Joint Circular No. 14/TTLB guiding the collection of part of hospital fees

JOINT CIRCULAR

Guidelines for Implementing the Collection of a Portion of Hospital Fees

Pursuant to Decree No. 95-CP dated August 27, 1994 of the Government on the collection of a portion of hospital fees, Decree No. 33/CP dated May 23, 1995 of the Government amending Point 1 of Article 6 of Decree No. 95-CP, and Decree No. 28/CP dated April 29, 1995 of the Government detailing and guiding the implementation of certain provisions of the Ordinance on Preferential Treatment for Persons Engaged in Revolutionary Activities, Martyrs, and Families of Martyrs, War Invalids, and Persons Contributing to the Revolution, the Ministry of Health - Ministry of Finance - Ministry of Labor, Invalids and Social Affairs - State Price Control Board guide the implementation of the above three Decrees regarding the collection of a portion of hospital fees as follows:

I. GENERAL PRINCIPLES ON THE COLLECTION OF A PORTION OF HOSPITAL FEES:

1. A portion of hospital fees is part of the total cost for medical examination and treatment. A portion of hospital fees only includes charges for medicines, intravenous fluids, blood, chemicals, tests, X-rays, essential consumables, and medical services; it does not include depreciation of fixed assets, regular maintenance costs, administrative expenses, training, scientific research, construction investment in facilities and major equipment.

2. For outpatients, the fee schedule for collecting a portion of hospital fees is calculated based on each medical consultation and technical services directly used by the patient.

3. For inpatients, the fee schedule for collecting a portion of hospital fees is calculated based on the daily inpatient bed rate of each specialty according to the hospital classification level and actual direct expenses incurred for the patient, including: medicine, blood, intravenous fluids, tests, X-rays, and contrast agents.

II. OBJECTS SUBJECT TO AND EXEMPT FROM PAYMENT OF A PORTION OF HOSPITAL FEES:

A. Objects subject to payment of a portion of hospital fees:

1. Individuals without a health insurance card (BHYT), who do not fall under the category exempt from paying a portion of hospital fees.

2. Individuals with a BHYT card but who wish to seek medical examination and treatment according to their own requirements.

3. Individuals belonging to the category exempt from paying a portion of hospital fees but who wish to seek medical examination and treatment according to their own requirements.

B. Objects exempt from payment of a portion of hospital fees:

1. Children under six years old.

2. Individuals suffering from schizophrenia, epilepsy, leprosy, pulmonary tuberculosis.

3. Patients residing in communes recognized by the Ethnic Minorities Commission and mountainous regions as highland areas.

4. Ethnic minorities engaged in land reclamation and economic new zones for a period of three years from the date of arrival.

5. Disabled individuals, orphans, elderly people without support, and patients in extreme poverty certified by the Department of Labor, Invalids, and Social Affairs at the district or county level. The certificate is valid for two years from the date of issuance.

6. Individuals granted a "Free Medical Examination and Treatment Card" due to organ donation.

C. Patients with a health insurance card will have a portion of hospital fees paid by the health insurance agency when seeking medical examination and treatment at healthcare facilities.

D. The following objects shall be provided with state funds by the Department of Labor, Invalids, and Social Affairs to purchase health insurance cards directly, and when seeking medical examination and treatment, the health insurance agency will pay a portion of hospital fees to healthcare facilities.

1. Cadres engaged in revolutionary activities before 1945 currently receiving monthly living allowances.

2. War invalids, persons entitled to benefits equivalent to war invalids due to disability caused by injury amounting to 21% or more.

3. War invalids due to illness causing disability amounting to 41% or more.

4. Parents, spouse, or children of martyrs currently receiving monthly allowances.

5. Persons entitled to service benefits and the first and second children under 18 years old of war invalids or war invalids due to illness causing disability amounting to 81% or more.

