Circular No. 22/2023/TT-BYT stipulates uniform prices for health insurance medical services among hospitals of the same level nationwide and provides guidance on applying and settling costs for health insurance medical services in certain cases, issued by the Minister of Health.

CIRCULAR

UNIFIED PRICING OF HEALTH INSURANCE SERVICES FOR DIAGNOSTIC AND TREATMENT BETWEEN HOSPITALS OF THE SAME RANK ACROSS THE NATION AND GUIDELINES FOR APPLYING PRICES AND PAYING COSTS FOR DIAGNOSTIC AND TREATMENT SERVICES IN CERTAIN CASES

Pursuant to the Law on Diagnosis and Treatment No. 40/2009/QH12 dated November 23, 2009;

Pursuant to the Law on Prices No. 11/2012/QH12 dated June 20, 2012;

Pursuant to Decree No. 146/2018/NĐ-CP dated October 18, 2018 of the Government detailing and guiding implementation measures of the Health Insurance Law, as amended and supplemented by Decree No. 75/2023/NĐ-CP dated October 19, 2023;

Pursuant to the Government Decree No. 177/2013/NĐ-CP dated November 14, 2013 detailing and guiding the implementation of certain provisions of the Law on Prices, amended and supplemented by the Government Decree No. 149/2016/NĐ-CP dated November 11, 2016;

Pursuant to the Government Decree No. 60/2021/NĐ-CP dated June 21, 2021 on the mechanism of self-management of public service units;

Pursuant to the Government Decree No. 24/2023/NĐ-CP dated May 14, 2023 on the basic salary for civil servants, public officials, and armed forces personnel;

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

At the proposal of the Director of the Department of Planning and Finance, Ministry of Health;

The Minister of Health issues this Circular to unify prices of health insurance diagnostic and treatment services between hospitals of the same rank across the nation and to guide the application of prices and payment of costs for health insurance diagnostic and treatment services in certain cases.

Article 1. Scope of Regulation and Applicability

Article 1. This Circular unifies prices of health insurance diagnostic and treatment services between hospitals of the same rank across the nation and guides the application of prices and payment of costs for health insurance diagnostic and treatment services in certain specific cases.

Article 2. For health insurance diagnostic and treatment services not reimbursable from the health insurance fund, the price range and authority to set the price shall be implemented according to the provisions of the Law on Prices, the Law on Diagnosis and Treatment, the Law on Organization of Local Administration, and related guiding documents.

Article 3. Price of Diagnostic and Treatment Services health insurance

1. The price of diagnostic services and consultations as stipulated in Appendix I attached hereto.

2. The price of hospital bed day services as stipulated in Appendix II attached hereto.

3. The price of technical services and laboratory tests as stipulated in Appendix III attached hereto.

4. Additional notes for some technical services as stipulated in Appendix IV attached hereto.

5. The price of technical services performed using anesthesia without general anesthesia does not include the cost of drugs and oxygen used for such services as stipulated in Appendix V attached hereto. The cost of drugs and oxygen will be settled with the social insurance agency and patients based on actual usage and the results of procurement bidding conducted by the unit.

Article 4. Structure of Health Insurance Diagnostic and Treatment Service Prices

The prices of diagnostic and treatment services prescribed in this Circular are established based on direct costs and salaries to ensure the provision of diagnostic and treatment services, specifically as follows:

1. Direct costs included in the price of diagnostic services:

a) Costs for clothing, hats, masks, sheets, pillows, mattresses, mats, office supplies, gloves, cotton, bandages, alcohol, gauze, saline solution, and other consumables used in diagnostic activities;

b) Costs for electricity, water, fuel, waste management (solid and liquid), laundry, sterilization of textiles and examination tools, hygiene and environmental sanitation costs, disinfectants and anti-infection materials during diagnostic activities;

c) Maintenance and repair costs for buildings, equipment, replacement of assets, tools, and equipment such as air conditioners, computers, printers, dehumidifiers, fans, tables, chairs, beds, cabinets, lighting fixtures, and other necessary tools and equipment during diagnostic activities.

