Circular No. 14/2005/TT-BYT guiding the implementation of medical examination and treatment for children under six years old and the management, use, and settlement of medical examination and treatment expenses at public healthcare facilities.

CIRCULAR

Guidelines for implementing medical examinations, treatment, management, utilization, settlement of medical examination and treatment expenses for children under six years old

at public health facilities

at public health facilities

Pursuant to Decree No. 49/2003/NĐ-CP dated May 15, 2003 of the Government stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health;

Pursuant to Article 18 and Article 28 of Decree No. 36/2005/NĐ-CP dated March 17, 2005 of the Government detailing implementation of certain provisions of the Law on Protection, Care and Education of Children;

The Ministry of Health guides the implementation of medical examinations, treatment, management, utilization, and settlement of medical examination and treatment expenses for children under six years old at public health facilities as follows:

This technical regulation sets out technical requirements, testing methods, sampling procedures; management requirements; responsibilities of organizations and individuals producing, trading, and importing cigarettes.

Public health facilities under the Ministry of Health, central agencies and units, and localities shall implement medical examinations, treatments, management, utilization, and settlement of medical examination and treatment expenses without payment for children under six years old according to the provisions of this Circular.

II. PROVISIONS ON MEDICAL EXAMINATIONS AND TREATMENTS FOR CHILDREN UNDER SIX YEARS OLD

1. Provisions on treatment levels: The treatment level for implementing medical examinations and treatments without payment for children under six years old at public health facilities is specified as follows:

a) Public health facilities include: commune health stations, district general outpatient clinics, district general hospitals, provincial general hospitals, and primary-level health facilities under ministries and sectors are responsible for initial medical examinations and treatments for children under six years old in their respective areas.

b) In cases where the facilities' expertise is exceeded, the initial medical examination and treatment facilities have the responsibility to transfer children to provincial general hospitals or specialized hospitals.

c) In cases where the expertise of provincial-level facilities is exceeded, children should be transferred to central general hospitals or specialized hospitals under the Ministry of Health and other ministries and sectors.

d) Based on the organization of the healthcare system in the locality, the Director of the Department of Health shall submit to the People's Committee of the province or centrally-administered city for decision allowing children in certain areas to receive initial medical examinations and treatments at provincial-level facilities without referral letters (children residing in cities, towns, or near provincial-level facilities).

2. Procedures for medical examinations and treatments:

a) At facilities responsible for initial medical examinations and treatments for children: Families must present the Medical Examination and Treatment Card of the child; if the child has not been issued a card, they must present the Birth Certificate or Birth Registration Certificate or a certificate from the Commune People's Committee.

b) At facilities mentioned in points b and c of Clause 1, Section II: In addition to presenting the Medical Examination and Treatment Card of the child (if the child has not been issued a card, they must present the Birth Certificate or Birth Registration Certificate or a certificate from the Commune People's Committee), families must also present the hospital transfer procedures as prescribed, including the hospital transfer letter and summary of the medical record (except for cases specified in point d of Clause 1, Section II above).

c) In emergency situations, children can receive free medical examinations and treatments at any public health facility. Families must present the Medical Examination and Treatment Card of the child, or if the child has not been issued a card, they must present the Birth Certificate or Birth Registration Certificate or a certificate from the Commune People's Committee before the child is discharged from the hospital.

3. Children who undergo medical examinations and treatments according to the designated level enjoy benefits as stipulated. In cases where public health facilities organize medical examinations and treatments using high-end services and techniques upon request by the family, the facility may collect from the family the difference between the cost of the requested high-end service or technique and the current reimbursement rate.

4. Responsibilities of parents or guardians:

Parents or guardians of children under six years old are responsible for complying with the regulations on medical examinations and treatments for children as prescribed in this Circular.

5. Responsibilities of medical examination and treatment facilities:

a) Organize reception and guidance for medical examinations and treatments in a convenient manner, creating favorable conditions and ensuring full rights for children when undergoing medical examinations and treatments.

b) In emergency situations, out-of-level, or unauthorized transfers, public health facilities have the responsibility to promptly admit and treat children; depending on the child's condition, they must keep the child for inpatient treatment if necessary. If it is determined that inpatient treatment is unnecessary or falls within the expertise of lower-level facilities, procedures for outpatient treatment or referral back to lower-level facilities should be carried out.

c) In cases where the expertise is exceeded, lower-level facilities must promptly carry out hospital transfer procedures as prescribed to transfer children to higher-level facilities for treatment, without delay or inappropriate referrals.

d) Check the Medical Examination and Treatment Card; if there is no card, check the Birth Registration Certificate or Birth Certificate or a certificate from the Commune People's Committee (except for newborns), and the hospital transfer file (if the patient is a transfer case) immediately upon arrival for medical examination and treatment. In special cases where children need emergency care far from their residence and have difficulty traveling, and the family does not bring along any of the aforementioned documents: The Director of the health facility shall decide based on the actual situation whether the child can receive free medical examination and treatment and be settled into the medical examination and treatment expenses for children under six years old.

