Circular 21/2024/TT-BYT stipulates the valuation methods for medical examination and treatment services issued by the Minister of Health.

 CIRCULAR

REGULATIONS ON THE METHODS FOR PRICING HEALTH EXAMINATION AND TREATMENT SERVICES

On the basis of Law on Health Examination and Treatment dated January 9, 2023;

On the basis of Law on Prices dated June 19, 2023;

Decree No. Government Decree No. 95/2022/NĐ-CP dated November 15, 2022 stipulating functions, tasks, powers, and organizational structure of the Ministry of Health;

Decree No. Decision No. 96/2023/NĐ-CP of December 30, 2023 of the Government detailing and guiding the implementation of certain provisions of the Law on Health Examination and Treatment;

The Minister of Health issues this Circular to regulate the methods for pricing health examination and treatment services.

PART I
METHODS FOR PRICING HEALTH EXAMINATION AND TREATMENT SERVICES

Section 1

METHODS FOR PRICING

Article 1. Principles and Basis for Pricing

1. The method for pricing health examination and treatment services is a way to determine the price for each health examination and treatment service, including cost-based methods and comparative methods.

2. Pricing must apply the principles and bases for pricing health examination and treatment services as stipulated in Clause 3 and Clause 4, Article 110 of the Law on Health Examination and Treatment and Clause 6, Article 119 of Decree No. 96/2023/NĐ-CP dated December 30, 2023 of the Government detailing and guiding the implementation of certain provisions of the Law on Health Examination and Treatment (hereinafter referred to as Decree No. 96/2023/NĐ-CP) and the following principles:

a) The selection of pricing methods shall be carried out in accordance with the provisions of Article 2 of this Circular;

b) Overlapping factors constituting costs in the price of health examination and treatment services shall not be counted.

3. Expenses that are not considered reasonable and legitimate for determining the price of health examination and treatment services include:

a) Expenses that are not considered reasonable and legitimate for determining the price of health examination and treatment services shall be implemented in accordance with the current laws regarding expenses that are not deductible when determining taxable income for corporate income tax and expenses that are not included in the cost formation of service prices as stipulated by relevant legal documents;

b) Expenses already covered by the state budget according to the law, including special allowances, which include:

- Special allowances, attraction allowances, subsidies, and other benefits for medical staff, contractual employees, and military personnel directly engaged in medical work at state healthcare facilities in areas with particularly difficult socio-economic conditions;

- Attraction allowances, long-term service allowances, some subsidies, and reimbursement for travel expenses for civil servants, public officials, and personnel receiving salaries in the armed forces (People's Army and People's Public Security) working in areas with particularly difficult socio-economic conditions;

- Special allowances for personnel working at the Vietnam Friendship Hospital, Thong Nhat Hospital, Da Nang Central Hospital under the Ministry of Health, and Central Protection Departments 1, 2, 2B, 3, and 5, and Department A11 of hospitals under the Ministry of National Defense;

- Special allowances based on profession or job.

c) Expenses already included in the price of health examination and treatment services.

Article 2. Selection of Pricing Methods

1. The cost-based method shall be applied to price health examination and treatment services when the factors forming the price can be identified.

2. The comparative method shall be applied to price health examination and treatment services when it is necessary to collect information from at least three units providing such services for comparison. The selection of information collection about comparative services is regulated in Article 4 of this Circular.

3. Based on practical conditions, the head of the agency, organization, or unit responsible for establishing the pricing plan for health examination and treatment services (hereinafter referred to as the unit responsible for establishing the pricing plan) decides to select and apply one of the two pricing methods specified in Clause 1 and Clause 2 of this Article to establish the pricing plan.

4. In cases where health examination and treatment services can simultaneously apply both pricing methods, the head of the unit responsible for establishing the pricing plan may prioritize the application of the comparative method if the conditions stipulated in Clause 2 of this Article are met.

Section 2

COMPARISON METHOD

Article 3. Comparison Method

1. The comparison method is a valuation method for medical examination and treatment services based on information collected about the prices of similar medical examination and treatment services provided in the domestic market at the time of valuation to propose the price of the medical examination and treatment services to be valued.

2. Medical examination and treatment services for comparison are medical examination and treatment services of the same type as the medical examination and treatment services to be valued. Services of the same type are those with the same name, the same professional technical procedures, and fall under one of the following cases:

a) Provided by healthcare facilities of the same level of professional technical expertise;

b) Equivalent in terms of the professional qualifications of personnel, technology, and equipment;

c) Equivalent in management model or equivalent in the category of public health units.

Article 4. Collection of Comparative Price Information

1. The unit responsible for formulating the pricing plan shall collect information on the prices of similar medical examination and treatment services provided by other healthcare facilities for comparison with the services to be valued and shall be fully responsible for the integrity of the information collection process and the results thereof.

