Consolidated Document number 14/VBHN-BYT stipulates uniform service fees for medical examination and treatment under health insurance between hospitals of the same level nationwide and provides guidance on applying these fees and settling costs for medical examination and treatment in certain cases.

CIRCULAR

UNIFIED PRICING OF HEALTH INSURANCE SERVICES FOR DIAGNOSTIC AND TREATMENT BETWEEN HOSPITALS OF THE SAME RANK ACROSS THE NATION AND GUIDELINES FOR APPLYING PRICES AND PAYING COSTS FOR DIAGNOSTIC AND TREATMENT SERVICES IN CERTAIN CASES

Circular No. 39/2018/TT-BYT dated November 30, 2018 of the Minister of Health stipulating uniform prices for medical examination and treatment services under health insurance between hospitals of the same level nationwide and guiding the application of prices and payment of costs for medical examination and treatment services under health insurance in certain cases, which took effect from January 15, 2018, has been amended and supplemented by:

Circular No. 13/2019/TT-BYT dated July 5, 2019 of the Minister of Health amending and supplementing some articles of Circular No. 39/2018/TT-BYT dated November 30, 2018 of the Minister of Health stipulating uniform prices for medical examination and treatment services under health insurance between hospitals of the same level nationwide and guiding the application of prices and payment of costs for medical examination and treatment services under health insurance in certain cases, which took effect from August 20, 2019.

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

Pursuant to the Price Law dated June 20, 2012;

Pursuant to the Law Amending and Supplementing Certain Provisions of the Health Insurance Law on June 13, 2014;

Pursuant to Decree No. 85/2012/NĐ-CP dated October 15, 2012 of the Government on the mechanism of operation and financial mechanism for public health service units and prices of medical examination and treatment services of public medical establishments;

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. 149/2016/NĐ-CP dated November 11, 2016 of the Government amending and supplementing some provisions of Decree No. 177/2013/NĐ-CP dated November 14, 2013 of the Government detailing and guiding the implementation of certain provisions of the Price Law;

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 stipulating 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 issues this Circular stipulating uniform prices for medical examination and treatment services under health insurance between hospitals of the same level nationwide and guiding the application of prices and payment of costs for medical examination and treatment services under health insurance in certain cases.

Article 1. Scope of Regulation and Applicability

1. This Circular stipulates uniform prices for medical examination and treatment services under health insurance between hospitals of the same level nationwide and guides the application of prices and payment of costs for medical examination and treatment services under health insurance in specific cases.

2. This Circular applies to healthcare facilities, units, organizations, and individuals involved in the process of medical examination and treatment and settlement of costs for medical examination and treatment according to the health insurance regime.

3. For medical examination and treatment services not reimbursable from the health insurance fund, the price framework and authority to set price levels shall be implemented in accordance with the Price Law, Medical Examination and Treatment Law, Local Administration Organization Law, and guiding documents.

Article 2. Prices of medical examination and treatment services under health insurance

1.2 Prices of medical examination and consultation services as specified in Appendix I attached hereto.

2.3 Prices of daily bed charges as specified in Appendix II attached hereto.

3.4 Prices of medical technology services as specified in Appendix III attached hereto.

4.5 Adding notes to some medical technology services that have been ranked equivalent by the Ministry of Health in Decision No. X of the Ministry of Health as specified in Appendix IV attached hereto.

Article 4. Structure of Health Insurance Diagnostic and Treatment Service Prices

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

1. Direct costs included in the price of medical examination

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, equipment, procurement and replacement of assets, tools, and instruments 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 price of daily bed charges for treatment

a) Costs related to clothing, hats, masks, bedding, office supplies, gloves used in examination, injection, infusion, cotton, bandages, alcohol, gauze, saline solution, and other consumables serving daily care and treatment (including costs for changing dressings for inpatients, except in cases paid outside the daily bed charge price as stipulated in Clause 5 and Clause 6, Article 7 of this Circular); electrodes, ECG cables, blood pressure cuffs, SPO2 cables in the use of patient monitoring machines for intensive care beds.

