates;

b) Annually, every six months (on June 30 and December 31), units and localities shall compile reports to the Ministry of Health for review and supplementary determination 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 5. Guidance on Implementing Examination Fees

The number of times and examination fees in certain cases are determined as follows:

1. In the case where a patient comes to the outpatient department for an examination and is then referred for inpatient treatment according to professional requirements, the payment for the examination fee shall be implemented in accordance with Clause 2 of this Article. If a patient does not register for an examination at the outpatient department but comes for an examination and is admitted for inpatient treatment at clinical departments according to professional requirements, there will be no payment for the examination fee.

2. Medical facilities that organize specialized clinics within clinical departments, if patients register for an examination at the outpatient department and undergo examinations at specialized clinics within clinical departments, such examinations shall be considered as outpatient examinations. The calculation of costs and the number of examinations in this case shall be carried out in accordance with the guidance provided in Clause 3 of this Article.

3. In the same visit to the same medical facility for an examination (which may occur on the same day or due to objective conditions or professional requirements, the examination process cannot be completed on the first day and must continue on subsequent days), if a patient needs to see additional specialties after seeing one specialty, from the second examination onwards, only 30% of the examination fee for one examination will be charged, and the maximum payment for examination fees shall not exceed twice the price of one examination fee.

4. In the case where a patient comes to a medical facility for an examination, receives medication for outpatient treatment, but later exhibits unusual symptoms and returns to the medical facility for re-examination on the same day and continues to be examined, this examination shall be considered as the second examination or subsequent examinations on the same day. Payment shall be made in accordance with the guidance provided in Clause 3 of this Article;

Article 6. Determination of Number of Hospitalization Days and Application of Daily Bed Rates

1. Determining the number of inpatient treatment bed days for payment of hospitalization fees:

a) The number of inpatient treatment days equals the discharge date minus (-) the admission date plus (+) 1: applicable to cases where:

- In the case where a seriously ill patient undergoing inpatient treatment has not improved, died, or worsened, but the family requests discharge or transfer to a higher-level facility;

- In the case where a patient who has been treated at a higher-level facility through emergency care still requires continued inpatient treatment and is transferred back to a lower-level facility or to another medical facility;

b) The number of inpatient treatment days equals the discharge date minus the admission date: applicable to the remaining cases.

c) In the case where a patient is admitted and discharged on the same day (or admitted the previous day and discharged the following day) with a treatment time of over four hours but less than twenty-four hours, it shall be counted as one day of treatment. For patients admitted to the emergency department without going through the outpatient department, if the emergency treatment and care time is four hours or less (including cases of discharge, admission, or transfer, death), the examination fee, drug cost, medical supplies, and technical service fees shall be paid, but there will be no payment for intensive care unit bed fees.

d) In the case where a patient is admitted and discharged on the same day with a treatment time of four hours or less, the examination fee, drug cost, medical supplies, and technical service fees used by the patient shall be paid, but there will be no payment for inpatient bed fees.

2. In the case where a patient transfers between two departments in the same day, each department shall be counted as half a day. In the case where a patient transfers among three or more departments in the same day, the daily bed rate for that day shall be calculated as the average of the highest and lowest bed rates at departments where the patient stayed for more than four hours.

3. The postoperative daily bed rate for surgical and burn patients shall apply for a maximum of ten days after surgery. From the eleventh day after surgery onwards, the daily bed rate for internal medicine shall apply according to the corresponding departments specified in Section 3 of Appendix II issued together with this Circular.

4. The daily bed rate applies to one person per bed. In the case where two people share one bed at the same time, only half of the bed rate shall be paid; in the case where three or more people share one bed, only one-third of the daily bed rate for inpatient treatment shall be paid.

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 ICU departments, detoxification centers, or ICU-detoxification centers, and these departments meet the operational conditions stipulated in Decision No. 01/2008/QD-BYT dated January 21, 2008, issued by the Minister of Health regarding the issuance of emergency, intensive care, and detoxification regulations (hereinafter referred to as Decision No. 01/2008/QD-BYT).

b)[7] In the case where some beds in the Emergency Department or Anesthesia Recovery Department are used for intensive treatment; postoperative beds for special surgeries and these beds meet the requirements of ICU beds stipulated in the emergency, intensive care, and detoxification regulations issued together with Decision No. 01/2008/QD-BYT dated January 21, 2008, by the Minister of Health.

c) Patients lying in these beds must be cared for, treated, and monitored according to the emergency, intensive care, and detoxification regulations. Other cases can only apply the daily bed rate for intensive care beds and other types of beds specified in Appendix II issued together with this Circular.

6. For clinical departments with intensive care beds (for example, pediatric departments with pediatric intensive care beds, neonatal departments, or special care departments for premature infants): the daily bed rate for intensive care beds specified in Service No. 2 of Appendix II issued together with this Circular shall be applied.