2. Information on the prices of similar medical examination and treatment services must meet the following requirements:

a) Already or currently being applied at the healthcare facility providing the price information;

b) Collected within a range of 24 months from the date of establishing the pricing plan of healthcare facilities in the same province or centrally-administered city.

In cases where there are fewer than three different service providers in the same province or centrally-administered city, the scope of information collection should be expanded according to criteria from near to far to obtain information from at least three service providers.

3. Information on the prices of similar medical examination and treatment services shall be based on at least one of the following sources of documentation:

a) Prices determined, appraised, published, or provided by state agencies with authority;

b) Actual transaction prices recorded on sales invoices of organizations or individuals in accordance with regulations or prices recorded in service provision contracts;

c) Declared prices, announced prices, or posted prices in accordance with regulations; prices determined by organizations with appraisal functions;

d) Prices provided by associations, healthcare facilities;

đ) Prices obtained through officially published information on websites or electronic portals of agencies or organizations;

e) Prices surveyed and collected on the market in the form of information survey forms in accordance with Appendix I issued together with this Circular;

g) Bidding prices or selling prices listed in service provider quotations or goods manufacturers' quotations. Quotations must bear the seal of the unit (if applicable) and contain full information on:

- Name, address;

- Tax code (if applicable);

- Date of information provision;

- Validity period of the quotation, bid (if applicable);

h) Prices in databases of medical examination and treatment service prices in accordance with legal provisions.

Article 5. Analysis of Information

1. Determine whether the collected medical examination and treatment services for comparison are of the same type as the services to be valued by comparing the collected information with the provisions of Clause 2, Article 3 of this Circular.

2. If more than three pieces of information are collected, the decision to select the number of pieces of information for comparison shall be made according to the priority principle:

a) Selecting information collected at the time closest to the time of formulating the pricing plan;

b) Within the same province or centrally-administered city or areas with similar socio-economic conditions.

3. Adjust information before conducting comparisons:

b) In cases where the collected price has a foreign currency unit, it must be converted into Vietnamese Dong according to the selling exchange rate of the Vietnam Joint Stock Commercial Bank for Foreign Trade published at the time of price determination.

a) The specific price of medical examination and treatment services is determined based on the average price of the comparison medical examination and treatment services after adjustment;

b) Proposing a specific price for medical examination and treatment services based on the analysis of the collected information stipulated in Article 4 of this Circular and Paragraphs 1 and 2 of this Article, ensuring that the proposed price complies with the provisions of Article 1 of this Circular and does not exceed the highest price of the comparison medical examination and treatment services after adjustment as stipulated in Paragraph 3 of this Article.

Section 3

COST METHOD

Article 6. Cost Method

1. The cost method is a pricing method for medical examination and treatment services based on factors forming the price of medical examination and treatment services at the time of determining the price or during the period specified in the pricing plan, consistent with the professional procedures of medical examination and treatment services.

2. The price of medical examination and treatment services prescribed in Article 110 of the Medical Examination and Treatment Law and Article 119 of Decree No. 96/2023/NĐ-CP shall be determined as follows:

Where:

a) Total cost: implemented according to Clause 3 of Article 119 of Decree No. 96/2023/NĐ-CP;

b) Accumulation or anticipated profit (if any): implemented according to Article 8 of this Circular;

c) Financial obligations: implemented according to the provisions of the law.

3. The costs in the factors forming the price of medical examination and treatment services shall be determined in one of the following ways:

a) For cost factors forming the price of medical examination and treatment services on the market where comparable services exist and information can be collected, the comparative method provided for in Section 2 of this Chapter shall be used to determine the costs. In cases where there are not three service providers, the head of the unit establishing the pricing plan shall be responsible for deciding to use the actual information collected;

b) Based on economic-technical norms issued by competent authorities;

c) Based on reasonable actual costs of the factors forming the price;

d) Based on state policies or cost items already regulated by the state or already stipulated by law (taxes, accounting, statistics, and related laws);

đ) Based on cost allocation according to appropriate criteria in accordance with Clause 4 of Article 7 of this Circular.

4. Specific methods for determining the price of medical examination and treatment services and proposing specific prices for medical examination and treatment services using the cost method: Based on the provisions of Articles 6, 7, and 8 of this Circular to determine and ensure that the proposed price complies with the provisions of Article 1 of this Circular.

Article 7. Determining Costs and Establishing Pricing Plans for Medical Examination and Treatment Services

1. The unit establishing the pricing plan shall aggregate cost factors and cost groups forming the price of a medical examination and treatment service according to the model prescribed in Appendix II attached to this Circular.

