JOINT CIRCULAR No. 14/2002/TTLT-BYT-BTC GUIDING THE ORGANIZATION OF MEDICAL EXAMINATION AND TREATMENT AND THE ESTABLISHMENT, MANAGEMENT, USE, SETTLEMENT, AND AUDIT OF THE POOR PEOPLE'S HEALTH INSURANCE FUND PURSUANT TO DECISION No. 139/2002/QD-TTg DATED OCTOBER 15, 2002 OF THE GOVERNMENT PRIME MINISTER

CIRCULAR

JOINT CIRCULAR OF THE MINISTRY OF HEALTH AND THE MINISTRY OF FINANCE NO.

GUIDELINES FOR THE ORGANIZATION OF MEDICAL EXAMINATIONS AND TREATMENTS AND THE ESTABLISHMENT, MANAGEMENT, USE, SETTLEMENT, AND AUDIT OF FUNDS FOR MEDICAL EXAMINATIONS AND TREATMENTS FOR POOR PEOPLE PURSUANT TO DECISION NO. 139/2002/QĐ-TTg DATED OCTOBER 15, 2002 15/10/2002 of the Prime Minister

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BASED ON DECISION NO. 139/2002/QĐ-TTg DATED OCTOBER 15, 2002 OF THE PRIME MINISTER ON THE REGIME OF MEDICAL EXAMINATIONS AND TREATMENTS FOR POOR PEOPLE, THE MINISTRIES OF FINANCE AND HEALTH ISSUE GUIDELINES FOR THE ORGANIZATION OF MEDICAL EXAMINATIONS AND TREATMENTS AND THE ESTABLISHMENT, MANAGEMENT, USE, SETTLEMENT, AND AUDIT OF FUNDS FOR MEDICAL EXAMINATIONS AND TREATMENTS FOR POOR PEOPLE AS FOLLOWS:

I. GENERAL PROVISIONS

1. State medical examination and treatment facilities from commune health stations to hospitals and institutes at the central level shall implement the regime of medical examinations and treatments for poor people in accordance with the provisions of this Circular.

2. The Fund for Medical Examinations and Treatments for Poor People (hereinafter referred to as the Fund) is a state fund established at the provincial level, managed by the Provincial People's Committee (PPC), operating on a non-profit basis, ensuring the preservation and development of capital.

3. The Fund is formed from the following sources: State budget (including support from the central budget; supplementary from social security funds within the local budget, including all state budget funds previously allocated and purchased health insurance cards for serving medical examinations and treatments for poor people) and contributions from organizations and individuals both domestically and internationally; encouraging individual, unit, and organization support for individuals to purchase health insurance cards or actual payment through the Fund. The financial resources of the Fund are managed in accordance with the Law on State Budget and the provisions of this Circular.

4. The Fund has an account opened at the National Treasury System and earns interest on deposits according to current regulations.

II. SPECIFIC PROVISIONS

1. Establishment of the Fund for Medical Examinations and Treatments for Poor People

1.1. The Chairman of the PPC decides to establish the Fund. The Management Board of the Fund is headed by the Chairman of the PPC as the Head; the Director of the Department of Health as the Deputy Head in charge of day-to-day operations; the Director of the Department of Finance and Prices as the Deputy Head in charge of finance; members of the Board include leaders of the Departments of Labor, Invalids and Social Affairs, Planning and Investment, the Ethnic Minorities' Committee, Social Insurance, and representatives of the Vietnam Fatherland Front at the provincial level.

1.2. The Fund is located at the Department of Health with its own seal. The Department of Health is responsible for organizing, managing, and directing the Fund according to the decision of the Chairman of the PPC. Annually, the Department of Health is responsible for preparing the budget for managing the Fund within the regular health service budget of the Department of Health.

2. Recipients of the medical examination and treatment regime for poor people:

2.1. In accordance with Article 2 of Decision No. 139/2002/QĐ-TTg dated October 15, 2002 of the Prime Minister, recipients of the medical examination and treatment regime for poor people include:

a. Poor people as defined by the current poverty standard set forth in Decision No. 1143/2000/QĐ-LĐTBXH dated November 1, 2000 of the Minister of Labor, Invalids and Social Affairs.

b. Residents of communes with particularly difficult economic and social conditions as stipulated in Decision No. 135/1998/QĐ-TTg dated July 31, 1998 ofthe Prime Minister approving the "Program for Economic and Social Development in Communes with Particularly Difficult Conditions in Mountainous Areas and Remote Regions."

c. Ethnic minority residents in the Central Highlands as stipulated in Decision No. 168/2001/QĐ-TTg dated October 30, 2001 of the Prime Minister regarding "Long-term Orientation, Five-Year Plan 2001-2005, and Fundamental Measures for Economic and Social Development in the Central Highlands" and ethnic minority residents in six particularly difficult provinces in the Northern Mountains as stipulated in Decision No. 186/2001/QĐ-TTg dated December 7, 2001 of the Prime Minister regarding "Economic and Social Development in Six Particularly Difficult Provinces in the Northern Mountains during the Period 2001-2005."

