JOINT CIRCULAR No. 18-BYT/TTLB ON GUIDELINES FOR IMPLEMENTING DECISION No. 91-TTg DATED APRIL 25, 1974 OF THE PRIME MINISTER REGARDING THE ECONOMICS OF PAYING FOR MEDICINE IN TREATING ILLNESS FOR STATE OFFICIALS, WORKERS, AND EMPLOYEES

CIRCULAR

Joint Circular of the Ministry of Health and the Ministry of Finance No. 18/YT-TC-LB dated June 19, 1975 guiding additional implementation of
Decision No. 91/TTg dated April 25, 1974 of the Prime Minister on economic payment for medical drug expenses for cadres, workers, and civil servants of state agencies.
implement Decision No. 91/TTg dated April 25, 1974
The Ministry of Health and the Ministry of Finance issued Circular No. 32-BYT/TT dated December 24, 1974, and the Ministry of Home Affairs, the Ministry of Health, and the Ministry of Finance issued Circular No. 05/TT-LB dated February 7, 1975, to guide the implementation of Decision No. 91-TTg dated April 25, 1974 of the Prime Minister. Below, the Ministry of Health and the Ministry of Finance provide additional guidance on specific issues:
medical expenses for treatment of cadres, workers, and civil servants of the State
civil servant of the State

The Ministry of Health and Finance issued Circular No. 32-BYT/TT on December 24, 1974, and the Ministry of Interior, Health, and Finance jointly issued Circular No. 05/TT-LB on February 7, 1975, to guide the implementation of Prime Minister's Decision No. 91-TTg dated April 25, 1974. Below, the Ministry of Health and Finance provides additional guidance on specific issues.

In Joint Circular No. 32-BYT/TT dated December 24, 1974, the ministries requested localities to actively promote the establishment of multi-specialty outpatient clinics in the second quarter of 1975 so that from the third quarter of 1975 onwards, common and acute diseases can be treated and medications dispensed on-site for cadres, workers, and civil servants seeking treatment. For Hanoi and Haiphong, this process may be delayed but must be completed no later than the end of December 1975.

According to Circular No. 32-BYT/TT dated December 24, 1974, the ministries required localities to actively promote the establishment of multi-specialty outpatient clinics in the second quarter of 1975 so that from the third quarter of 1975 onwards, ordinary medical examinations and drug dispensing could be conducted for cadres, workers, and civil servants at these clinics. For Hanoi and Haiphong, this process may be delayed but must still be completed before the end of December 1975.

Based on the above regulations, regarding financial matters, from January 1, 1975, to June 30, 1975, for provinces (and from January 1, 1975, to December 31, 1975, for Hanoi and Haiphong), management units will continue to manage their own funds according to the standard of 24 dong per person per year to cover the cost of ordinary and acute medical treatment and drug provision for cadres, workers, and civil servants under their jurisdiction.

From July 1, 1975, onward for provinces (and from January 1, 1976, for Hanoi and Haiphong), patients visiting outpatient clinics will receive medications from state-owned pharmaceutical counters adjacent to the clinics based on prescriptions from clinic doctors. The settlement of medication bills will be handled by the clinics with the pharmaceutical counters according to Circular No. 32-BYT-TT.

Financial authorities will allocate funds to health authorities based on the number of staff, workers, and government employees registered as present in administrative and public service units managed by localities, and according to the average budget standard of 2 dong per person per month (or 1.50 dong per person per month for units with their own medical facilities). Health authorities will distribute the corresponding budget to each outpatient clinic based on the number of staff, workers, and government employees under the management of each clinic.

Financial authorities will allocate funds to health agencies based on the number of cadres, workers, and civil servants registered as present in administrative and public service agencies managed by localities, and according to a per capita budget standard of 2 dong/month (or 1.50 dong/month for agencies with their own health services). Health agencies will distribute corresponding budgets to each clinic based on the number of cadres, workers, and civil servants within their management scope.

Administrative and public service agencies under central sector management located in localities will deduct funds from their approved budgets and transfer them to the local financial authority to be transferred to the health agency as mentioned above.

For production and business units under local management as well as those under central sector management, they will register with the local financial and health authorities the number of cadres, workers, and civil servants and deduct funds according to the per capita standard (2 dong/month or 1.50 dong/month) to be transferred to the local financial authority, which will then transfer it to the health agency for distribution to outpatient clinics. This expense will be accounted for in the cost of production.

At the end of each quarter and year, the health agency will settle accounts with the local financial authority for the funds spent on drug payments at outpatient clinics for cadres, workers, and civil servants for ordinary and acute medical treatment.

II. Funding for payment of drugs for social and chronic diseases.

1- The expenditure for social and chronic disease examination and treatment for cadres, workers, and civil servants of the State shall temporarily be calculated at an average rate of 1 dong per person per month while the health sector has not yet organized on-site examination and drug distribution at outpatient clinics for such diseases.