2. In cases where costs are determined based on economic-technical norms issued by competent authorities:

Cost = Economic-Technical Norm x Unit Price

a) Economic-Technical Norms are determined as follows:

- For demand-based medical examination and treatment services: medical examination and treatment facilities may issue them within their authority.

- For medical examination and treatment services as stipulated in points a, b, and c of Clause 2 of Article 119 of Decree No. 96/2023/NĐ-CP: apply the economic-technical norms issued by competent authorities.

If the actual cost factor is lower than the cost according to the economic-technical norm issued by the competent authority at the time the unit establishes the pricing plan: The unit establishing the pricing plan shall determine the cost-forming factor based on the actual cost but must ensure that the medical examination and treatment service meets the quality standards prescribed by law.

If the actual cost is higher than the cost according to the economic-technical norm issued by the competent authority at the time the unit establishes the pricing plan: The unit establishing the pricing plan shall calculate according to the economic-technical norm issued by the competent authority.

Payment of medical examination and treatment costs shall be carried out according to Clause 7 of Article 119 of Decree No. 96/2023/NĐ-CP.

b) Unit Price is determined as follows:

The unit price of various costs (including VAT) is the supply price to the unit determined according to the published price (if any) or the invoice price according to the law at the time of establishing the pricing plan plus (+) reasonable and valid circulation costs to the unit or the winning bid price according to regulations. Prioritize documents close to the time of building the pricing plan and within 24 months from the date the unit builds the pricing plan.

If there are insufficient documents and invoices as required, the head of the unit shall decide based on the information collected according to one of the forms prescribed in Articles 4 and 5 of this Circular to determine the unit price.

In cases where there are not three suppliers, the head of the unit establishing the pricing plan shall be responsible for deciding to use the actual information collected..

The unit price of wages shall be implemented according to current laws on wages. Labor costs shall be implemented according to point a of Clause 3 of Article 119 of Decree No. 96/2023/NĐ-CP;

In cases where there are multiple unit prices for costs, the head of the unit shall decide to calculate the unit price according to the average price or weighted average price or choose the unit price of that cost ensuring compliance with professional requirements and bear responsibility for their decision without exceeding the maximum price of the collected information.

3. In cases where costs are determined without economic-technical norms issued by competent authorities:

In cases where cost factors have many types and different unit prices, they shall be determined based on the reasonable actual costs of the factors forming the price of medical examination and treatment services. The head of the unit shall decide and be responsible for ensuring the principles of thrift and efficiency.

4. In cases where costs are determined by allocation methods:

a) For costs related to multiple services that cannot be separated, they need to be aggregated and allocated according to appropriate criteria such as revenue, costs, quantity, volume, time, and other relevant criteria suitable for the unit and related laws. Cost allocation must ensure that no overlapping costs included in the price of medical examination and treatment services are counted.

In cases where cost factors arise over multiple accounting periods, data from multiple accounting periods need to be compiled to allocate appropriately according to the actual situation and relevant laws for each medical examination and treatment service.

b) The criteria for allocation to be determined by the head of the unit based on referring to the allocation criteria set out in Appendix III and Appendix IV issued together with this Circular and other relevant criteria (if any) suitable for the professional requirements of the unit.

5. Based on current regulations and existing databases, the unit may refer to one of two methods outlined in Appendix III and Appendix IV issued together with this Circular to develop a pricing plan to submit to the competent authority for decision.

Article 8. Accumulation or anticipated profit

1. The unit developing the pricing plan shall determine accumulation or anticipated profit (if any) according to the profit rate or profit level or accumulation level as prescribed by law.

The unit developing the pricing plan may choose one of the cost price criteria or net revenue when determining the anticipated profit level or accumulation level of medical examination and treatment services to ensure that the service prices are not higher than market service prices (for services with market prices).

2. Anticipated profit:

a) Profit rate is the percentage (%) of profit calculated on cost price or net revenue;

b) The profit level is determined according to point a of this clause based on the actual profit level of the nearest preceding years according to the financial report of the unit.

3. Accumulation level: The determination of the accumulation level is decided by the head of the unit who bears responsibility for their decision. The accumulation level prescribed in this Clause shall not be used as a basis for determining the surplus or deficit from the implementation of financial autonomy of the unit.

