Joint Circular No. 15/2008/TTLT-BTC-BYT guides the implementation of medical examination and treatment; management, use, and settlement of medical examination and treatment expenses for children under six years old who do not have to pay at public health facilities.

JOINT CIRCULAR

Guidelines for implementing medical examinations and treatments; managing, using, and settling accounts for medical examination and treatment expenses for children under six years old who do not have to pay at public health facilities

settlement of medical examination and treatment expenses for children under six years old

no payment at public health facilities

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

Pursuant to Decree No. 60/2003/NĐ-CP dated June 6, 2003 of the Government detailing and guiding the implementation of the Law on State Budget;

The Ministry of Finance and the Ministry of Health jointly issue guidelines for implementing medical examinations and treatments; managing, using, and settling accounts for medical examination and treatment expenses for children under six years old who do not have to pay 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.

1. Public health facilities implementing the policy of medical examinations and treatments for children under six years old include health facilities under the Ministry of Health, central ministries, agencies, and units, and localities.

2. The subjects eligible for free medical examinations and treatments at public health facilities as stipulated in this Circular are children under six years old (children who have not reached seventy-two months of age).

3. Medical examination and treatment expenses for children under six years old shall be allocated from the central budget for public health facilities under central ministries, agencies, and units; from the local budget for local public health facilities according to the current administrative division of state budget management.

4. The establishment, allocation, management, use, and settlement of accounts for medical examination and treatment expenses for children under six years old shall be carried out in accordance with the State Budget Law, current guiding documents of the State Budget Law, and the provisions of this Circular.

5. In addition to the state budget funds, public health facilities may solicit financial support from domestic and foreign organizations and individuals for the medical treatment of children under six years old suffering from serious illnesses. Such funds shall be managed and used in accordance with current regulations.

II. PROCEDURES AND FORMALITIES

FOR MEDICAL EXAMINATIONS AND TREATMENTS OF CHILDREN UNDER SIX YEARS OLD

1. Provisions on the level of treatment:

The level of treatment for free medical examinations and treatments for children under six years old at public health facilities shall be implemented according to the following specific provisions:

a) Public health facilities including: Commune Health Stations, District General Hospitals, Provincial General Hospitals, and primary-level health facilities under various ministries and sectors are responsible for initial medical examinations and treatments for children under six years old residing in their respective areas.

b) In cases where the facilities' expertise is exceeded, the facilities providing initial medical examinations and treatments shall transfer children to provincial general hospitals or specialized hospitals within the province, or to general hospitals or specialized hospitals outside the province for appropriate examination and treatment.

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

Based on the organization of the healthcare system in the locality, the Director of the Department of Health shall decide which provincial-level facilities can provide initial medical examinations and treatments for children without referral letters.

2. Procedures for medical examinations and treatments:

a) Children under six years old must present their medical examination and treatment cards when seeking medical care at public health facilities; if they have not been issued such cards, they must present their birth certificates or birth registration certificates or certificates issued by the People's Committee of the commune where the child's guardian resides (hereinafter referred to as medical examination and treatment cards).

b) At the facilities mentioned in points b and c of Clause 1, Section II of this Circular: in addition to presenting the medical examination and treatment card of the child, the family must also present the referral procedures, including the referral letter and summary of the initial medical examination and treatment records (except for cases specified in point d of Clause 1, Section II of this Circular).

c) In emergency situations, children can receive free medical examinations and treatments at any public health facility. The family must present the child's medical examination and treatment card before the child is discharged from the hospital.

3. Responsibilities of public health facilities:

a) Organizing reception work; guiding medical examinations and treatments smoothly, creating favorable conditions, and ensuring full rights for children seeking medical care.

b) In emergency situations, public health facilities have the responsibility to promptly admit and treat children free of charge. Depending on the child's condition, if inpatient treatment is required, the facility will process the admission procedures; if outpatient treatment is deemed sufficient or belongs to the lower level's expertise, the facility will process discharge or referral procedures.

c) In cases where the expertise is exceeded, lower-level facilities must promptly complete the referral procedures to transfer children to higher-level facilities for treatment without delay.

d) Checking medical examination and treatment cards; if there is no card, checking birth registration certificates or birth certificates or certificates issued by the People's Committee of the commune (except for newborns), and referral documents as stipulated in points b and c of Clause 1, Section II of this Circular (for those transferring to higher levels due to technical expertise) immediately upon arrival for medical care.