2- Starting from July 1, 1975, outpatient clinics under the health sector in localities must provide medication to patients who are cadres, workers, and civil servants suffering from social and chronic diseases. Health Departments need to actively promote the organization to ensure the implementation of this policy.

3- From January 1, 1975, until the organization of on-site examination and drug distribution at outpatient clinics (no later than July 1, 1975), administrative and public service agencies will include in their budgets an average expenditure of 1 dong per person per month to cover the cost of drugs for social and chronic disease treatment for cadres, workers, and civil servants under their jurisdiction. Production and business units can also use funds within the aforementioned average standard to cover expenses for social and chronic disease treatment, which will be accounted for in the cost of production.

- Local finance departments will transfer the corresponding budget according to the average standard per person per year applicable in the locality to the health department based on the number of staff, workers, and government employees in administrative and public service units under local management and those under central management and registered with the locality.

- Production and business units under local management as well as those under central sector management will list the cadres, workers, and civil servants under their jurisdiction and register with the local finance and health departments, transferring the corresponding funds according to the local per capita standard annually to the local finance department, which will then transfer it to the local health department.

- Local finance departments will transfer to local health departments the funds according to the local per capita standard annually based on the number of cadres, workers, and civil servants in the administrative and public service sectors under local management and those in central sector administrative and public service sectors registered with the locality.

- Local health departments will allocate beds based on the outpatient bed allocation by the Ministry of Health and Finance to the locality, redistributing them to affiliated hospitals and providing corresponding funds to these hospitals to cover the cost of drugs and supplementary treatment for social and chronic disease patients under their management.

At the end of each year, the Department of Health settles accounts with the Department of Finance.

Part on social and chronic disease treatment for central administrative and service agencies' staff stationed in local areas shall be annually reimbursed from the central budget to the local budget.

For enterprises, farms, schools that have clinics or hospitals but are too far from local hospitals, social and chronic disease treatment shall be self-resolved within the allocated budget, and patients will only be referred to higher-level facilities when the diagnosis exceeds their capacity, with recommendations for further treatment provided by higher-level facilities if necessary, especially for severe cases which may require hospitalization.

III. Examination and treatment for officials, workers, and employees on business trips who fall ill

Staff members who fall ill while traveling away from their units should seek medical care at the nearest healthcare facility for examination and treatment. The healthcare facility will provide medication without requiring payment from the patient. In case of serious illness, they will be referred to the nearest hospital for inpatient treatment. The healthcare facility will issue a separate certificate confirming the provision of medication, which will be compiled and settled annually with the financial department.

IV. Regarding officials, workers, and employees entitled to examination and treatment at the Vietnam-Soviet Hospital

As of January 1, 1975, central administrative and service agencies located in Hanoi under the management of central sectors shall allocate a budget of 6 dong per person per year for common medications provided at the agency's healthcare facilities for staff eligible for examination and treatment at the Vietnam-Soviet Friendship Hospital. The remaining budget of 18 dong per person per year (within the defined medical fee limit of 24 dong per person per year) shall be directly allocated by the Ministry of Health to the hospital for medications provided at outpatient clinics for these eligible individuals.

Regarding local staff with standards equivalent to those eligible for examination and treatment at the Vietnam-Soviet Friendship Hospital, as of January 1, 1975, they shall be examined and treated at local healthcare facilities and may be referred to the Vietnam-Soviet Friendship Hospital for diagnosis and treatment recommendations to be followed up locally, or admitted for inpatient treatment at the hospital if necessary.

Central agency retirees and those unable to work residing in Hanoi previously treated at the Vietnam-Soviet Friendship Hospital shall continue to receive examination and treatment there. Retirees and those unable to work residing in other locations shall be treated where they reside. If necessary, local health authorities may refer them to the Vietnam-Soviet Friendship Hospital for diagnosis and treatment recommendations to be followed up locally, or admit them for inpatient treatment.

On the Ministry of Health's unified management of healthcare facilities

To strictly implement Decision No. 91-TTg dated April 25, 1974, of the Prime Minister and Resolution No. 15-CP dated January 14, 1975, of the Council of Ministers, sectors with their own healthcare facilities need to expedite preparations for transferring such facilities to the Ministry of Health, which will unify the management of all healthcare facilities previously managed by sectors (except those under the police and railway sectors, which will continue to be managed by their respective sectors under current regulations).

Decision No. 91-TTg of the Prime Minister addresses many new issues regarding the management of medical examinations and treatments for state staff. During implementation, if localities and sectors encounter difficulties or obstacles, they should promptly report them to the relevant ministries for comments and solutions to improve the management of medical examinations and treatments.