e) Prescribe medications, distribute medications, use medical supplies, conduct tests, imaging diagnostics, functional examinations, rehabilitation, and necessary technical services according to the condition of the illness, ensuring safety and appropriateness in accordance with professional regulations. The Director of the health facility is responsible for organizing inspections and handling violations according to authority, wastage, and loss of funds.

f) Ensure adequate supply of drugs in the list, blood, intravenous fluids, chemical reagents, X-ray films, contrast agents, and medical supplies as prescribed by the Ministry of Health during the medical examination and treatment of children under six years old.

g) Enhance human resources and technical infrastructure, particularly for the Pediatrics Department and neonatal care, ensuring a balanced number of beds for the Pediatrics Department in accordance with the guidelines of the Ministry of Health.

h) Healthcare facilities have the responsibility to publicly disclose medical services provided on demand so that the public can be informed and make choices.

i) Monitor and compile activities related to pediatric healthcare for children under six years old and report to the supervising authority quarterly on the 15th day of the first month of each quarter.

k) Statistically record and collect the portion required from families of children as stipulated in Clause 3, Section II above, and issue receipts for hospital fees for these collections according to regulations.

III. PROVISIONS ON THE USE AND SETTLEMENT OF FUNDS FOR MEDICAL EXAMINATION AND TREATMENT OF CHILDREN UNDER SIX YEARS OLD

1. Fund Usage:

a) Public health facilities are responsible for using the allocated funds for medical examination and treatment of children under six years old to provide such services at their units in accordance with this Circular, including costs for cases where children are transferred from other healthcare facilities based on professional requirements.

b) In cases where children have been treated and used medicines, blood, infusions, supplies, chemicals... free of charge under approved Programs and Projects, healthcare facilities shall not include these expenses in the settlement of funds for medical examination and treatment of children under six years old.

2. Settlement of Funds for Medical Examination and Treatment of Children Under Six Years Old:

a) Healthcare facilities shall base on the medical records of children to prepare detailed lists of costs for medical examination and treatment for each child (according to the attached form and must be signed and confirmed by the patient's family member) as evidence for the settlement of funds for medical examination and treatment without payment for children under six years old as follows: - Costs for medicines, blood, infusions, consumable supplies used for treatment are calculated based on the purchase price of the healthcare facility; - Costs for medical examination, bed days for inpatient treatment, and technical services are calculated based on the current hospital fee rates of the healthcare facility.

b) Healthcare facilities are responsible for accurately and truthfully compiling the costs for medical examination and treatment of children to settle them promptly, serving as a basis for monitoring the use of funds for medical examination and treatment without payment for children under six years old.

c) Healthcare facilities shall base on the total costs for medical examination and treatment of children to account for the settlement of expenses under item 15 sub-item 60. - Costs for medicines, blood, infusions, and direct supplies used for treatment of children are summarized and settled under corresponding items and sub-items. - Fees for medical examination, bed days for inpatient treatment, and technical services such as laboratory tests, imaging diagnostics, rehabilitation, surgery, and procedures are summarized and settled under item 119 sub-item 99.

3. Settlement Documents:

a) Detailed list of costs for medical examination and treatment of children under six years old, which must clearly indicate the Medical Examination and Treatment Card number of the child or the Birth Registration Certificate number or the Birth Certificate number; if only a certificate from the People's Committee of the commune is available, it should be kept in the settlement file.

b) In cases of receiving transferred children, a transfer introduction letter must be included in the settlement file.

IV. IMPLEMENTATION

1. Provincial Departments of Health under the central government are responsible for directing subordinate healthcare facilities to effectively implement free medical examination and treatment for children under six years old; they must regularly compile and report the situation of medical examination and treatment and fund usage for children under six years old to the Ministry of Health and the Ministry of Finance for consolidation and reporting.

2. Annually, healthcare facilities are responsible for preparing budgets for upgrading infrastructure and purchasing equipment to serve medical examination and treatment for children, detailing and consolidating them into the unit's budget report to the supervising authority and financial department to allocate funds to provide comprehensive, convenient, and quality medical services for children.

3. The exemption and reduction of hospital fees for children aged six and above shall be implemented in accordance with the current state policy on hospital fees.

4. Other provisions shall be carried out in accordance with Decree No. 36/2005/NĐ-CP dated March 17, 2005 of the Government and Circular No. 26/2005/TT-BTC dated April 6, 2005 of the Ministry of Finance.

5. This Circular takes effect 15 days after its publication in the Official Gazette. Specifically, the use and settlement of funds for medical examination and treatment shall be implemented from January 1, 2005. Previous regulations contrary to this Circular are hereby abolished. Any issues encountered during implementation should be reported promptly to the Ministry of Health for review, amendment, and supplementation as appropriate.