2. Direct costs included in the price of hospital bed day services:

a) Costs for clothing, hats, masks, blankets, sheets, pillows, mattresses, mosquito nets, mats, office supplies, gloves used in examinations, injections, infusions, cotton, bandages, alcohol, gauze, saline solution, and other consumables used in daily care and treatment (including costs for changing dressings for inpatients, except for cases covered under the price of hospital bed day services as stipulated in Clause 5 and Clause 6, Article 7 of this Circular); electrodes, ECG cables, blood pressure cuffs, SPO2 cables during the use of patient monitoring machines for intensive care beds.

b) Costs as specified in Point b and Point c, Clause 1 of this Article serving the care and treatment of patients according to professional requirements.

c) Specifically, costs for medicines, whole blood, blood products meeting standards, medical equipment (excluding the aforementioned consumables); types of syringes, needles, syringe needles used in injections and infusions; feeding pumps; infusion tubes, connectors, syringe pump cables, infusion machine cables used in injections and infusions; oxygen gas, oxygen breathing tubes, oxygen masks (except for cases where patients are prescribed mechanical ventilation) are not included in the structure of hospital bed day service prices and will be settled based on actual usage for patients.

3. Direct costs included in the price of technical services:

a) Costs for clothing, hats, masks, sheets, pillows, mattresses, mats, textiles; office supplies; drugs, infusions, chemicals, consumables, replacement materials used during the provision of technical services;

b) Costs as specified in Point b and Point c, Clause 1 of this Article serving the provision of technical services according to professional requirements.

4. Salary costs included in the price of diagnostic services, hospital bed day services, and technical services, including:

a) Rank-based salaries, position allowances, contributions according to state regulations for public service units, and the basic salary level as stipulated in the Government Decree No. 24/2023/NĐ-CP dated May 14, 2023 on the basic salary for civil servants, public officials, and armed forces personnel;

b) Overtime allowances, surgical and procedural allowances pursuant to Decision No. 73/2011/QĐ-TTg dated December 28, 2011 of the Prime Minister on special allowances for civil servants, public officials, and workers in public healthcare facilities and epidemic prevention allowances.

5. The cost of wages in the service price for medical examination and treatment prescribed in Clause 4 of this Article does not include the following allowances and benefits guaranteed by the state budget according to the provisions of the law:

a) Allowances for preferential treatment, attraction, subsidies, and other benefits for medical staff, contractual workers, and military health personnel directly engaged in specialized medical work at state healthcare facilities located in areas with extremely difficult socio-economic conditions;

b) Attraction allowances, long-term service allowances, certain subsidies, and travel expenses for civil servants, employees, and those receiving salaries in the armed forces (People's Army and People's Public Security) working in areas with extremely difficult socio-economic conditions;

c) Special allowances for staff working at Hanoi Friendship Hospital, Thong Nhat Hospital, Da Nang C Hospital under the Ministry of Health, Central Protection Departments 1, 2, 2B, 3, and 5, and Department A11 of the 108 Military Central Hospital and Department A11 of the Military Traditional Medicine Institute;

d) Special allowances according to profession or job.

6. The settlement of medical examination and treatment costs between the social insurance agency and healthcare facilities according to the service prices stipulated in this Circular and the costs of medicines, whole blood, blood products, chemicals, and medical equipment not included in the service prices (specifically noted in each service) shall be carried out according to the payment principles set forth in Article 24 of Decree No. 146/2018/NĐ-CP dated October 17, 2018, of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law, which has been amended and supplemented by Decree No. 75/2023/NĐ-CP dated October 19, 2023, of the Government.

7. The costs specified in Clauses 1, 2, 3, and 4 of this Article shall be determined based on economic and technical norms, cost standards issued by competent authorities, the prices of cost factors, actual reasonable cost levels according to current regulations and policies, ensuring average and advanced standards, meeting quality service requirements.

Economic and technical norms serve as the basis for establishing service prices for medical examination and treatment and shall not be used as grounds for settling specific medical examination and treatment services (except for special cases stipulated in Clause 6 of Article 5, Clause 16 of Article 6, and Clause 8 of Article 7 of this Circular).

Article 4. Principles for applying service prices to healthcare facilities that have signed health insurance medical examination and treatment contracts

1. Institutes with hospital beds, central hospitals with medical examination and treatment functions, licensed to operate as hospitals; district central hospitals with medical examination and treatment functions classified as hospitals: apply the price level of equivalent-grade hospitals.