In special cases, if children under six years old need emergency treatment far from their place of residence and have difficulty traveling and the family does not carry 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 care and be settled into the medical examination and treatment expenses for children under six years old allocated to the facility.

e) Prescribing medications, distributing medications, using medical supplies, conducting tests, imaging diagnostics, functional examinations, rehabilitation services, and necessary technical services according to the child's condition, ensuring safety and rationality in accordance with professional regulations. The Director of the public health facility is responsible for organizing inspections and handling violations according to authority, preventing waste and loss of funds.

e) Ensure the adequate supply of medicines listed in the catalog, blood, intravenous fluids, testing chemicals, X-ray films, contrast agents, medical supplies in accordance with the regulations of the Ministry of Health during the examination and treatment process for children under six years old.

g) Public health facilities have the responsibility to publicly disclose examination and treatment services upon request so that the public can be informed and make choices.

h) Monitor and compile activities related to the examination and treatment of children under six years old and report to the supervising authority on a quarterly basis, specifically on the 15th day of the first month of each quarter.

III. ESTABLISHING, ALLOCATING, ADJUSTING AND SUPPLEMENTING THE BUDGET ESTIMATE

1. For Ministries, agencies, and units at the central level:

a) Annually, within the time frame specified for establishing the state budget estimate, Ministries, agencies, and units at the central level with public health facilities shall establish the budget estimate for the examination and treatment expenses for children under six years old and consolidate it into the annual expenditure budget of the Ministry, agency, or unit at the central level to be submitted to the Ministry of Finance in accordance with the regulations. The bases for establishing the budget estimate include:

- The situation regarding the examination and treatment of children under six years old at public health facilities managed by Ministries, agencies, and units at the central level;

- The projected surplus of the examination and treatment expenses for children under six years old in the implementation year (if any);

- The need for state budget funds allocated for the examination and treatment of children under six years old.

b) Based on the allocated budget estimate for the examination and treatment expenses for children under six years old, Ministries, agencies, and units at the central level are responsible for allocating the budget estimate to subordinate public health facilities according to the current regulations on the allocation of state budget estimates.

c) During the implementation year, Ministries, agencies, and units at the central level may adjust the budget estimate for the examination and treatment expenses for children under six years old between surplus and deficit units under their management to ensure timely funding for the examination and treatment of children under six years old. The procedures and formalities for adjusting the budget estimate among subordinate units shall be carried out in accordance with the current regulations on adjusting state budget estimates.

In cases where there is still a shortage after adjustment of funds; Ministries, agencies, and units at the central level shall submit a document to the Ministry of Finance to consider and decide on supplementary funding from the central government's reserve fund to ensure sufficient and timely funding for the examination and treatment of children under six years old.

2. For localities:

Based on the division of financial tasks stipulated by the Provincial People's Council and the organizational structure of local specialized agencies, the Department of Finance shall take the lead and coordinate with the Department of Health to present to the Chairman of the Provincial People's Committee the procedures for establishing, allocating, adjusting, and supplementing the budget for health facilities to be consistent with the actual conditions of the locality.

In cases where children under six years old from the locality are transferred to examine and treat at public health facilities outside the province as stipulated in point d, Clause 2, Section IV of this Circular (if applicable): Annually, based on the situation of children under six years old from the locality being transferred to examine and treat at public health facilities outside the province (excluding those directly under the Ministry of Health, Ministries, agencies, and units at the central level), the Department of Health shall coordinate with the Department of Finance to determine the specific amount of funds allocated for this task, report to the Provincial People's Committee for consideration and decision to allocate the budget to the Department of Health for implementation in accordance with the current regulations on the allocation and transfer of state budget estimates.