7. Hospitals classified as Class III, Class IV, or unranked but approved by competent authorities to perform special surgeries: the highest surgical daily bed rate of the hospital providing the service shall be applied.

Example: At Hospital A, which has been approved to perform special surgeries: If the hospital is ranked as Class III, the daily bed rate for surgical Class I postoperative patients in Class III hospitals shall be applied; if the hospital is ranked as Class IV or unranked, the daily bed rate for surgical Class I postoperative patients in Class IV hospitals shall be applied.

8. In case a surgery is classified differently according to specialties (except pediatrics) as stipulated in Circular No. 50/2014/TT-BYT dated December 26, 2014 of the Minister of Health on the classification of surgeries, procedures, and staffing levels for each surgery and procedure (hereinafter referred to as Circular No. 50), the price level for surgical and burn ward bed days shall be applied based on the lowest surgery classification.

9. For surgeries that the Ministry of Health has ranked equivalently with those specified in this Circular but have different classifications according to specialties as stipulated in Circular No. 50, the price level for surgical and burn ward bed days shall be applied based on the classification of such surgeries as specified in Circular No. 50.

10. For surgeries not classified according to the provisions of Circular No. 50, the price level for surgical ward bed day type 4 corresponding to the hospital category shall be applied.

11. For central traditional medicine hospitals under the Ministry of Health at category I: the price for ward bed days shall be applied according to the departments corresponding to the types of beds in category I hospitals, without applying the prices of specialized hospitals under the Ministry of Health in Hanoi and Ho Chi Minh City.

12. For departments within Traditional Medicine Hospitals (excluding those specified in Clause 11 of this Article) and rehabilitation hospitals:

a) Intensive Care Unit (ICU) beds: as provided for in Clause 5 of this Article;

b) Emergency Care beds: as provided for in Clause 6 of this Article;

c) Patients treated in oncology and pediatric departments: the price for internal ward bed day type 1 shall be applied;

d) Patients treated for spinal cord injury, cerebrovascular accident, or brain trauma: the price for internal ward bed day type 2 shall be applied;

đ) Patients treated in other departments: the price for internal ward bed day type 3 shall be applied.

13. For healthcare facilities organizing departments in a multi-specialty format: the price for internal ward bed day of the lowest specialty among the corresponding departments shall be applied according to the hospital category.

14. In cases where patients lie on stretchers or foldable beds: the price shall be applied at 50% of the ward bed day price for the respective specialty as stipulated in Appendix II attached to this Circular.

15.[8] The ward bed day price after performing "Cataract Surgery by Phaco Method" shall be applied at the level of "Surgical and Burn Ward Bed Day" type 3 corresponding to the hospital category as stipulated in Appendix II attached to this Circular.

Article 7. Guidelines for Implementing Technical Service Prices and Laboratory Tests

1. Medical technical services shall be implemented in the following order:

a) For specific services already defined with prices in the appendices issued along with this Circular: apply the defined prices.

b) For medical technical services not defined with prices in the appendices issued along with this Circular but ranked equivalently in terms of technology and implementation costs: apply the prices of services ranked equivalently by the Ministry of Health in terms of technology and implementation costs.

c) In cases where there is overlap between different specialties, the technical service performed in a particular specialty shall be applied at the price of the technical service in that specialty.

2. For medical technical services approved by competent authorities (Ministries and central agencies for units under central management, Provincial Health Departments for units under local management) in the service catalogues but not yet defined with prices; for medical technical services ordered but unable to be performed due to disease progression or patient condition: reimbursement shall be made based on the actual quantity of drugs and materials used for the patient and their purchase prices as prescribed by law.

3. In cases where multiple interventions are performed during a single surgery: reimbursement shall be made based on the most complex surgery with the highest price, and other technical services arising outside the technical process of the surgery shall be reimbursed as follows:

a) At 50% of the price of additional surgeries if the same surgical team performs them;

b) At 80% of the price of additional surgeries if a different surgical team is required;

c) In cases where the additional service is a procedure, reimbursement shall be made at 80% of the price of the additional service.

4. For the service "Changing Dressings on Wounds or Incisions up to 15 cm in Length": it shall only be applied to inpatient patients in the following cases: infected wounds or incisions; wounds with fluid leakage, blood in skin avulsion injuries, open skin areas over 6 cm; wounds with gauze packing; leg wounds with drainage tubes leaking fluid; multiple wounds or incisions; or after a surgery requiring two or more incisions; it shall not be applied in the following cases: endoscopic surgery, changing dressings on incisions or wounds, routine dressing changes, or umbilical cord care for newborns.²; the wound has been packed with gauze; the drainage from the wound on the leg is excessive; multiple wounds or surgical incisions; or after surgery but requires two incisions or more; this does not apply to bandaging in the following cases: laparoscopic surgery, changing the surgical incision dressing, routine wound care, and newborn umbilical cord care.