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

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

3. Direct costs included in the price of medical technology services

a) Costs related to clothing, hats, masks, bedding, office supplies, drugs, infusions, chemicals, consumables, and replacement materials used during the provision of medical technology services;

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

4. Salary costs included in the price of medical examination, daily bed charges, and medical technology services include:

a)6 Salary grade, position level, allowances, and contributions according to the state regulations for public service units and the minimum wage level prescribed in Decree No. 38/2019/ND-CP dated May 9, 2019 of the Government on the minimum wage level for civil servants, public officials, and military personnel.

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

5. The salary costs included in the service price as stipulated in Clause 4 of this Article do not include expenditures under the state budget regulations provided in the following documents:

a) Decree No. 64/2009/ND-CP dated July 30, 2009 of the Government on policies for medical officers and public officials working in areas with extremely difficult socio-economic conditions;

b) Decree No. 116/2010/ND-CP dated December 24, 2010 of the Government on policies for public officials, civil servants, and personnel receiving salaries in the armed forces working in areas with extremely difficult socio-economic conditions;

c) Decision No. 46/2009/QD-TTg dated March 31, 2009 of the Prime Minister on special allowances for officers and public officials working at the Vietnam Friendship Hospital, Thong Nhat Hospital, Da Nang Hospital C under the Ministry of Health, Central Units 1, 2, 2B, 3, and 5 Protection Departments, Department A11 Military Central Hospital 108, and Department A11 Military Traditional Medicine Institute (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/NĐ-CP dated December 14, 2004 of the Government on salary systems for civil servants, public officials, and military personnel and Decree No. 76/2009/NĐ-CP dated September 15, 2009 of the Government amending and supplementing some articles of Decree No. 204/2004/NĐ-CP dated December 14, 2004 of the Government on salary systems for civil servants, public officials, and military personnel.

6. Payment for medical examination and treatment services between social insurance agencies and healthcare facilities according to the service prices specified in this Circular and costs for medicines, chemicals, medical supplies not included in the service prices (specifically noted in each service), blood, and blood products shall be made in accordance with the principles set forth in Article 24 of Decree No. 146/2018/ND-CP dated October 17, 2018 of the Government detailing and guiding the implementation of certain provisions of the Law on Health Insurance.

7. The costs specified in Clauses 1, 2, 3, and 4 of this Article are determined based on economic and technical norms, cost standards issued by competent authorities, the prices of cost factors, actual reasonable cost levels according to current regulations and policies, ensuring average and advanced standards, meeting quality service requirements. Economic and technical norms serve as the basis for establishing service prices for medical examinations and treatments but are not used as grounds for payment for specific medical examination and treatment services (except for certain special cases stipulated in Clause 6 of Article 5, Clause 16 of Article 6, and Clause 8 of Article 7 of this Circular). During implementation, if there are unsuitable norms, units and localities should report to the Ministry of Health for review and adjustment of norms and prices accordingly.

Article 4. Principles for applying service prices to healthcare facilities that have signed health insurance examination and treatment contracts

1. Hospitals with beds, medical centers with functions of examination and treatment, licensed to operate as hospitals; district medical centers with functions of examination and treatment, classified as hospitals: shall apply the price level of equivalent hospital grades.

2. Provincial or municipal administrative health protection clinics not directly affiliated with provincial or municipal general hospitals: shall apply the outpatient examination price level of Grade II hospitals.

3. Examination and treatment facilities not yet classified; military clinics, military-civilian clinics, military infirmaries, infirmaries; private multi-specialty and specialty clinics: shall apply the price level of Grade IV hospitals.

4. For regional multi-specialty clinics:

a) In cases where a license to operate a hospital has been granted or where the provisions stipulated in Clause 12, Article 11 of Decree No. 155/2018/NĐ-CP dated November 12, 2018 of the Government amending and supplementing certain regulations related to investment conditions under the management of the Ministry of Health apply: shall apply the price level of Grade IV hospitals;

b) In cases where only emergency, outpatient examination and treatment tasks are performed: shall apply the price level of Grade IV hospitals. For cases where the Department of Health decides on bed retention: shall apply a price equal to 50% of the daily ward price of Grade IV hospitals' internal medicine type 3 wards. The maximum number of days for payment is 03 days/person/treatment session. Examination fees will not be paid if bed retention fees at the health station have already been paid.

