JOINT CIRCULAR No. 18-YT/TC/LB Circular guiding supplementary implementation of Decision No. 91-TTg dated April 25, 1974 of the Prime Minister on economic settlement of medical drug expenses for state cadres, workers, and civil servants

CIRCULAR

JOINT MINISTRY OF HEALTH AND FINANCE DECREE NO. 18-YT/TC/LB
ON JUNE 19, 1975, GUIDELINES FOR IMPLEMENTING DECISION NO. 91/TTG OF APRIL 25, 1974
ISSUED BY THE PRIME MINISTER REGARDING HEALTH CARE AND MEDICINE PAYMENTS FOR STATE EMPLOYEES, WORKERS, AND CIVIL SERVANTS
The Ministry of Health and the Ministry of Finance issued Circular No. 32-BYT/TT on December 24, 1974, and the Ministry of Home Affairs, the Ministry of Health, and the Ministry of Finance issued Circular No. 05/TT-LB on February 7, 1975, to guide the implementation of Decision No. 91-TTG of April 25, 1974, issued by the Prime Minister. Below, the Ministry of Health and the Ministry of Finance provide additional guidance on specific issues:
In Circular No. 32-BYT/TT dated December 24, 1974, the ministries requested localities to actively promote the establishment of multi-specialty clinics in the second quarter of 1975 so that from the third quarter of 1975 onwards, ordinary medical examinations and drug distribution could be conducted at these clinics for state employees, 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 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 pay for ordinary and acute medical treatments and medications for state employees, 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 clinics will receive medications from pharmaceutical counters located adjacent to the clinics based on prescriptions from clinic doctors and nurses. The settlement of medication bills will be handled by the clinics with the pharmaceutical counters according to Circular No. 32-BYT-TT.

In Circular No. 32-BYT/TT dated December 24, 1974, the joint 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 medicines dispensed on-site for staff, workers, and government employees who come for consultation. For Hanoi and Haiphong, this process may be delayed but must be completed before the end of December 1975.

Financial authorities will allocate funds to health agencies based on the number of state employees, 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 per month (or 1.50 dong per month for agencies with their own health services). Health agencies will distribute corresponding budgets to each clinic based on the number of state employees, workers, and civil servants within their management scope.

Administrative and public service agencies under central management located in localities will transfer funds allocated in their approved budgets to local financial authorities for distribution to health agencies as mentioned above.

For production and business units under local management as well as those under central management, they will register with local financial and health authorities the number of state employees, workers, and civil servants and transfer funds according to the per capita standard (2 dong per month or 1.50 dong per month) to local financial authorities for distribution to health agencies for outpatient clinics. These expenses will be accounted for in cost prices.

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.

At the end of each quarter and annually, health agencies will settle accounts with local financial authorities for the funds spent on paying for medications provided at outpatient clinics for state employees, workers, and civil servants for ordinary and acute illnesses.

1. Funding for social and chronic disease examinations and treatments for state employees, workers, and civil servants will temporarily be calculated at an average rate of 1 dong per person per month until the health sector can organize on-site examinations and medication distribution at clinics for such conditions.

2. Starting no later than July 1, 1975, local health departments must implement the provision of medications at local health clinics for state employees, 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 examinations and medication distribution at clinics (no later than July 1, 1975), administrative and public service agencies will include in their budgets funding at an average rate of 1 dong per person per month to pay for medications for social and chronic diseases for state employees, workers, and civil servants under their jurisdiction. Production and business units may also use funds within the aforementioned per capita standard to cover expenses for medications for social and chronic diseases, which will be accounted for in cost prices.

1- The expenditure for the examination and treatment of social and chronic diseases for staff, workers, and government employees will temporarily be calculated at an average rate of 1 dong per person per month until the health sector organizes the provision of medicines on-site for the treatment of social and chronic diseases at outpatient clinics.
2- At the latest from July 1, 1975, the provision of medicines at outpatient clinics under the health sector in localities for patients who are staff, workers, and government employees suffering from social and chronic diseases must be implemented. Departments of Health need to actively promote the organization to ensure the implementation of the aforementioned policy.