Section 4

PRICING ACCORDING TO SERVICE DELIVERY MODE

MEDICAL EXAMINATION AND TREATMENT SERVICES

Article 9. Documentation and Approval Procedures for Pricing Plans

1. Pricing Plan Documentation:

a) Medical examination and treatment facilities (or units assigned by the competent authority to prepare the pricing plan for medical examination and treatment services) shall prepare and submit the Pricing Plan Documentation in one original copy or one certified copy to the competent authority for pricing in accordance with clauses 5 and 6 of Article 110 of the Medical Examination and Treatment Law;

b) The Pricing Plan Documentation includes:

- A letter requesting pricing or price adjustment accompanied by the bases, necessity, and proposed objectives for pricing or price adjustment, and a consolidated list of service items according to the model prescribed in Appendix V issued together with this Circular;

- The pricing plans for services requiring pricing implemented according to the model prescribed in Appendix II issued together with this Circular (if applicable); the head of the unit is responsible for the data explained, proposals, and retention of explanatory documents on calculation methods;

- A document summarizing the opinions of related agencies attached with copies of their opinions as required (if applicable);

- Other relevant documents and organizational measures for implementing new prices (if applicable).

2. Review of Pricing Plans:

a) Based on the Pricing Plan Documentation prepared by the unit in accordance with clause 1 of this Article, the agency tasked with reviewing the Pricing Plan shall organize an evaluation to determine and propose specific service pricing levels for the unit to report to the competent authority for setting specific service prices for the unit on the Pricing Plan Documentation submitted to the agency for review;

b) The documentation submitted to the competent authority for pricing or price adjustment includes the following documents:

- A proposal regarding pricing or price adjustment for medical examination and treatment services along with a draft pricing or price adjustment document for such services;

- A report on the review of the Pricing Plan; a report explaining and incorporating comments from the review (if applicable);

- Other relevant documents and materials (if applicable).

3. Authority to Set Specific Service Prices for Medical Examination and Treatment Services shall be carried out in accordance with clauses 5, 6, and 7 of Article 110 of the Medical Examination and Treatment Law and clause 9 of Article 119 of Decree No. 96/2023/NĐ-CP.

The People's Council of the province shall specify the specific service prices for medical examination and treatment services within the scope of authority prescribed in clause 6 of Article 110 of the Medical Examination and Treatment Law and shall not exceed the highest price of corresponding medical examination and treatment services prescribed by the Minister of Health.

4. Regarding the form of pricing or price adjustment documents: it shall be carried out in accordance with clause 1 of Article 24 of the Price Law.

Article 10. Price for medical examination and treatment upon request

Medical examination and treatment facilities shall establish service prices for medical examination and treatment upon request as follows:

1. Establish different price levels for medical examination and treatment services upon request at various medical examination and treatment facilities based on specialty, time of service provision, level of expertise of service providers, care and treatment personnel; infrastructure conditions and level of care; quantity and quality of technical services.

2. In cases where additional costs not included in the price of medical examination and treatment services arise: the unit may apply cost-based methods to determine and propose the price of such services, specifically:

a) If the unit incurs additional costs due to hiring domestic (outside regular staff of the unit, department providing demand-based services) or foreign personnel: these costs, including fees for hiring personnel under contracts, food, accommodation, travel, interpreter and translator fees, and other reasonable and legitimate expenses related to hiring personnel, may be included in the price of medical examination and treatment services based on the agreement and voluntary consent of the service user.

b) If the unit provides medical examination and treatment services at home: it may include reasonable and legitimate additional costs incurred to provide such services.

Chapter II
IMPLEMENTATION

Article 11. Effective Date

1. This Circular takes effect from October 17, 2024.

2. The following Circulars cease to be effective from January 1, 2025:

a) Circular No. 13/2023/TT-BYT dated June 29, 2023 issued by the Minister of Health stipulating the framework price and pricing method for medical examination and treatment services upon request provided by state-owned medical examination and treatment facilities;

b) Circular No. 21/2023/TT-BYT dated November 17, 2023 issued by the Minister of Health stipulating the framework price for state-provided medical examination and treatment services and guiding the application of prices and payment of costs for medical examination and treatment in certain cases;

c) Circular No. 22/2023/TT-BYT dated November 17, 2023 issued by the Minister of Health stipulating uniform prices for medical examination and treatment services under health insurance between hospitals of the same grade nationwide and guiding the application of prices and payment of costs for medical examination and treatment under health insurance in certain cases.

3. Amend, supplement, and abolish provisions in Circular No. 22/2023/TT-BYT dated November 17, 2023 issued by the Minister of Health stipulating uniform prices for medical examination and treatment services under health insurance between hospitals of the same grade nationwide and guiding the application of prices and payment of costs for medical examination and treatment under health insurance in certain cases as follows:

a) Amend Clause 5 of Article 2 as follows:

"5. The price of technical service performed using non-sedative anesthesia does not include the cost of drugs and oxygen used for the service as specified in Appendix VI attached hereto, which serves as the basis for settlement with health insurance agencies and medical examination and treatment facilities temporarily recording data; in which the notes of the services are applied as with the service but performed using non-sedative anesthesia. The cost of drugs and oxygen is settled with the health insurance agency and the patient according to actual usage and procurement results of the medical examination and treatment facility.

