Joint Circular No. 16/2006/TTLT-BYT-BTC guiding amendments and supplements to certain points of Joint Circular No. 21/2005/TTLT-BYT-BTC dated July 27, 2005 of the Ministry of Health and the Ministry of Finance on mandatory health insurance.

JOINT CIRCULAR

JOINT CIRCULAR NO. 16/2006/TTLT-BYT-BTC OF THE MINISTRIES OF HEALTH AND FINANCE ON DECEMBER 6, 2006 GUIDING AMENDMENTS AND SUPPLEMENTS TO CERTAIN POINTS OF JOINT CIRCULAR NO. 21/2005/TTLT-BYT-BTC OF THE MINISTRIES OF HEALTH AND FINANCE ON IMPLEMENTATION OF COMPULSORY HEALTH INSURANCE

Pursuant to the Health Insurance Regulation issued together with Decree No. 63/2005/NĐ-CP dated May 16, 2005 of the Government;

In order to promote achievements and promptly address difficulties encountered during the implementation of health insurance payment settlement, the Ministries of Health and Finance issue this guidance on amending and supplementing certain points of Joint Circular No. 21/2005/TTLT-BYT-BTC dated July 27, 2005 of the Ministries of Health and Finance on compulsory health insurance implementation as follows:

I. CONTENT OF AMENDMENTS AND SUPPLEMENTS

1. Repeal the following contents: "The temporary health insurance contribution rate is 50,000 VND/person/year" of Points 11 and 12, Section I, Part I.

2. Supplement Point 15 into Section I, Part I as follows:

"15. The health insurance contribution rate for the subjects specified in Points 11 and 12 shall be based on the annual state budget allocation for medical examination and treatment expenses approved by the competent authority."

3. Amend and supplement Subpoint a, Point 3, Section II, Part III as follows:

"a. Quarterly, the provincial Social Insurance Office shall be responsible for compiling the situation of the medical examination and treatment fund usage in the previous quarter by healthcare facilities within its jurisdiction to adjust and settle medical examination and treatment costs promptly for healthcare facilities. In case the medical examination and treatment fund is in deficit, it shall report to the Vietnam Social Insurance for resolution."

4. Repeal the following content: "- The Social Insurance Office shall be responsible for pre-funding a minimum amount equal to 80% of the medical examination and treatment costs settled in the previous quarter to healthcare facilities when settling accounts, both parties reconcile and offset, and the Social Insurance Office implements the advance funding for the next quarter. By the end of November each year, the Social Insurance Office shall be responsible for pre-funding a minimum amount to allow healthcare facilities to purchase medicines and medical supplies for patients in the following year (the last part of Subpoint b, Point 1.1, Section II, Part IV)."

5. Supplement Subpoint c into Point 1.1, Section II, Part IV as follows:

"c) Time limit for medical examination and treatment cost settlement:

- Quarterly, before the 10th day of the first month of the quarter, healthcare facilities shall compile actual medical examination and treatment costs for insured patients in the previous quarter, which have been appraised by the Social Insurance Office, and submit them to the Social Insurance Office for settlement.

- Based on the compiled actual medical examination and treatment costs of healthcare facilities and the costs of patients in emergency cases, transfers, etc., which have been appraised, the Social Insurance Office shall be responsible for settling and paying the medical examination and treatment costs to healthcare facilities no later than 25 days from the end of the quarter. At the same time, based on the settlement figures between both parties, the Social Insurance Office shall be responsible for pre-funding a minimum amount equal to 80% of the actual medical examination and treatment costs of the previous quarter, which have been appraised by the Social Insurance Office.

- In case the actual settlement exceeds the allocated medical examination and treatment fund, the provincial Social Insurance Office shall adjust from the fund available within the province to settle the excess costs for healthcare facilities no later than 35 days from the end of the quarter. If the local medical examination and treatment fund is insufficient, the provincial Social Insurance Office shall report to the Vietnam Social Insurance for overall adjustment.

- Semi-annually, the Vietnam Social Insurance shall timely adjust the health insurance fund for provinces to settle healthcare facilities. In case the reserve fund cannot adjust, it shall temporarily follow the provisions at Subpoint d, Point 1, Section II, Part III of Joint Circular No. 21/2005/TTLT-BYT-BTC dated July 27, 2005, while reporting to the Ministries for resolution."

The entire process is illustrated in the example below:

Assuming in Quarter I/2007, Hospital X in Province Y received outpatient and inpatient medical examination and treatment services with a temporarily allocated medical examination and treatment fund of 100 million VND (A). The actual medical examination and treatment costs for insured patients at the hospital, which were appraised and agreed upon by both parties, were 70 million VND (B), and the costs for emergency cases, transfers, etc., at other healthcare facilities outside Hospital X were 40 million VND ().CThe remaining allocated medical examination and treatment fund of Hospital X will be A - C = 100 million VND - 40 million VND = 60 million VND (D). In this case, the costs at Hospital X (B = 70 million VND) exceed the remaining allocated medical examination and treatment fund (D = 60 million VND) after deducting costs at other levels, so the excess cost E = B - D = 70 million VND - 60 million VND = 10 million VND will be supplemented by the Social Insurance Office after balancing the provincial medical examination and treatment fund. If the provincial medical examination and treatment fund is insufficient, the provincial Social Insurance Office shall report to the Vietnam Social Insurance for overall adjustment (if applicable).

The amount the provincial Social Insurance Office will pre-fund for Hospital X to ensure medical examination and treatment services in Quarter II/2007 will be: B x 80% = 70 million VND x 80% = 56 million VND.

(Similarly, to determine, settle, and pre-fund for the hospital in subsequent quarters)

II. EFFECTIVE DATE

This Circular takes effect 15 days after its publication in the Official Gazette. All previous regulations that conflict with this Circular are hereby repealed.

During implementation, if there are difficulties, please reflect them to the Ministries for consideration and resolution.