Joint Circular No. 15/2008/TTLT/BTC-BYT guiding 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 conducting medical examinations and treatments; managing, using, and settling expenses for medical examinations and treatments for children under six years old without payment at public health facilities

Based on 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 conducting medical examinations and treatments; managing, using, and settling expenses for medical examinations and treatments for children under six years old without payment 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, various ministries, agencies, and units at the central level 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. Expenses for medical examinations and treatments for children under six years old shall be allocated from the central budget for public health facilities under ministries, agencies, and units at the central level; from the local budget for local public health facilities according to the current division of financial management authority.

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

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

II. PROCEDURES AND FORMALITIES

MEDICAL EXAMINATIONS AND TREATMENTS FOR CHILDREN UNDER SIX YEARS OLD

1. Provisions on the treatment level:

The treatment level 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: communal health stations, district multi-purpose clinics, municipal general hospitals, provincial general hospitals, and primary-level health facilities under the management of various 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 capacity of specialized expertise is exceeded, public health facilities performing initial medical examinations and treatments shall be responsible for transferring 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 capacity of specialized expertise of provincial-level health facilities is exceeded, they shall transfer children to central general hospitals or specialized hospitals under the Ministry of Health or other central ministries and sectors.

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

2. Procedures for medical examinations and treatments:

a) When children under six years old undergo medical examinations and treatments at public health facilities, they must present a medical examination and treatment card; if they have not been issued such a card, they must present a birth certificate or a birth registration certificate or a certificate issued by the People's Committee of the commune where the guardian resides (hereinafter referred to collectively as the medical examination and treatment card).

b) At the health facilities mentioned in points b and c, clause 1, Section II of this Circular: in addition to presenting the child's medical examination and treatment card, the family must also present the hospital transfer procedures, including a referral letter and a summary of the initial medical examination and treatment records (except for cases specified in point d, 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 in a convenient manner, creating favorable conditions, and ensuring full rights for children undergoing medical examinations and treatments.

b) In emergency situations, public health facilities have the responsibility to promptly receive and treat children free of charge. Depending on the child's condition, if inpatient treatment is required, the facility will process the necessary procedures for inpatient treatment; if outpatient treatment is deemed sufficient or if the case falls within the scope of lower-level facilities, the necessary procedures will be processed for the family to take the child home for outpatient treatment or to transfer to a lower-level facility.

c) In cases where the capacity of specialized expertise is exceeded, lower-level facilities must promptly complete the necessary procedures for transferring the child to a higher-level facility for treatment, without delay.

d) Checking the medical examination and treatment card; if there is no card, checking the birth registration certificate or a certificate issued by the People's Committee of the commune (except for newborns), and the hospital transfer procedures as stipulated in points b and c, clause 1, Section II of this Circular (for cases involving technical specialty transfers) immediately upon the child's arrival for medical examination and treatment.

In special cases, when 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 base their decision on the actual situation to determine whether the child can receive free medical examinations and treatments and be settled into the allocated expenses for medical examinations and treatments for children under six years old.

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 within their authority regarding professional misconduct, waste, and loss of funds.

f) Ensuring adequate supply of drugs in the list, blood, intravenous fluids, chemical reagents for testing, 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) Public health facilities under state management have the responsibility to publicly disclose services for voluntary medical examination and treatment so that citizens are aware and can choose.

h) Monitor and compile activities related to medical examination and treatment for children under six years old and report to the supervising authority quarterly 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, during the time 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 medical examination and treatment expenses for children under six years old and consolidate this within their annual state budget expenditure estimates, which they will submit to the Ministry of Finance according to regulations. The basis for establishing the budget estimate includes:

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

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

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

b) Based on the allocated budget estimate for medical examination and treatment 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 current regulations on allocating state budget estimates.

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

In cases where there is still a shortage after adjustments, Ministries, agencies, and units at the central level shall issue a document to the Ministry of Finance to request consideration and decision to supplement from the central government's reserve fund to ensure sufficient and timely funding for medical examination and treatment for children under six years old.

2. For localities:

Based on the division of financial expenditure 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 regulations on the process of establishing, allocating, adjusting, and supplementing budget estimates for health facilities in accordance with local realities.

In cases where children under six years old from the locality are transferred for medical examination and treatment to 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 for medical examination and treatment to 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 cooperate with the Department of Finance to specifically determine the amount of funds allocated for this task, report to the Provincial People's Committee for consideration and decision to allocate the budget estimate to the Department of Health for implementation according to current regulations on allocating and transferring state budget estimates.

IV. MANAGEMENT, USE, PAYMENT AND SETTLEMENT

1. Management and use of funds:

a) Public health facilities entrusted with managing funds for medical examination and treatment for children under six years old shall withdraw the budget estimate from the State Treasury at the transaction location according to 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 public health facility to which the budget estimate for medical examination and treatment for children under six years old is allocated shall directly manage and use it to implement free medical examination and treatment services for children under six years old at the unit, including cases where children under six years old are transferred from other public health facilities according to the Ministry of Health's regulations on transfer for treatment.