The price level of technical services from service number 59, 61, 64 in the Appendix attached hereto shall be used for health insurance settlement from November 17, 2023."

b) Amend Clause 8 and Clause 9 of Article 7 as follows:

"8. The provisions of Clause 7 of this Article, Clause 6 of Article 5, and Clause 16 of Article 6 of this Circular only apply for settlement between the health insurance agency and the medical examination and treatment facility and do not apply for calculating the co-payment of patients.

9. During natural disasters, catastrophes, or epidemics: the health insurance agency shall settle with medical examination and treatment facilities based on actual service prices and quantities, without applying the settlement provisions of Clause 7 of this Article, Clause 6 of Article 5, and Clause 16 of Article 6 of this Circular.";

c) Abolish the content of the provision at Point c Clause 3 of Article 9:

"3. Responsibilities of the Department of Health:

c) Report to the competent authority to allocate hospital beds and decide on the number of staff for healthcare facilities under local management so that these facilities have sufficient beds and personnel to meet needs and improve the quality of medical examination and treatment services for the people."

Article 12. Cross-referencing Provisions

In case the regulatory legal documents and provisions cited in this Circular are amended, supplemented, or replaced, they shall be implemented according to the new regulatory legal documents.

Article 13. Responsibilities of the Ministry of Health

1. Responsibilities of the Ministry of Health: The Planning-Finance Department shall take the lead in directing and organizing the implementation of this Circular and providing guidance on the specialized content within its assigned functions and tasks.

2. Departments and Bureaus under the Ministry of Health shall be responsible for organizing the implementation of this Circular according to their assigned functions and tasks.

Article 14. Responsibilities of Provincial/Municipal Health Departments

1. Report to the competent authority to decide specific service prices for medical examination and treatment as stipulated in Clause 6, Article 110 of the Law on Medical Examination and Treatment.

2. Report to the competent authority to issue, amend, or supplement economic-technical norms and cost levels (if any) as the basis for setting service prices for medical examination and treatment.

3. Take the lead and coordinate with relevant units to organize the implementation and inspection of this Circular within their jurisdiction.

Article 15. Responsibilities of Medical Examination and Treatment Facilities

1. Strictly implement regulations on professional technical standards, transfer of medical examination and treatment facilities, prescription of services, medicines, and medical equipment suitable for the condition of patients.

2. Use funds from revenue sources consistent with costs already structured into the price of medical examination and treatment services to purchase and repair non-fixed medical equipment to ensure conditions for professional work, hygiene, patient safety, and improve service quality.

3. Establish, manage, and utilize financial results in accordance with Decree No. 60/2021/NĐ-CP dated June 21, 2021 of the Government on the mechanism of self-financing for public service units in cases where revenue exceeds expenditure significantly. Medical examination and treatment facilities shall not use the accumulation level specified in Article 8 of this Circular to determine the total surplus or deficit from the implementation of self-financing mechanisms.

4. Bear responsibility for the accuracy, reasonableness, and legality of data and documents in the pricing plan file and issuance of economic-technical norms within their authority.

5. Ensure the provision of medical examination and treatment services upon request complies with the following principles:

a) Ensuring compliance with functions, tasks, organizational regulations, and ensuring the completion of assigned functions and tasks.

b) In addition to meeting requirements for infrastructure, medical equipment, means, and human resources as prescribed by laws on medical examination and treatment, medical examination and treatment facilities must also meet the following additional requirements when providing services upon request:

- Ensuring the number of beds for implementing services upon request at any given time does not exceed 20% of the average number of beds operated in the previous year (excluding beds for special requests arranged in separate areas or independently without mixing with regular beds in departments or rooms funded through loans, fundraising, joint ventures, partnerships, public-private partnership (PPP) models, procurement from development funds, or other legitimate sources as prescribed);

- Ensuring a certain proportion of time (at least 70%) for specialists and excellent doctors to provide medical examination and treatment services to patients with health insurance cards, those without health insurance cards but not using services upon request, and supporting lower-level facilities.

c) Publicize and disclose the list, prices, and supply capacity of medical examination and treatment services for the public to know and choose to use based on voluntary agreements between service users and medical examination and treatment facilities; ensuring that patients receive medical examination and treatment services according to the treatment protocols issued by competent authorities.

d) Implement separate accounting and tracking of revenue, expenses, and reflect them fully in accounting books and financial reports; must allocate and use depreciation of fixed assets in accordance with laws on asset management and utilization; fulfill all obligations to the State as prescribed by law.