6. Persons contributing to the revolution before August 19, 1945 currently receiving monthly allowances.

7. Persons captured and sentenced to prison for revolutionary activities with certification as prescribed.

8. Mothers honored with the title "Heroic Mother Vietnam."

9. Heroes of the Armed Forces, Heroes of Labor.

10. Persons supporting martyrs currently receiving monthly allowances.

11. Persons injured at work or suffering from occupational diseases and currently receiving monthly allowances.

12. Rubber plantation workers retired and receiving monthly allowances pursuant to Decision No. 206/CP dated May 30, 1971 of the Council of Ministers concerning allowances for rubber plantation workers who have retired.

The contribution rate for health insurance for the objects specified in Section D, Part II of this Circular is 3% of the current minimum wage.

III. CALCULATION OF THE PRICE FOR A PORTION OF HOSPITAL FEES:

A. For outpatient patients:

The fee schedule is calculated for each medical consultation and each type of technical service, test, X-ray, therapeutic procedure, and medication provided to the patient.

Technical services include: various procedures and minor procedures applied in diagnosis and treatment across specialties.

Tests include: biochemical tests, hematological tests, microbiological tests, histopathological tests, electrophysiological tests, and imaging diagnostics.

The calculation of the price for each medical consultation and each type of technical service and test includes: consumable materials, chemicals, X-ray films, contrast agents, and a portion of other necessary costs to perform the service.

B. For inpatient patients:

1. The fees collected for a portion of hospital fees for inpatient patients include the following items:

a) Bed day fees including: a portion of common consumables and a portion of regular expenses necessary for medical examination and treatment and patient care.

b) Actual direct expenses incurred for the patient including: medicine, blood, intravenous fluids, tests, X-rays, and contrast agents.

2. Inpatient bed days as mentioned in point a, clause 1, section B, part III above are classified as follows:

a) Intensive Care and Obstetric Bed Days:

These are the bed days of patients treated in intensive care units, delivery days, and two post-delivery observation days.

b) Internal Medicine Bed Days:

These are the bed days of patients treated in internal medicine departments within hospitals, divided into three types as follows:

- Type 1: Includes departments such as Infectious Diseases, Respiratory Diseases, Hematology, Oncology, Cardiovascular Diseases, Neurology, Pediatrics, Gastroenterology, Nephrology; days starting from the third day after delivery and post-surgical days starting from the eleventh day after surgery.

- Type 2: Includes departments such as Orthopedics, Dermatology, Allergy, Otorhinolaryngology, Ophthalmology, Dentistry, General Surgery, Non-Surgical Obstetrics.

- Type 3: At departments such as Traditional Chinese Medicine, Rehabilitation.

c) Surgical and Burn Bed Days:

Is the number of inpatient days for patients after surgical interventions and burn treatments, including four types as follows:

- Type 1: After special category surgeries; Third to fourth degree burns covering more than 70%.

- Type 2: After category 1 surgeries; Third to fourth degree burns covering from 25% to 70%.

- Type 3: After category 2 surgeries; Second degree burns covering more than 30%, third to fourth degree burns covering less than 25%.

- Type 4: After category 3 surgeries; First degree burns, second degree burns covering less than 30%.

(the classification of surgeries is applied according to Circular No. 21/BYT-TT dated July 28, 1981 issued by the Ministry of Health).

3. The calculation of inpatient days for patients is as follows: subtract the admission date from the discharge date. If a patient is admitted and discharged on the same day, it counts as one day.

C. Specific Pricing:

1. The Inter-Ministerial Committee temporarily promulgates the "Partial Hospital Fee Framework" attached to this Circular for application at state health examination and treatment facilities.

2. To align with current economic and social conditions and varying average incomes across regions, the Chairman of the People's Committee of provinces and centrally-administered cities shall issue local pricing schedules; the Minister of Health shall issue pricing schedules for hospitals and research institutes under the Ministry of Health and hospitals under other Ministries and sectors, but prices must fall within the framework set by the Inter-Ministerial Committee as attached to this Circular.

3. For specific healthcare services not covered by the pricing framework detailed in Part A "Health Examination and Health Check-up Price Framework" and Part C "Technical Service and Laboratory Test Price Framework" of the pricing framework attached to this Circular, pricing shall be based on equivalent service frameworks, temporarily determined by the Chairman of the Provincial People's Committee and the Minister of Health, subsequently the Ministry of Health will compile a list of these services to propose to the Inter-Ministerial Committee for supplementation.