5. Commune, ward, town health stations, health stations of agencies, units, organizations, schools, combined civilian-military health stations:

a) Outpatient examination fee: shall apply the price level of commune health stations. Technical service fees shall be 70% of the technical service fees listed in Appendix III.

b) For commune health stations decided by the Department of Health to retain beds: shall apply a price equal to 50% of the daily ward price of Grade IV hospitals' internal medicine type 3 wards. The maximum number of days for payment is 03 days/person/treatment session. Examination fees will not be paid if bed retention fees at the commune health station have already been paid.

6. In cases where patients have health insurance cards but use examination and treatment services according to their own requirements, the payment for examination and treatment costs under health insurance shall be implemented according to the provisions set out in point a, Clause 1, Article 20 of Decree No. 85/2012/NĐ-CP dated October 15, 2012 of the Government regarding operational mechanisms, financial mechanisms for public health institutions and service prices for examination and treatment at public examination and treatment facilities.

Article 5. Determining the number of times, price level, and payment for outpatient examination fees in certain specific cases

1. In cases where patients come to the outpatient department for examination and are then referred for inpatient treatment based on professional requirements, the payment for examination fees shall be implemented according to the provisions of Clause 3 of this Article. If patients do not register for examination at the outpatient department but come for examination and inpatient treatment at clinical departments based on professional requirements, examination fees will not be paid.

2. Healthcare facilities that organize specialized examinations in clinical departments, where patients register for examination at the outpatient department and specialized examinations at clinical departments, shall be considered as having undergone an outpatient examination. The calculation of the number of examinations and pricing shall be carried out according to the provisions of Clause 3 of this Article.

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

4. Patients who come to a healthcare facility for examination, have been examined and prescribed medication for home treatment, but later show abnormal symptoms and return to the same facility for re-examination on the same day and continue to be examined, this visit shall be considered as the second visit or subsequent visits within the same day. Payment shall be made according to the provisions of Clause 3 of this Article.

5. A patient who comes to a multi-disciplinary health center for outpatient examination and is then referred to a hospital or district health center for further examination shall be considered as a new outpatient examination.

6. Healthcare facilities must coordinate and arrange human resources and examination tables to ensure the quality of outpatient examinations. For examination tables with more than 65 examination sessions/day: the social insurance agency will only pay 50% of the examination fee from the 66th session onwards for that examination table. Within a maximum period of one quarter, if a healthcare facility still has examination tables with more than 65 sessions/day, the social insurance agency will not pay for examination fees from the 66th session onwards for those examination tables.

Article 6. Determining the number of days for bed occupancy, applying the price level, and settling the bed day fee between the social insurance agency and healthcare facilities.

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:

- Patients with severe conditions undergoing inpatient treatment whose condition has not improved, who have died, or whose condition has worsened but their family requests to be discharged or transferred to a higher-level facility;

- Patients who have been treated at a higher-level facility through the emergency phase but still require continued inpatient treatment and are transferred back to a lower-level facility or to another healthcare facility;

b) The number of inpatient treatment days equals the discharge date minus the admission date: applicable to all other 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) and the treatment time exceeds four hours but is 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 outpatient examination fee, medication costs, medical supplies, and technical service fees will be settled, but the bed day fee for intensive care will not be settled.

d) If a patient's treatment time from admission to discharge is four hours or less, only the outpatient examination fee, medication costs, medical supplies, and technical service fees that the patient has used will be settled, and the inpatient bed day fee will not be counted.

2. When a patient transfers between two departments within the same day, each department shall be counted as half a day. If a patient transfers among three or more departments within the same day, the bed day fee for that day shall be calculated as the average of the highest-priced bed day fee at the department where the patient stayed for over four hours and the lowest-priced bed day fee at the department where the patient stayed for over four hours.

3. The maximum bed day fee for surgical and burn wards shall apply up to ten days after surgery. From the eleventh day post-surgery onwards, the bed day fee for internal medicine wards according to the corresponding departments specified in Section 3 of Appendix II issued together with this Circular shall apply.