6. Report to the competent authority to promptly amend and supplement economic-technical norms in cases where such norms are inconsistent with reality as stipulated in Clause 3, Article 7 of this Circular.

7. Propose the competent authority to adjust service prices for medical examination and treatment in cases where service prices fluctuate or factors forming prices increase or decrease, ensuring consistency with market service price fluctuations or changes in the Consumer Price Index announced annually by the National Assembly or changes in state policies.

During the implementation process, if there are difficulties or obstacles, please report to the Ministry of Health (Planning-Finance Department) for timely guidance and resolution.

 

ANNEX I

PRICE INFORMATION SURVEY FORM
(Annexed to Circular No. 21/2024/TT-BYT dated October 17, 2024 of the Minister of Health)

PRICE INFORMATION SURVEY FORM

Survey location: Town (commune)... District (county)... City (province)...

Name of surveyed facility...

Address of surveyed facility:...

 

 

ANNEX II

PRICING PLAN - COMPREHENSIVE COMPONENTS AND GROUPS OF COSTS FORMING THE PRICE OF A MEDICAL EXAMINATION AND TREATMENT SERVICE
(Annexed to Circular No. 21/2024/TT-BYT dated October 17, 2024 of the Minister of Health)

Note: This Appendix applies in cases where the cost method is used to develop the Pricing Plan. The entity developing the Pricing Plan adjusts the content of the cost components and the price-forming cost groups in accordance with the aggregated data to explain the costs of the price-forming factors.

 

ANNEX III

CALCULATING THE COST OF MEDICAL DIAGNOSTIC AND TREATMENT SERVICES BASED ON COST FACTORS
(Annexed to Circular No. 21/2024/TT-BYT dated October 17, 2024 of the Minister of Health)

The cost of medical diagnostic and treatment services is determined according to the following formula:

1. Calculating labor costs

1.1. Direct labor costs

Direct labor refers to workers directly performing medical diagnostic and treatment services in clinical and paraclinical departments. Direct labor costs are determined based on the labor norms for each technical service (as specified in Circular No. 19/2022/TT-BYT dated December 31, 2022 issued by the Minister of Health guiding the establishment of economic and technical norms for medical diagnostic and treatment services under the Ministry of Health's jurisdiction (hereinafter referred to as Circular No. 19/2022/TT-BYT) and the hourly wage rate. The steps to estimate direct labor costs for medical diagnostic and treatment services are as follows:

. Annually, based on the progress of plan formulation, the Departments of Science and Technology refer to the Program's objectives and content and criteria for selecting projects for each region, advise the People's Committee of provinces and cities on the goals, content, scope, and scale of projects within the Program's scope to be included in the annual science and technology plan of the province or city. After discussing the annual plan with relevant departments and agencies at the local level, the project is refined and supplemented to seek the opinion of the provincial or municipal Science and Technology Council.. Identify the types of workers directly involved in providing medical diagnostic and treatment services.

Step 2. Determine the labor norm regarding the number of people, level of expertise, and hours of work required to directly perform each medical diagnostic and treatment service. This is the labor norm for direct labor established for each technical service.

Step 3. Determine the unit cost per hour for each type of worker, classified by level of expertise.

Step 4. Direct labor cost to perform one medical diagnostic and treatment service = ∑_i Labor norm (hours) * Unit cost per hour (i is the group of laborers according to each type)

1.2. Indirect labor costs

Indirect labor costs related to the provision of medical diagnostic and treatment services are estimated using the cost allocation method. Indirect labor includes workers who do not directly provide medical diagnostic and treatment services, belonging to functional departments and common support departments (such as Pharmacy, Infection Control, Nutrition departments) and indirect labor in clinical and paraclinical departments.

The steps to allocate indirect labor costs to medical diagnostic and treatment services are as follows:

Step 1. Determine the labor costs (including wages, salaries, allowances, and other contributions as prescribed) of workers in functional departments and common support departments and indirect labor in clinical and paraclinical departments.

Step 2. Allocate the labor costs determined in step 1 to clinical and paraclinical departments.

Step 3. Based on the allocated costs to each department within clinical and paraclinical departments, allocate costs to the medical diagnostic and treatment services provided in each department.

2. Direct Costs

2.1 Direct costs with economic-technical norms

The steps to determine the cost of drugs, chemicals, and medical equipment for medical diagnostic and treatment services are as follows:

. Annually, based on the progress of plan formulation, the Departments of Science and Technology refer to the Program's objectives and content and criteria for selecting projects for each region, advise the People's Committee of provinces and cities on the goals, content, scope, and scale of projects within the Program's scope to be included in the annual science and technology plan of the province or city. After discussing the annual plan with relevant departments and agencies at the local level, the project is refined and supplemented to seek the opinion of the provincial or municipal Science and Technology Council.. Identify the list, types, and quantities of drugs, chemicals, and medical equipment necessary for providing medical diagnostic and treatment services.