4. In cases where price indices fluctuate necessitating adjustments to the pricing framework, the Inter-Ministerial Committee authorizes the Ministry of Health to reissue guidelines for partial hospital fee pricing after consultation with the Ministry of Finance and the Government Price Control Board.

IV. FORM OF PARTIAL HOSPITAL FEE COLLECTION:

A. For outpatient patients:

Collection is based on the pricing schedule specified for each outpatient visit and technical service, laboratory test, radiography, fluoroscopy, and contrast media... provided to the patient.

The amount collected for each outpatient visit and services, laboratory tests... is based on the pricing framework detailed in Part A: "Health Examination and Health Check-up Price Framework" and Part C: "Technical Service and Laboratory Test Price Framework", attached to this Circular.

B. For inpatients: the collection includes two parts as follows:

1. Bed day fees: calculated by multiplying the total number of inpatient days by the applicable bed rate for each specialty as stipulated in Part B1: "Daily Bed Rate Price Framework".

2. Direct costs incurred for the patient: including drug costs, intravenous fluids, blood, laboratory tests, X-ray films, and contrast media used during treatment.

Drug costs, intravenous fluids, and contrast media are calculated based on the hospital's purchase price. Blood costs are charged according to the current regulations. Laboratory tests and X-ray films are priced according to the framework detailed in Part C: "Technical Service and Laboratory Test Price Framework", attached to this Circular.

To alleviate difficulties for seriously ill patients who incur high direct costs but lack the ability to contribute, the total amount of the two collections (1) and (2) above shall not exceed the maximum amount calculated according to the pricing framework detailed in Part B2: "Maximum Daily Inpatient Treatment Cost Table" (multiply the price for each type of inpatient day in this table by the number of inpatient days for the patient). In cases where patients voluntarily choose treatment beyond their needs, they must pay the full actual cost.

C. Patients required to pay partial hospital fees shall directly pay the hospital fees to the hospital.

D. Patients with health insurance cards: the health insurance agency will settle all actual costs and bed day fees with the hospital according to the hospital fee schedule applicable at each hospital.

E. In cases where patients require long-term post-operative inpatient care, starting from the eleventh day, bed day fees will be charged according to the internal medicine bed day price schedule for type 1 beds, as detailed in Part B1: "Daily Bed Rate Price Framework".

F. In cases where inpatients need outpatient examinations and treatments at other hospitals as prescribed by their treating physician, the following procedures apply:

1. If the patient falls under the category required to pay partial hospital fees: the patient will directly settle the fees with the hospital providing outpatient care.

2. If the patient has a health insurance card: the health insurance agency will settle the fees with the hospital providing outpatient care.

3. If the patient falls under the exemption category for partial hospital fees as stipulated in Point B, Part II of this Circular, no payment is required.

Healthcare facilities (collectively referred to as Hospitals) have the responsibility to ensure the provision of drugs, intravenous fluids, blood, chemicals, laboratory tests, X-ray films, contrast media, and essential consumables for patients. Specifically, essential drugs listed in the main drug directory shall not be purchased by patients according to the decision of the Ministry of Health.

V. DISTRIBUTION AND USE OF FUNDS COLLECTED FROM PARTIAL HOSPITAL FEES

The revenue from partial hospital fees, including hospital fees settled by the health insurance agency for patients, is part of the state budget revenue, retained by the unit for use as follows:

1. 70% is used by healthcare facilities collecting such hospital fees to supplement funds for purchasing drugs, intravenous fluids, blood, chemicals, X-ray films, medical supplies, equipment, including clothing, quilts, mosquito nets, beds, mats, and low-cost consumables quickly worn out to serve patients promptly.