2.2. Recipients specified in Article 2 of Decision No. 139/2002/QĐ-TTg dated October 15, 2002 of the Prime Minister do not fall under the category of recipients of the medical examination and treatment regime for poor people, including:

Those who are entitled to mandatory health insurance benefits under Decree No. 58/1998/NĐ-CP dated August 13, 1998 of the Government and other current regulations (recipients whose health insurance cards are purchased compulsorily by the state budget or economic organizations): workers currently employed or retired; those receiving allowances under the Law on Persons Contributing to the Nation; veterans and their children affected by chemical warfare; parents, legal guardians of husbands and wives, spouses, and children under 18 years old of active-duty officers whose health insurance cards are purchased and issued by the Ministry of Defense in accordance with Decree No. 63/2002/NĐ-CP dated June 18, 2002 of the Government...

3. Work on establishing budgets, managing, using, and settling accounts for the Fund

3.1. Establishing the Fund's budget:

Annually, based on the number of recipients of the medical examination and treatment regime for poor people approved by the Chairman of the PPC, the Department of Health, in collaboration with the Department of Finance and Prices and relevant departments and agencies in the province, will develop a budget for medical examinations and treatments for poor people with a minimum standard of 70,000 VND per person per year, where the state budget guarantees at least 75% of the total value of the Fund.

a. Determining the state budget allocation for the Fund as follows: For the first year (2003):

From the second year (2004) onwards:

From the second year onwards, in cases of Fund deficit, the state budget support for the Fund ensures = Number of recipients x 70,000 VND x 75%

b. The remaining budget for establishing the Fund is raised from the following sources: Contributions from individuals, organizations, and businesses both domestically and internationally coordinated by the PPC in conjunction with the Vietnam Fatherland Front, central ministries and sectors, and local authorities. Interest earned from the Fund's deposits at the National Treasury that have not been utilized.

3.2. Managing and Using the Fund:

3.2.1. The purchase of health insurance cards (HIC) or actual payment (in the form of issuing medical examination and treatment cards for poor people issued by the Ministry of Health) for recipients as stipulated in Article 2 of Decision No. 139/2002/QĐ-TTg is carried out as follows:

a. Purchasing health insurance cards: Annually, based on the list of beneficiaries entitled to medical examination and treatment benefits for the poor approved by the Chairman of the Provincial People's Committee, the Management Board organizes the purchase of health insurance cards with a value of 50,000 VND/person/year at the health insurance agency located in the locality and distributes the cards directly to the beneficiaries at the beginning of the year. For localities that have not yet implemented health insurance medical examinations and treatments at the commune level, the health insurance agency is responsible for coordinating with the district health centers to organize medical examinations and treatments for the poor with health insurance cards at the commune level. The health insurance agency settles the costs of medical examinations and treatments for the poor with health insurance cards with state medical examination and treatment facilities according to current health insurance regulations, but does not implement the co-payment mechanism. At the end of the year, any surplus funds for medical examinations and treatments for the poor remaining in the Health Insurance Fund will be transferred to the next year to continue purchasing health insurance for the poor.

b. Actual payment and settlement: The Management Board is responsible for settling the costs of medical examinations and treatments for the poor with state medical examination and treatment facilities according to the payment level applicable to health insurance. For the commune level (including communes, wards, towns, collectively referred to as the commune level): Annually, the Fund allocates 10,000 VND/poor person/year for medical examinations and treatments for the poor at commune health stations. The Management Board authorizes the district, county, town health centers to purchase common medicines and medical consumables according to the commune health station's budget for medical examinations and treatments for the poor at the commune health station. Quarterly, the commune health station is responsible for reporting and settling the expenses provided in kind with the Management Board through the district health center. In cases where there are surplus medicines and medical consumables, when preparing the budget for the following year, the previous year's surplus must be deducted. For the district and provincial levels: At the beginning of each quarter, the Management Board transfers 70% of the estimated total funds to be settled during the quarter to medical examination and treatment facilities at the district and provincial levels. The Management Board settles all costs of medical examinations and treatments for state medical examination and treatment facilities at the district and provincial levels every six months. At the end of the year, the medical examination and treatment facilities must report the annual settlement to the Management Board so that the Management Board can complete the annual settlement of the Fund. For the central level: The Management Board settles the costs of medical examinations and treatments for central-level medical examination and treatment facilities every six months for patients with referral letters and health insurance cards for the poor. When requesting the provincial Management Boards to settle the costs of medical examinations and treatments for the poor, central-level medical examination and treatment facilities must clearly notify the patient list, the referring medical examination and treatment facility, final diagnosis, number of days of treatment, and the hospital fee amount to be settled for each case. To settle the costs for medical examination and treatment facilities, the Management Board must conduct an audit or sign a contract with the health insurance agency to conduct an audit of medical examination and treatment costs. Audit costs and printing costs for health insurance cards for the poor are deducted from the Fund but shall not exceed 5% of the total Fund value.