IV. MANAGEMENT, USE, PAYMENT AND SETTLEMENT

1. Management and use of funds:

a) Public health facilities entrusted with managing the examination and treatment expenses for children under six years old shall withdraw the budget estimate from the State Treasury at the transaction location in accordance with the current regulations of the Ministry of Finance guiding the system of management, issuance, and payment of state budget expenditures through the State Treasury.

b) The examination and treatment expenses for children under six years old allocated and transferred to which public health facility shall be directly managed and used by that public health facility to fulfill the free examination and treatment mission for children under six years old at the unit, including cases where children under six years old are transferred to other public health facilities according to the Ministry of Health's regulations on transferring treatment levels.

At the end of the fiscal year, any remaining funds from this source shall be carried over to the next year for continued use in examining and treating children under six years old in the following year; these funds shall not be used for other purposes.

c) For public health facilities granted autonomy and self-responsibility for finance: the examination and treatment expenses for children under six years old shall be accounted for and paid according to the current hospital fee regime of the State, consolidated into regular expenditure sources, and granted autonomy and self-responsibility for finance in accordance with Decree No. 43/2006/NĐ-CP dated April 25, 2006 of the Government and guiding documents for Decree No. 43/2006/NĐ-CP.

Example: In 2007, Health Facility A was allocated a budget estimate of 100 million VND for the examination and treatment expenses for children under six years old. During the year, the unit spent 80 million VND on the examination and treatment of children under six years old: the unit has the right to autonomous and self-responsibility for finance according to Decree No. 43/2006/NĐ-CP and guiding documents for Decree No. 43/2006/NĐ-CP for the amount of 80 million VND; the remaining balance of 20 million VND shall be carried over to the next year for use in examining and treating children under six years old in the following year.

2. Payment of funds:

a) Content and level of payment:

- Costs for medicines, blood, intravenous fluids, consumable materials already issued and used for the treatment of children under six years old: payment shall be made according to the purchase price of the health facility.

- Costs for examination, bed days for treatment, technical services: payment shall be made according to the current hospital fee prices decided by the competent authority for public health facilities.

- Transportation costs for patients who are children in emergency situations or undergoing inpatient treatment and must be transferred to higher-level hospitals according to the regulations of the Minister of Health:

+ In cases where transportation is provided by the public health facility: payment shall be made for fuel costs based on the actual kilometers traveled (for both the outbound and return trips) and the current national fuel rate for each type of vehicle, regardless of the number of patients on the transport vehicle.

In the case where the family members of children do not use the means of public health facilities: the public health facility that introduces the child for transfer shall settle with the family members of the child at a rate of 30,000 VND per 100 km (for a single trip).

- Expenses for purchasing essential medical equipment (not fixed assets) directly serving the examination and treatment of children under six years old: settle according to the purchase price of the public health facility.

- Expenses for nutritional support for children under six years old who are being treated at public health facilities belonging to the categories of homeless children and children from poor households as defined by the state: maximum amount of 30,000 VND per day per child, with a support period not exceeding 30 days. Public health facilities may provide support in kind or directly pay money to the family members of the child, depending on the actual conditions of the public health facility and the specific circumstances of each child.

b) For public health facilities that organize examination and treatment services on demand if the families of children under six years old have a need to use them, the public health facility is allowed to collect from the family of the child the difference between the service cost on demand and the current hospital fee payment level prescribed by the competent authority.

c) In the case where children under six years old have been treated and used various types of medicines, blood, infusions, medical supplies, chemicals, etc., free of charge through approved Programs and Projects, public health facilities are not allowed to settle these expenses into the allocated budget for the examination and treatment of children under six years old.

d) In the case where children under six years old from localities are transferred to public health facilities outside their province (excluding health facilities under the Ministry of Health, other Ministries, agencies, and units at the central level) for examination and treatment, the settlement of funds will be carried out in the following forms:

- The Department of Health (or delegate provincial general hospitals) shall enter into contracts with public health facilities outside the province to carry out examinations and treatments for children under six years old from their locality when transferring; periodically, transfer funds to public health facilities outside the province to settle the costs of examinations and treatments for children under six years old according to the prescribed regulations.

- The family of the child shall settle the examination and treatment costs at the public health facility where the child is being treated according to the current hospital fee level and obtain receipts to return to their locality for settlement. The public health facility of the locality where the child patient was transferred, based on the hospital fee receipt and the examination and treatment records of the public health facility outside the province provided by the family of the child, has the responsibility to settle all costs that the family of the child has paid according to the current hospital fee level.