5. For the service "Changing bandages for incisions longer than 15 cm to 30 cm" in inpatient treatment, it shall only be applied in the following cases:

a) Infected incisions, gastrointestinal fistulas, bile fistulas, urinary fistulas;

b) Incisions after contaminated surgery (peritonitis or osteomyelitis or abscess), incisions after digestive tract, urinary system, bile duct, or abdominal ascites surgery;

c) Incisions after surgery requiring two or more incisions;

d) In cases of cesarean section surgery: apply this price but not more than three times.

6. For immunological crossmatching tests at 37°C using anti-globulin serum (indirect Coombs test) in blood transfusions: reimbursement shall be made according to the price of the "Crossmatch with Anti-Human Globulin" service with code 1340 or 1341 as stipulated in Appendix III.

Article 8. Implementation organization

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

a) Expenses as prescribed in the documents mentioned in Clause 5, Article 3 of this Circular;

b) State budget funds to implement salary reform policies as currently prescribed by the Government regarding the basic salary for officials, civil servants, employees, and armed forces personnel.

c) In cases where the financial resources of the unit are insufficient to sustain regular operations, the unit may be classified by the competent authority as a public service organization partially self-financing its regular expenses or a public service organization fully financed by the state for regular expenses.

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 framework of medical examination and treatment services as stipulated in the appendices issued along with this Circular when supplementing pricing factors according to the schedule, adjusting economic and technical standards, or changes in the cost of pricing factors.

3. Responsibilities of the Health Departments:

b) Take the lead, coordinate with the Provincial Finance Departments to report to the People's Councils of provinces for consideration and decision on service prices and implementation timelines for medical examination and treatment facilities under provincial management.

b) Chair and coordinate with relevant units to organize the implementation, inspection, supervision, interim review, and final assessment of this Circular within their jurisdictional area.

c) Direct healthcare facilities under local management to strictly implement professional regulations and comprehensively apply measures to improve service quality.

d) Report to the competent authority to allocate hospital beds and determine the number of staff for healthcare facilities under local management to ensure these facilities have sufficient beds and personnel to meet demand and enhance the quality of medical examination and treatment services for the people.

4. Responsibilities of healthcare facilities:

a) Must use funds equivalent to the maintenance and repair costs of equipment, tools, and instruments included in the service fee for outpatient examinations and inpatient bed days (for special-class, class I, and class II hospitals, equivalent to 5% of the service fee rate; for class III and class IV hospitals, equivalent to 3% of the service fee rate) to repair, upgrade, and expand outpatient areas and departments; purchase and replace tables, chairs, beds, cabinets, trolleys, air conditioners, fans, heating lamps, space heaters, computers, multi-disciplinary and specialized examination kits; quilts, sheets, pillows, mattresses, mats; etc., to ensure professional conditions, hygiene, patient safety, and improve service quality.

b) Strictly implement medical professional regulations, particularly regarding the referral of patients for inpatient treatment; transfer to higher-level facilities, and the prescription of services, medications, and supplies in accordance with regulations.

Article 9. Cross-References

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

Article 10. Provisions on implementation

[9]

1. This Circular takes effect from January 15, 2019. The service fees for medical examination and treatment according to the basic salary level specified in Decree No. 72/2018/NĐ-CP of the Government shall be applied from December 15, 2018, as detailed in Appendices I, II, and III of this Circular.

2. Circular No. 15/2018/TT-BYT dated May 30, 2018, issued by the Ministry of Health on unified pricing for medical examination and treatment services under health insurance between hospitals of the same category nationwide and guidance on cost reimbursement for medical examination and treatment services under health insurance in certain cases will cease to be effective from the date this Circular takes effect.

Article 11. Transitional Provisions

[10]

1. Continue to apply the list of medical examination and treatment techniques classified as equivalent in terms of technical procedures and costs as stipulated in Decision No. 140/QĐ-BYT dated January 15, 2019, issued by the Minister of Health on the issuance of the List of Equivalent Techniques for Circular 37/2018/TT-BYT.

2. During the period awaiting the competent authority's decision on service fees for medical examination and treatment as prescribed in this Circular, healthcare facilities may continue to implement the previously prescribed rates until the competent authority decides on the rates according to this Circular.

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

Place of Receipt: - Office of the Government (Government Gazette, Government Portal). - Minister (for signature); - Ministry of Health Electronic Portal; - To be filed: VT, PC, KHTC.

CERTIFIED CONSOLIDATED DOCUMENT DEPUTY MINISTER DEPUTY MINISTER Nguyen Truong Son