2. 30% is used as follows:

a) 25%-28% is used to reward employees with high sense of responsibility, excellent performance in their professional duties, and dedicated service to patients.

b) 2%-5% remaining is transferred to the supervisory authority (hospitals under the Ministry of Health transfer to the Ministry of Health; hospitals of provinces and centrally-administered cities transfer to the provincial Department of Health; hospitals of sectors transfer to the supervisory Ministry or sector) to establish a support fund for hospitals without the conditions to collect hospital fees and to reward units and individuals with outstanding achievements in health examination and treatment work.

The Ministry of Health, provincial health departments under central cities, and relevant ministries and sectors shall be responsible for guiding the reward regulations and specifying the specific amount to be transferred to the supervising authority for each type of hospital.

VI. IMPLEMENTATION ORGANIZATION:

1. Hospitals must organize a separate billing department for collecting hospital fees, which shall be carried out by the finance and accounting office. At the place where hospital fees are collected, price lists for partial hospital fees must be posted so that patients can be informed. Other departments of the hospital may not collect money from patients in any form.

2. Hospital departments must keep detailed and accurate records of all expenses and the number of days of treatment for each patient in their respective departments to serve as the basis for settlement upon discharge.

3. The hospital director shall establish and be responsible for implementing the advance payment of hospital fees before patients are admitted for inpatient treatment at levels appropriate to each group of diseases, but shall not delay the reception, emergency care, or treatment of patients due to this collection.

4. The hospital director shall be responsible for examining and resolving the issue of waiving the payment of a portion of hospital fees for patients who fall within the category entitled to such waiver as stipulated in Section B, Part II of this Circular, and for waiving the bed fee for patients who are not eligible for the waiver but are experiencing significant difficulties and are unable to pay the full portion of hospital fees.

5. Accounting and statistical reporting:

The amount collected for partial hospital fees shall be recorded under item 13 "Hospital Fee Revenue."

Expenses shall be recorded as follows: 70% of expenses shall be recorded under item 74 "Operating Expense" and item 75 "Business Expense"; 25%-28% of expenses shall be recorded under item 69 "Reward Expense"; 2%-5% of expenses shall be recorded under item 97 "2%-5% Hospital Fee Deduction (including health insurance) to be remitted to the higher-level supervisory authority" according to the current state budget classification.

The collection of hospital fees must use invoices and receipts issued by the Ministry of Finance. Detailed and accurate records of hospital fee collections must be maintained promptly.

Hospitals must open a hospital fee account at the State Treasury at the same level. At least once every five days, hospitals must deposit excess balances beyond the specified reserve fund limit into the hospital fee account for future withdrawal when needed. The reserve fund limit for central-level hospitals is 20 million VND. The reserve fund limit for provincial-level hospitals is 15 million VND. The reserve fund limit for district-level hospitals is 10 million VND. Special cases requiring higher reserve fund limits will be decided by the Minister of Health after consultation with the Minister of Finance.

Quarterly and annually, hospitals must prepare reports on hospital fee revenues and submit them to the supervising authority and the financial authority at the same level. Financial authorities at all levels are responsible for reviewing the revenue and expenditure of hospital fees by the unit, and simultaneously processing the recording of revenue and expenditure through the State Treasury system for hospital fee revenues.

VII. IMPLEMENTATION PROVISIONS:

This Circular takes effect from the date of issuance. All previous regulations contrary to those set forth in this Circular are hereby repealed. This Circular replaces Circular No. 14/TTLB dated June 15, 1989, jointly issued by the Ministry of Health and the Ministry of Finance, and Circulars No. 20/TTLB dated November 23, 1994, and No. 11/TTLB dated June 29, 1995, jointly issued by the Ministry of Health, the Ministry of Finance, the Ministry of Labor, Invalids and Social Affairs, and the State Price Control Board.

During implementation, if hospitals encounter difficulties or obstacles, they should discuss within their leadership and seek opinions from higher authorities and related sectors to coordinate solutions, and must absolutely not cause difficulties for patients, especially in emergency cases and for poor patients.

Those who violate the regulations on collecting partial hospital fees as stipulated in Decree No. 95/CP and this Circular shall be subject to disciplinary action, administrative penalties, or criminal prosecution depending on the severity of the violation, in accordance with the provisions of the law.