Based on the actual situation in the locality and the specific circumstances of each child under six years old, the Department of Health is responsible for guiding public health facilities in the locality to consider applying the above settlement methods appropriately, ensuring full benefits for children under six years old when they go for examination and treatment.

3. Accounting and settlement: 

a) Units using the budget for the examination and treatment of children under six years old shall implement accounting and settlement according to the current administrative and public institution accounting regulations. Relevant documents related to the settlement and finalization of the budget for the examination and treatment of children under six years old shall be kept separately to serve the work of compiling, inspecting, supervising, and evaluating the implementation of the examination and treatment of children under six years old.

b) Settlement and finalization documents include:

- Payment voucher for examination and treatment costs for children under six years old (prepared according to the attached model in this Circular): the items recorded in the payment voucher must be consistent with the activities of examination and treatment at the unit and current regulations. The Director of the public health facility is responsible for the accuracy and honesty of the payment voucher. The State Treasury shall base the payment voucher for examination and treatment costs for children under six years old and relevant documents (if any) to control expenditures according to regulations.

- Hospital transfer letter (applicable in cases where children are transferred from lower-level health facilities).

- Copy of poverty certificate and orphan certificate issued by the competent authority (applicable to children under six years old receiving nutritional support).

As for the expenses of the Department of Health for the examination and treatment of children under six years old from the locality who are transferred to public health facilities outside the province as stipulated in Point d Clause 2 Section IV of this Circular, the settlement and finalization documents include: 

+ Examination and treatment contract for children under six years old;

+ Summary table of examination and treatment costs for children under six years old (prepared by the public health facility outside the province).

+ Relevant payment vouchers.

c) Units directly using the budget for the examination and treatment of children under six years old shall account and finalize into Category 15 Item 60, detailed according to the corresponding sub-items of the National Budget Classification currently in effect.

Specifically, for the expenses for the examination and treatment of children under six years old from the locality who are transferred to public health facilities outside the province as stipulated in Point d Clause 2 Section IV of this Circular, units shall account and finalize into Category 119 Sub-item 14.

d) For public health facilities that still have a surplus due to the difference between the cost according to the medical record and the actual expenditure for the examination and treatment of children under six years old, which were not accounted for in Category 15 Item 60 before the effective date of this Circular, the excess amount can be considered for accounting reduction in some items of Category 15 Item 01, while increasing corresponding items of Category 15 Item 60 for the aforementioned difference in the 2007 budget settlement.

4. Consolidation and settlement process:  

a) At the local level:

The Department of Finance, in collaboration with the Department of Health, shall guide the consolidation and settlement of the budget for the examination and treatment of children under six years old to suit the actual conditions of the locality.

b) At the Central level:

- Public health facilities under ministries, agencies, and units at the central level shall consolidate and settle the budget for medical examination and treatment expenses for children under six years old in their unit's final settlement report to be submitted to the respective ministries or managing agencies; such ministries or managing agencies shall be responsible for reviewing and consolidating these reports into the general final settlement report to be sent to the Ministry of Finance for verification in accordance with current regulations.

- The Ministry of Finance shall be responsible for consolidating and settling the medical examination and treatment expenses for children under six years old from ministries, agencies, units at the central level, and localities in the state budget final settlement report to be reported to the Prime Minister in accordance with current regulations.

V. IMPLEMENTATION

1. This Circular shall take effect fifteen days from the date of publication in the Official Gazette and shall replace the following Circulars:

- Circular No. 26/2005/TT-BTC dated April 6, 2005, issued by the Ministry of Finance guiding the management, use, and settlement of medical examination and treatment expenses for children under six years old who do not have to pay at public health facilities;

- Circular No. 14/2005/TT-BYT dated May 10, 2005, issued by the Ministry of Health guiding the implementation of medical examination and treatment and the management, use, and settlement of medical examination and treatment expenses for children under six years old at public health facilities.

2. In case of any difficulties during implementation, they should be promptly reflected to the Ministry of Finance and the Ministry of Health for research and resolution./.