- Production and business units under local management as well as those under central management will list state employees, workers, and civil servants under their jurisdiction and register with local financial and health authorities, transferring funds according to the per capita standard applicable in the locality to local financial authorities for distribution to health authorities.

- Local financial authorities will transfer funds to health authorities based on the number of state employees, workers, and civil servants in administrative and public service agencies under local management and those under central management and registered with the locality, according to the per capita standard applicable in the locality.

- Health authorities will allocate funds to hospitals based on the outpatient bed standards allocated by the Ministry of Health and the Ministry of Finance to the locality, providing corresponding funds to those hospitals to pay for medications and supplementary costs for treating social and chronic diseases for patients under their management.

- 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.

- Units of production and business under the management of local authorities as well as units of production and business under the management of central sectors shall prepare lists of officials, workers, and staff to be registered with the Department of Finance and Health of the locality and transfer the corresponding financial amount according to the average per capita rate per year applicable in the locality to the Department of Finance for allocation to the Department of Health.

- The Department of Finance shall, based on the number of officials, workers, and staff in the administrative and public service sector under the management of the locality and those in the administrative and public service sector under the management of the central government and registered with the locality, transfer to the Department of Health the financial amount according to the average per capita rate per year applicable in the locality.

- The Department of Health shall, based on the outpatient bed index allocated by the Ministry of Health and Finance to the locality, reallocate to subordinate hospitals and provide them with the corresponding financial amount to settle drug costs and social chronic disease maintenance allowances for patients under their management.

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

Part on treating social and chronic diseases for central administrative and service agencies' staff stationed at localities shall be annually reimbursed by the central budget to the local budget.

For enterprises, farms, schools that have clinics or hospitals but are too far from local hospitals, the treatment of social and chronic diseases shall be handled by the unit within the allocated budget. The unit will only refer patients to higher-level facilities when their diagnostic capabilities are exceeded, seeking diagnosis and treatment guidance. In severe cases, they may be referred for inpatient treatment.

III. MEDICAL EXAMINATION AND TREATMENT FOR STAFF TRAVELING ON BUSINESS WHO FALL ILL

Staff traveling on business away from their units who fall ill should seek medical examination and treatment at the nearest healthcare facility. Healthcare facilities provide medication without requiring payment for drugs. In severe cases, they should be referred to the most convenient hospital for inpatient treatment. Healthcare facilities issue separate certificates confirming the issuance of these medications, which are compiled and settled annually with the financial department.

IV. REGARDING STAFF TO BE TREATED AT THE VIETNAM-RUSSIA HOSPITAL

As of January 1, 1975, central administrative and service agencies located in Hanoi under the management of central ministries shall allocate a budget of 6 dong per person per year for common medicines provided at their healthcare facilities for staff to be treated at the Vietnam-Russia Hospital. The remaining amount 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 medicines provided at outpatient clinics for these individuals.

Staff under the jurisdiction of local authorities with standards equivalent to those of staff entitled to treatment at the Vietnam-Russia Hospital shall, as of January 1, 1975, be able to receive medical examination and treatment at local healthcare facilities and may be referred to the Vietnam-Russia Hospital for diagnosis and treatment guidance, allowing them to continue treatment locally or be admitted for inpatient care at the hospital if necessary.

Central agency retirees and disabled personnel residing in Hanoi previously treated at the Vietnam-Russia Hospital shall continue to receive medical examination and treatment there. Retirees and disabled personnel residing elsewhere shall be treated at their local facilities, and in necessary cases, local health authorities may refer them to the Vietnam-Russia Hospital for diagnosis and treatment guidance, allowing them to continue treatment locally or be admitted for inpatient care.

V - REGARDING THE MINISTRY OF HEALTH'S UNIFIED MANAGEMENT
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, departments with their own healthcare facilities need to expedite preparations for transferring these facilities to the Ministry of Health, which will unify the management of all healthcare facilities previously managed by various departments (except for healthcare facilities under the police and railway sectors, which will continue to be managed by their respective departments under current regulations).

Decision No. 91-TTg of the Prime Minister addresses many new issues regarding the management of medical examination and treatment for state staff. During implementation, localities and departments encountering difficulties or problems should promptly report them to the relevant ministries for timely advice and resolution, ensuring the establishment of a new standardized management system for medical examination and treatment.