3. 2.2. Poor persons as defined in Article 2 of Decision No. 139/2002/QĐ-TTg are exempt from paying advance payments when undergoing treatment at state medical examination and treatment facilities.

3. 2.3. Supporting part of the hospitalization fees for sudden difficult cases (not falling under the provisions of Article 2 of Decision No. 139/2002/QĐ-TTg): The provincial People's Committee decides the target groups, levels, and procedures for reviewing applications for partial hospitalization fee support for sudden difficult cases due to severe illnesses with high treatment costs at state medical examination and treatment facilities, prioritizing policy beneficiaries, families with meritorious service to the revolution, and elderly individuals without family support.

3. 2.4. Strictly prohibit the misuse of the Fund for purposes other than those intended.

3. 3. Settlement of the Fund: Accounting systems and annual settlement reports of the Fund are carried out according to Decision No. 999/TC/QĐ/CĐKT dated November 21, 1996, issued by the Minister of Finance, and the attached forms in this Circular. The Department of Health takes the lead in coordinating with the Department of Finance and Price Control and relevant agencies to periodically inspect the collection and use of the Fund; review and approve the annual settlement report of the Fund submitted by the Management Board for approval by the Chairman of the Provincial People's Committee. At the beginning of each year, the Management Board is responsible for submitting the previous year's settlement report, which has been approved by the Chairman of the Provincial People's Committee, to the Ministry of Health and the Ministry of Finance for consolidation and reporting.

3. 4. Supervision of the Fund: For the method of providing medical examinations and treatments for the poor through health insurance cards, expenditure monitoring is organized by the health insurance agency according to current health insurance regulations. For the actual payment and settlement method, the supervision mechanism is applied as stipulated in current health insurance regulations.

III. ORGANIZATION OF MEDICAL EXAMINATIONS AND TREATMENTS:

1. State medical examination and treatment facilities from commune health stations to hospitals and central-level hospitals are responsible for providing medical examinations and treatments for the poor according to the provisions of this Circular. In cases exceeding their professional capacity, they should refer patients to higher levels. The specific medical examination and treatment levels for beneficiaries entitled to medical examination and treatment benefits for the poor in the locality are determined by the Chairman of the Provincial People's Committee.

2. Beneficiaries entitled to medical examination and treatment benefits for the poor who do not undergo medical examinations and treatments according to the prescribed level (crossing levels or exceeding levels) or seek medical examinations and treatments according to personal requirements must bear the costs of medical examinations and treatments according to current regulations. In emergency situations, the poor may be examined and treated at the nearest state medical facility, and the Management Board will settle the costs of medical examinations and treatments for that medical facility.

IV. IMPLEMENTATION PROVISIONS:

1. The provincial People's Committee directs the implementation of Decision No. 139/2002/QĐ-TTg dated October 15, 2002, of The Prime Minister and this Circular shall be implemented at all levels and relevant sectors within the provinces and centrally governed cities; annually, they shall compile and report to the Prime Minister on the operation of the Fund for Health Examination and Treatment for Poor People and the effectiveness of the Fund in health examination and treatment for poor people; simultaneously, they shall send reports to the Ministry of Health, the Ministry of Finance, the Ministry of Labor, Invalids and Social Affairs, the Committee for Ethnic Minorities, and the Vietnam Fatherland Front Central Committee.

2. The Ministry of Health shall take the lead in coordinating with the Ministry of Finance, related ministries and sectors, and the Vietnam Fatherland Front Central Committee to supervise and evaluate the implementation of the health examination and treatment regime for poor people by localities and report thereon. the Prime Minister.

At the district and commune levels, the Primary Health Care Steering Committees shall coordinate with the Vietnam Fatherland Front at the same level to supervise the implementation of the health examination and treatment regime for poor people in their respective localities. This Circular shall take effect from the date of issuance. During its implementation, if any difficulties arise, it is recommended that they be reported to the relevant ministries for consideration and resolution.

This Circular shall take effect from the date of issuance. During its implementation, if any difficulties arise, it is recommended that they be reported to the relevant ministries for consideration and resolution./.