4. The bed day fee is calculated for one person per bed. If two people share one bed at the same time, only half the fee will be settled; if three or more people share one bed, only one-third of the bed day fee for inpatient treatment will be settled.

5. The bed day fee 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 departments, or ICU-detoxification centers, and these departments meet the operational conditions stipulated in Decision No. 01/2008/QĐ-BYT dated January 21, 2008, issued by the Minister of Health regarding the regulation on emergency care, intensive care, and detoxification (hereinafter referred to as Decision No. 01/2008/QĐ-BYT).

b) In the Emergency Department or Anesthesia Recovery Department, some beds are used for intensive treatment; postoperative beds for special surgeries and these beds meet the requirements of ICU beds as stipulated in the Regulation on Emergency Care, Intensive Care, and Detoxification issued together with Decision No. 01/2008/QĐ-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 care, intensive care, and detoxification regulations. Other cases will only be eligible for the bed day fee for intensive care and other types of beds as specified in Appendix II issued together with this Circular.

6. For clinical departments with ICU beds (for example, pediatric departments with pediatric ICU beds, neonatal departments, or specialized care for premature infants): the bed day fee for intensive care as specified in Service No. 2 of Appendix II issued together with this Circular shall apply.

7. Hospitals classified as Class III, Class IV, or unranked but approved by the competent authority to perform special surgeries: the highest bed day fee for surgical wards of the hospital performing the service shall apply.

Example: At Hospital A, which is approved to perform special surgeries: If the hospital is ranked as Class III, the bed day fee for surgical ward after Class I surgery of a Class III hospital shall apply; if the hospital is ranked as Class IV or unranked, the bed day fee for surgical ward after Class I surgery of a Class IV hospital shall apply.

8. In cases where a surgery is classified differently across various specialties (excluding pediatrics) as stipulated in Circular No. 50/2014/TT-BYT dated December 26, 2014, issued by the Minister of Health regarding the classification of surgeries, procedures, and staffing levels for each surgery and procedure (hereinafter referred to as Circular No. 50): the bed day fee for surgical and burn wards shall apply based on the lowest surgery classification.

9. Surgeries classified by the Ministry of Health as equivalent to those specified in this Circular but classified differently across specialties as stipulated in Circular No. 50: the bed day fee for surgical and burn wards shall apply based on the surgery classification specified in Circular No. 50.

10. For surgeries not classified under Circular No. 50: the bed day fee for surgical ward type 4 of the corresponding hospital class shall apply.

11. For Traditional Medicine Hospitals directly under the Ministry of Health classified as Class I: the bed day fee shall apply according to the corresponding departments of a Class I hospital, and the fees of specialized hospitals directly under the Ministry of Health in Hanoi and Ho Chi Minh City shall not apply.

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

a) ICU Bed: as stipulated in Clause 5 of this Article;

b) Emergency ICU Bed: as stipulated in Clause 6 of this Article;

c) Patients treated in oncology and pediatric departments: the bed day fee for internal medicine ward type 1 shall apply;

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

đ) Patients treated in other departments: the bed day fee for internal medicine ward type 3 shall apply.

13. For healthcare facilities organizing departments in a multi-disciplinary format: apply the daily bed rate for the lowest-priced internal medicine specialty among the corresponding departments based on the hospital's classification level.

14. Only in cases of overload, healthcare facilities may add extra beds beyond the planned allocation to serve patients and these will be included in the settlement with the social insurance agency as stipulated in Clause 16 of this Article.

15. In cases where patients lie on stretchers or foldable beds: apply a price equal to 50% of the daily bed rate specified for each type of specialty as detailed in Appendix II attached hereto.