Step 2. Determine the economic-technical norms regarding quantity, type, and loss ratio (if applicable) of drugs and medical equipment according to treatment guidelines, manufacturer instructions, or other relevant regulations. For drugs and medical equipment where one unit can be used for more than one service (e.g., ultrasound probes, ultrasound gel, uniforms for staff), the norm is calculated by [1/number of procedures or patients using].

Step 3. Determine the unit cost (unit price) of drugs, chemicals, and medical equipment according to Article 7 of this Circular.

Step 4. The cost of drugs, chemicals, and medical equipment to perform one medical diagnostic and treatment service = Economic-technical norm of drugs/equipment * Unit cost * Loss ratio (if applicable).

2.2. Direct costs without economic-technical norms

Direct costs that cannot apply economic-technical norms are estimated using the cost allocation method. These costs are defined in point b, Clause 3, Article 119 of Decree No. 96/2023/NĐ-CP (excluding drug and medical equipment costs already having economic-technical norms). The steps to allocate direct costs without economic-technical norms to each medical diagnostic and treatment service are as follows:

Step 1. Determine the total expenditure of the cost item to be allocated throughout the entire medical diagnostic and treatment facility. Estimate the portion of this cost for clinical and paraclinical departments (cost C₁).

Step 2. Allocate the total cost C₁ to each clinical and paraclinical department based on appropriate allocation criteria (see Appendix at Section 5).

Step 3. Based on the costs allocated to each department and room within clinical and paraclinical departments, allocate costs to the medical diagnostic and treatment services provided in each department and room.

3. Anticipated profit

Management costs are defined in point d, Clause 3, Article 119 of Decree No. 96/2023/NĐ-CP. Management costs include expenses incurred in management and administrative units of the medical diagnostic and treatment facility and indirect costs associated with providing medical diagnostic and treatment services. The steps to allocate management costs to each medical diagnostic and treatment service are as follows:

Step 1. Identify the expense items included in management costs to calculate the total management cost throughout the entire medical diagnostic and treatment facility (cost C₀).

Step 2. Determine the total management cost (cost C₂) by subtracting the direct cost (cost C₁) from the clinical and paraclinical departments:

C₂=C₀ - ∑C₁

Step 3. Allocate the total management cost to each clinical and paraclinical department based on appropriate allocation criteria.

Step 4. Based on the costs allocated to each department and room within clinical and paraclinical departments, allocate costs to the medical diagnostic and treatment services provided in each department and room.

4. Depreciation Costs

4.1. Direct depreciation costs

The steps to estimate the depreciation cost of medical equipment based on economic-technical norms are as follows:

. Annually, based on the progress of plan formulation, the Departments of Science and Technology refer to the Program's objectives and content and criteria for selecting projects for each region, advise the People's Committee of provinces and cities on the goals, content, scope, and scale of projects within the Program's scope to be included in the annual science and technology plan of the province or city. After discussing the annual plan with relevant departments and agencies at the local level, the project is refined and supplemented to seek the opinion of the provincial or municipal Science and Technology Council.. Identify the location where the medical diagnostic and treatment service is performed (e.g., operating room, minor surgery room, laboratory).

Step 2. Inventory the medical equipment used to complete one medical diagnostic and treatment service, including equipment used directly in the technique and shared equipment in the technique room (such as air conditioning, surgical lights...).

Step 3. Determine the equipment usage rate for each type of medical device by identifying the necessary usage time to perform one or more rounds of medical examination and treatment services at the same time.

Step 4. Calculate depreciation cost per hour.

Step 5. Estimate the depreciation cost of medical equipment for performing one medical examination and treatment service = Equipment depreciation rate * Depreciation cost per hour.

4.2. Indirect depreciation costs

Indirect depreciation costs include: (i) indirect medical equipment depreciation of departments and units within clinical and paraclinical blocks; (ii) medical equipment depreciation of departments and units within administrative blocks; and (iii) infrastructure depreciation.

For group (i), estimate the total indirect medical equipment depreciation cost for each department and unit within clinical and paraclinical blocks.

For groups (ii) and (iii), allocate these costs to departments and units within clinical and paraclinical blocks as follows:

Step 1. Determine the total depreciation cost of groups (ii) and (iii) throughout the entire medical examination and treatment facility.

Step 2Allocate the total cost from the hospital to each department and unit within clinical and paraclinical blocks and administrative blocks.

Step 3. Allocate costs from administrative departments to clinical and paraclinical departments.