At the end of the fiscal year, any remaining funds from this source shall be carried over to the next year for continued use for medical examination and treatment for 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 medical 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 according to Decree No. 43/2006/ND-CP dated April 25, 2006 of the Government and guiding documents for Decree No. 43/2006/ND-CP.

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

2. Settlement of costs:

a) Content and level of payment:

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

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

- Transportation costs for children who are patients in emergency situations or undergoing inpatient treatment and need to 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.

+ In cases where the family of the child does not use the transportation of the public health facility: the public health facility introducing the child for transfer shall pay the family of the child at a rate of 30,000 VND per 100 km (for a single trip).

- To purchase certain essential medical equipment (not fixed assets) directly serving the examination and treatment of children under six years old: payment shall be made at the purchasing price of the healthcare facility.

- To support nutrition for children under six years old who are being treated at public healthcare facilities belonging to disadvantaged groups and children from households classified as poor according to the national poverty standard: the maximum amount is 30,000 VND/day/child, with a support period not exceeding 30 days. Public healthcare facilities may provide support in kind or directly pay money to the parents of the children, depending on the actual conditions of the public healthcare facilities and the specific circumstances of each child.

b) For public healthcare facilities that organize examination and treatment services upon request when families of children under six years old have such needs, the healthcare facilities are allowed to collect from the families the difference between the service cost and the current hospital fee reimbursement level as prescribed by the competent authority.

c) In cases where children under six years old have been treated and used medicines, blood, infusions, medical supplies, chemicals, etc., free of charge through approved Programs and Projects, public healthcare facilities are not permitted to include these costs in the budget for examination and treatment of children under six years old.

d) In cases where children under six years old from localities are referred to public healthcare facilities outside their province (excluding those under the Ministry of Health, central ministries, agencies, and units) for examination and treatment, the payment procedures will be carried out in the following ways:

- The Department of Health (or authorizing provincial general hospitals) signs contracts with public healthcare facilities outside the province to provide examination and treatment services for children under six years old from their locality when they are referred; periodically transferring funds to public healthcare facilities outside the province to cover the examination and treatment costs for children under six years old according to the prescribed regulations.

- Families of children self-pay the examination and treatment costs at the public healthcare facility where the child is treated based on the current hospital fee level and obtain receipts to claim reimbursement back home. The public healthcare facility in the locality where the child was referred is responsible for reimbursing the full amount paid by the family according to the current hospital fee level, based on the payment receipt and medical records provided by the family.

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 healthcare facilities in the locality to consider applying the above payment methods appropriately to ensure adequate benefits for children under six years old during examination and treatment.

3. Accounting and settlement:

a) Units using funds for the examination and treatment of children under six years old shall carry out accounting and settlement in accordance with the current administrative and public institution accounting regulations. Relevant documents related to the settlement of examination and treatment funds for children under six years old shall be kept separately to facilitate the consolidation, inspection, supervision, and evaluation of the implementation of examination and treatment activities for children under six years old.

b) Settlement files include:

- Payment vouchers for examination and treatment costs for children under six years old (prepared according to the attached Circular model): the expenses recorded in the payment voucher must be consistent with the examination and treatment activities at the unit and current regulations. The Director of the public healthcare facility is responsible for the accuracy and honesty of the payment voucher. The State Treasury will control expenditures based on the payment voucher for examination and treatment costs for children under six years old and related documents (if any) as prescribed.

- Referral letters (applicable in cases where children are referred from lower-level healthcare facilities).

- Copies of certificates confirming poverty status or disadvantaged children issued by authorized agencies (applicable for children under six years old receiving nutritional support).

For expenditures by the Department of Health for the examination and treatment of children under six years old from localities referred to public healthcare facilities outside the province as stipulated in Point d Clause 2 Section IV of this Circular, the settlement files include:

+ Contracts for examination and treatment of children under six years old;

+ Summary tables of examination and treatment costs for children under six years old (prepared by public healthcare facilities outside the province).

+ Related payment documents.

c) Units directly using funds for the examination and treatment of children under six years old shall account and settle under Category 15 Item 60, detailed according to corresponding sub-items of the current State Budget Manual.

Specifically, for expenditures for the examination and treatment of children under six years old from localities referred to public healthcare facilities outside the province as stipulated in Point d Clause 2 Section IV of this Circular, units shall account and settle under Category 119 Sub-item 14.

d) For public healthcare facilities that still have a surplus due to the difference between the costs according to medical records and the actual costs for the examination and treatment of children under six years old before the implementation of this Circular, which were not accounted for under Category 15 Item 60 for necessary expenses to implement examination and treatment services and bed-day fees (such as electricity, water, fuel, environmental sanitation, office supplies, communication expenses, and other regular expenses), the surplus can be considered for reduction in some items of Category 15 Item 01, while increasing corresponding items of Category 15 Item 60 for the aforementioned surplus 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 examination and treatment funds for children under six years old to suit the local situation.

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 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 budget for medical examination and treatment for children under six years old from ministries, agencies, and 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 after its 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 the budget for medical examination and treatment 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 the budget for medical examination and treatment for children under six years old at public health facilities.

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