16. The quarterly settlement of daily bed fees between the social insurance agency and healthcare facilities shall be carried out as follows:

a) Determine the actual number of beds used in the quarter (year) = Total number of days of inpatient treatment in the quarter (year) divided by the actual number of days in the quarter (year being 365 days), wherein the number of inpatient treatment days is converted according to the principle: stretcher bed, foldable bed, two-person shared bed: two converted bed days equals one day; three-person or more shared bed: three converted bed days equals one day.

b) In cases where the actual number of beds used in the quarter is lower than or equal to 120% of the allocated bed plan: pay 100% of the total amount based on the actual number of bed days and the prescribed rates.

c) In cases where the actual number of beds used exceeds 120% of the allocated bed plan in a year, the healthcare facility and the social insurance agency shall determine and agree on the payment method as follows:

- Determine the actual bed usage ratio per quarter (hereinafter referred to as the bed usage ratio) by dividing the actual number of beds used in the quarter by the actual number of beds used in 2015 (the year before the direct settlement was implemented) multiplied by 100%. In cases where the actual bed usage ratio calculated as above:

+ Is less than or equal to 130%: the health insurance agency pays the healthcare facility 100% of the total amount based on the actual number of bed days and the prescribed rates;

+ Exceeds 130% but does not exceed 140%: the health insurance agency pays the healthcare facility 97% of the total amount based on the actual number of bed days and the prescribed rates;

+ Exceeds 140% but does not exceed 150%: the health insurance agency pays the healthcare facility 95% of the total amount based on the actual number of bed days and the prescribed rates;

+ Exceeds 150%: the health insurance agency pays the healthcare facility 90% of the total amount based on the actual number of bed days and the prescribed rates.

d) In cases where healthcare facilities are consistently overloaded due to objective reasons such as: expansion of administrative boundaries, increase in the number of registration cards for initial medical examination and treatment: the Department of Health has the responsibility to report to the provincial People's Committee for consideration and assignment of additional beds and staffing positions to ensure the quality of medical examination and treatment services.

đ) In cases where healthcare facilities put construction projects, renovation, expansion, upgrading, or newly built facilities into operation without having been assigned additional beds by the competent authority: the Department of Health and the social insurance agency shall agree on the additional bed capacity of this area to be added to the previously assigned planned bed capacity to implement the settlement as stipulated in this clause.

17.8 Daily bed fee for surgical ward after performing "Phaco Cataract Surgery" shall apply the daily bed fee rate for "Burn Ward Surgical Ward" of type 3 corresponding to the hospital's classification level as detailed in Appendix II attached hereto.

Article 7. Application of prices and payment conditions for certain special technical services

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

a) For specific services that have been defined with prices in the appendices issued together with this Circular: apply the defined prices.

b) For technical services that have not been defined with prices in the appendices issued together with this Circular but have been classified as equivalent in terms of technology and cost: apply the prices of services classified by the Ministry of Health as equivalent in terms of technology and cost.

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 new medical technical services prescribed in Clause 1 and Clause 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 as equivalent in terms of technology and cost) which have not yet been defined with prices: healthcare facilities shall establish standard costs, pricing schemes, propose prices, and report to the Ministry of Health for review and determination of prices.

3. For technical services that have been approved by the competent authority (Ministries and central agencies for units under central management, Departments of Health for units under local management) in the list of technical services (excluding care services already included in the cost of daily bed treatment, services that are part of another service process) but have not yet been defined with prices; technical services that have been ordered but cannot be performed due to disease progression or patient condition: settle according to the actual quantity of drugs and materials used for the patient and the purchase price as prescribed by law.

4. In cases where multiple interventions are performed during the same surgery: settle according to the highest-priced complex surgery, and other technical services arising outside the surgical procedure shall be settled 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: settle at 80% of the price of the additional service.

5. For the service "Changing bandages for wounds or incisions up to 15 cm long": only settle for inpatients in the following cases: infected wounds or incisions; wounds with fluid leakage, blood in skin abrasions, exposed skin areas larger than 6 cm; wounds with gauze packing; leg wounds with drainage tubes leaking fluid; multiple wounds or incisions; or after one surgery but requiring two or more incisions; do not apply for changing bandages in the following cases: laparoscopic surgery, changing bandages for incisions or common wounds, changing umbilical cord bandages for newborns.²6. For the service "Changing bandages for incisions longer than 15 cm to 30 cm" in inpatient treatment, it only applies in certain cases as follows:

6. For the service "Changing bandages for surgical 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.

7. For indirect Coombs test at 37°C using anti-globulin serum in blood transfusion: Reimburse according to the price of the "Reaction with anti-human globulin" service with serial number 1340 or 1341 in Appendix III.