Step 4. Based on the allocated total costs of groups (i), (ii), and (iii) to each department and unit within clinical and paraclinical blocks, allocate costs to medical examination and treatment services provided in each department and unit.

5. Medical examination and treatment facilities refer to the criteria for allocating costs according to the table below:

 

ANNEX IV

DETERMINING THE COST PRICE OF MEDICAL EXAMINATION AND TREATMENT SERVICES BY COST ALLOCATION METHOD
(Annexed to Circular No. 21/2024/TT-BYT dated October 17, 2024 of the Minister of Health)

1. The total cost price of medical examination and treatment services is determined by the following formula:

Each cost is divided into the following cost groups.

2. Cost factors and groups of cost factors are calculated and allocated through six steps:

Step 1: Determine the total cost of the cost factor or group of cost factors to be calculated for the entire facility (referred to collectively as the Total Cost Factor (TCF)).

Step 2: Calculate the direct service implementation cost (DSPC) and the direct cost difference (DCD).

- All or part of the costs determined at step 1 of this section are calculated for all services of all departments based on cost levels and economic-technical norms (if available).

- DSPC is determined according to the cost level issued by the competent authority and responsible for the accuracy of that cost level, ensuring the principle of efficiency, suitability with the current activities of the unit, achieving quality in medical diagnosis and treatment, and economy. In cases where the unit's cost level cannot be determined, the comparative method with other units in the same area is used to determine the cost level.

- DCD is the difference (if any) between the cost of the service with economic-technical norms prescribed by the competent authority minus the DSPC calculated above.

Step 3: Calculate the common direct usage cost of departments (CDUCD).

CDUCD is the total common usage cost when implementing services of those departments excluding the portion of the direct service cost (DSPC) of the service already calculated at step 2 of this section (common costs for departments include drug costs, chemical costs, material costs, office supply costs, depreciation costs (fixed assets, medical equipment) in use, labor costs, or other common costs for departments) excluding direct costs for patients.

- CDUCD equals (=) the total direct cost received by the department minus the total DSPC specified at step 2 of this section (if applicable).

- Departments not directly providing services have their CDUCD reallocated according to the provisions at step 5.

Step 4: Allocate the costs used for common unit-wide activities (CCUAC) to all departments.

CCUAC = TCF determined at step 1 of this section minus the DSPC of all services of the unit at step 2 of this section and minus the CDUCD of all departments of the unit at step 3 of this section.

- CCUAC is reallocated to all departments of the unit according to criteria established in this Appendix and ratios among criteria suitable for the nature and technical characteristics, management.

Step 5: Reallocate all costs of departments not providing services to departments directly providing services (RCS).

The total CDUCD at step 3 of this section plus the CCUAC at step 4 of this section of all departments not directly providing services to patients will be reallocated to departments directly providing services to patients according to specific criteria established in this Appendix and ratios among criteria suitable for the nature, functions of management, and support functions of departments not directly providing services.

Step 6: Reallocate all calculated and allocated costs of departments directly providing services to each service of those departments (RCS).

- RCS equals (=) the CDUCD calculated at step 3 of this section, CCUAC calculated at step 4 of this section, and RCS calculated at step 5 of this section of the service-providing department being reallocated according to each service of the department according to the total number of labor hours or total machine usage time or both criteria depending on the characteristics and nature of the costs to be allocated.

- Allocation criteria determination methods are as follows:

Note: Labor hours can be divided according to time and the number of people needed according to economic-technical norms or the consumption rate of those directly performing services and those indirectly participating in service support or combined together.

3. Full cost of one service

Of which

- DSPC of the service is the direct costs of all cost factors included in the calculation at step 2, Clause 2.

- DCD is the direct cost difference (if any) of all cost factors included in the calculation at step 2, Clause 2.

- RCS from department is the cost allocated from the service-providing department at step 6, Clause 2 of all costs included in the calculation and allocation.

4. Cost factors and allocation criteria

- Cost factors may be grouped and shared or allocated according to individual service cost factors.

- Allocation criteria may be used independently or combined when allocating cost factors.

 

ANNEX V

COMBINED SERVICES PROPOSED FOR SPECIFIC PRICING
(Annexed to Circular No. 21/2024/TT-BYT dated October 17, 2024 of the Minister of Health)

 

Note: Columns marked with (*) are mandatory information.

 

ANNEX VI

SERVICE FEES FOR PROCEDURES PERFORMED UNDER LOCAL ANESTHESIA WITHOUT INCLUDING MEDICATION AND OXYGEN USED IN THE SERVICE
(Annexed to Circular No. 21/2024/TT-BYT dated October 17, 2024)

Unit Price: VND