8. The settlement and finalization of payments for certain technical services such as: Routine X-ray, Digital Radiography (for diagnosis), Computed Tomography up to 32 slices (for diagnosis, service serial number 42, 43 in Appendix III), Ultrasound (service serial number 1, 2 in Appendix III), Magnetic Resonance Imaging (MRI), service serial number 67, 68 in Appendix III, shall be carried out quarterly between the health insurance agency and healthcare facilities as follows:

a) Determine the maximum number of cases that the social insurance agency will reimburse according to the price set forth in this Circular by dividing the average number of cases based on the pricing standard by 8, then multiply the result by the actual working hours of the unit, then multiply by the actual number of working days in the quarter, then multiply by the actual number of machines in operation at the healthcare facility during the quarter, and finally multiply by 120%.

b) Pricing standard (number of cases per machine per 8-hour working day): Ultrasound service is 48 cases; Routine X-ray, Digital Radiography is 58 cases; Computed Tomography up to 32 slices is 29 cases; Magnetic Resonance Imaging (MRI) is 19 cases.

c) In case the number of cases proposed for reimbursement is less than or equal to the maximum number of cases calculated under point a of this clause: the social insurance agency will reimburse according to the actual number of cases and the price set forth in this Circular.

d) In case the number of cases proposed for reimbursement exceeds the maximum number of cases calculated under point a of this clause: For the number of cases equal to the maximum number of cases calculated under point a of this clause, the social insurance agency will reimburse according to the price set forth in this Circular. For the number of cases exceeding the maximum number of cases calculated under point a of this clause, the social insurance agency will reimburse according to the price excluding salary costs, with specific payment rates as follows:

- Diagnostic Ultrasound Service: 55% of the prescribed price.

- Routine X-ray; Digital Radiography: 85% of the prescribed price.

- Computed Tomography up to 32 slices Service: 95% of the prescribed price.

- Magnetic Resonance Imaging (MRI) service: 97% of the prescribed price.

Example: Healthcare Facility A has 3 operating X-ray machines, with actual working hours of 9 hours (1 extra hour per day); the healthcare facility organized medical examinations on Saturdays in Quarter III/2018 for 92 days, with 78 working days in the quarter.

The maximum number of cases that the health insurance agency will pay according to the X-ray price specified in this Circular is: (58:8) X 9 X 3 X 78 X 120% = 18,322.2 cases.

If the total number of X-ray cases proposed for payment by the facility in the third quarter of 2018 is less than or equal to 18,322 cases, it will be paid according to the price specified in this Circular.

If the number of cases proposed for reimbursement by the healthcare facility exceeds 18,322 cases, assuming it is 20,000 cases, the health insurance agency will reimburse 18,322 cases according to the price set forth in this Circular; the remaining 1,678 cases (= 20,000 cases - 18,322 cases) will be reimbursed by the health insurance agency at a rate of 85% of the prescribed price in this Circular.

9. The provisions in Clause 8 of Article 8, Clause 6 of Article 5, and Clause 16 of Article 6 of this Circular only apply to settlements between the social insurance agency and healthcare facilities, and do not apply to calculating co-payment costs for patients.

10. During natural disasters or epidemics, the social insurance agency will reimburse healthcare facilities according to the actual prices and quantities of services provided, without applying the settlement provisions in Clause 8 of Article 8, Clause 6 of Article 5, and Clause 16 of Article 6 of this Circular.

Article 8. State budget guarantee for costs not included in the price of medical examination and treatment services

1. Ministries, central agencies shall consolidate and report to the Ministry of Finance; Provincial Departments of Health shall consolidate and report to the People's Committees of provinces to continue ensuring the budget according to the budget allocation and current regulations regarding the source of implementing salary policy reform for:

a) Expenses according to the regulations stipulated in the documents mentioned in Clause 5 of Article 3 of this Circular.

b) State budget funds to implement salary policy reform according to the current government regulations on the basic salary for civil servants, public officials, and armed forces personnel.

2. In cases where the revenue of the unit does not ensure regular operations, and the unit is classified by the competent authority as a public service organization self-financing part of its regular expenses or a public service organization fully financed by the state for regular expenses: the unit will continue to receive state budget funding for the shortfall in regular expenses to ensure the benefits for employees and the normal operation of the unit according to the current budget management hierarchy.

Article 9. Implementation Organization

1. Responsibilities of the Ministry of Health:

a) Department of Planning and Finance:

- Serve as the unified contact point to coordinate with relevant departments and bureaus of the Ministry of Finance to review, adjust, and supplement the prices of medical examination and treatment services promptly when adding factors forming the price according to the schedule, state adjustments to salary policies, economic-technical standards, or changes in cost factors forming the price.

- Serve as the contact point, coordinating with related units to organize the implementation, inspection, interim summary, and overall assessment of the implementation of this Circular nationwide.

b) Medical Examination and Treatment Management Department serves as the contact point, coordinating with relevant departments and units to direct medical examination and treatment facilities to strictly implement professional regulations, implement comprehensive measures to improve service quality; organize inspections, audits, and supervision of professional activities related to service, drug, and material prescriptions, patient admissions for inpatient treatment, and other professional activities.

c) Health Insurance Department serves as the contact point, coordinating with relevant departments, the Inspectorate of the Ministry, and related units to organize inspections, supervision, or directing Provincial Health Departments and health management agencies of ministries and sectors to organize inspections and supervision of medical examination and treatment facilities, related units, and organizations in the implementation of this Circular's regulations.

d) The Inspectorate of the Ministry of Health takes the lead, coordinating with relevant departments, bureaus, and units to organize inspections or directing Provincial Health Departments and health management agencies of ministries and sectors to organize inspections of medical examination and treatment facilities, related units, and organizations in the implementation of this Circular's regulations.

2. Responsibilities of the Vietnam Social Security:

a) Implement this Circular, direct social insurance agencies at all levels to make timely payments according to current regulations and this Circular to medical examination and treatment facilities. During the implementation process, if any price discrepancies are found, issue a document to request the Ministry of Health to review and adjust.

b) Annually (monthly, quarterly, semi-annually, and annually), report to the Ministry of Health, directing social insurance agencies at all levels to report to provincial People's Committees, Departments of Health, health management agencies under ministries and sectors on cases of excessive use of services, medicines, medical supplies, and improper hospitalization of patients.

3. Responsibilities of the Health Departments:

a) Take the lead and coordinate with relevant units to organize the implementation, inspection, supervision, interim review, and final summary of this Circular within their jurisdiction.

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

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

4. Responsibilities of healthcare facilities:

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

b) Strictly implement medical regulations, particularly regarding the hospitalization of patients; transfer referrals, and the use of services, medicines, and medical supplies according to regulations.

Article 10. Reference Provisions

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

Article 11. Implementation Provisions

1. This Circular takes effect from January 15, 2019. The service fees for outpatient and inpatient care as stipulated in Decree No. 72/2018/NĐ-CP of the Government mentioned in Appendices I, II, and III of this Circular shall be applied from December 15, 2018.

2. Circular No. 15/2018/TT-BYT dated May 30, 2018 of the Ministry of Health on unified pricing of outpatient and inpatient services under health insurance among hospitals of the same level nationwide and guidance on cost reimbursement for such services under health insurance in certain cases will cease to be effective from the date this Circular takes effect.

Article 12. Transitional Provisions

1. Continue to apply the list of technical medical services and treatments classified as equivalent in terms of procedures and costs as specified in Decision No. 7435/QĐ-BYT dated December 14, 2018 of the Minister of Health on the list of technical medical services and treatments classified as equivalent in terms of procedures and costs implemented according to Circular No. 39/2018/TT-BYT.

2. Patients who are undergoing treatment at healthcare facilities before the implementation of the service fee rates prescribed in this Circular and who are discharged or complete their outpatient treatment period after the implementation of the service fee rates prescribed in this Circular shall continue to apply the service fee rates approved by the competent authority prior to the implementation of the service fee rates prescribed in this Circular until discharge or completion of the outpatient treatment period.

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

Place of Receipt: - Office of the Government (Official 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