2. Provincial and municipal health protection and care clinics not directly affiliated with provincial general hospitals: apply the service price level of Grade II hospitals.

3. Healthcare facilities not yet classified: military clinics, civilian-military clinics, military field hospitals, field hospitals; private multi-specialty and specialty clinics: apply the price level of Grade IV hospitals.

4. For regional multi-specialty clinics:

a) In cases licensed to operate as hospitals or falling under the provisions of Clause 12 of Article 11 of Decree No. 155/2018/NĐ-CP dated November 12, 2018, of the Government amending and supplementing certain regulations related to investment and business conditions under the management of the Ministry of Health: apply the service price level of Grade IV hospitals;

b) In cases only performing emergency services, outpatient medical examination and treatment: apply the service price level of Grade IV hospitals for outpatient services and technical procedures. For cases decided by the Department of Health to have inpatient beds: apply the inpatient bed service price equal to 50% of the inpatient internal ward type 3 daily price of Grade IV hospitals. The maximum number of days payable is three days per person per treatment session. No outpatient service fees will be settled if inpatient bed fees have already been paid.

5. Commune, ward, town health stations, health stations of agencies, units, organizations, schools, combined civilian-military health stations:

a) Outpatient service prices: apply the price level of commune health stations;

b) Technical procedure service prices: 70% of the technical procedure service prices as stipulated in Appendix III attached to this Circular;

c) For health stations decided by the Department of Health to have inpatient beds: apply the inpatient bed service price equal to 50% of the inpatient internal ward type 3 daily price of Grade IV hospitals. The maximum number of days payable is three days per person per treatment session. No outpatient service fees will be settled if inpatient bed fees have already been paid at the commune-level health station.

6. Maternity homes: apply the service price level of Grade IV hospitals.

For inpatient bed service prices: apply 50% of the inpatient internal ward type 3 daily price of Grade IV hospitals.

7. In cases where patients have health insurance cards but use medical examination and treatment services on demand, the patient will be reimbursed by the health insurance fund within the scope and level of reimbursement as stipulated by the Health Insurance Law and guiding documents.

Article 5. Determining the number of times, price level, and payment for outpatient examination fees in certain specific cases

1. In the case where a patient comes to the outpatient department for examination and is then referred for inpatient treatment according to professional requirements, the payment for outpatient examination shall be carried out in accordance with the provisions of Clause 3 of this Article. In the case where a patient does not register for outpatient examination at the outpatient department but comes for examination and is referred for inpatient treatment at clinical departments according to professional requirements, there will be no payment for outpatient examination.

2. Medical facilities that organize specialized examinations at clinical departments, where patients register for outpatient examination at the outpatient department and undergo specialized examinations at clinical departments, shall be considered as undergoing outpatient examination at the outpatient department. The calculation of the number of outpatient examinations and the price level shall be carried out in accordance with the provisions of Clause 3 of this Article.

3. Within the same visit to the same medical facility for outpatient examination (which may be on the same day or due to objective conditions or professional requirements, the outpatient examination process cannot be completed on the same day and must continue on the following day), if a patient needs to undergo additional specialized examinations after having undergone one specialized examination, from the second examination onwards, only 30% of the price of one outpatient examination will be charged, and the maximum payment for outpatient examination costs for that patient shall not exceed two times the price of one outpatient examination.

4. A patient who comes to a medical facility for outpatient examination, receives medication for home treatment, but subsequently exhibits unusual symptoms and returns to the same medical facility for re-examination on the same day and continues to be examined shall be considered as the second or subsequent examination in one day. Payment shall be carried out in accordance with the provisions of Clause 3 of this Article.

5. A patient who comes to a multi-disciplinary health center for outpatient examination and is then referred to a hospital or district health center for further examination shall be considered as a new outpatient examination.

6. Medical facilities must coordinate and arrange human resources and outpatient examination tables to ensure the quality of outpatient examinations. For examination tables with more than 65 outpatient visits per day, the social insurance agency will only pay 50% of the outpatient examination fee from the 66th visit onwards for that examination table. If within a maximum period of one quarter, the medical facility still has examination tables with more than 65 visits per day, the social insurance agency will not pay for outpatient examination fees from the 66th visit onwards for those examination tables.

Article 6. Determining the number of days of bed occupancy, applying the price level, and payment for bed occupancy costs between the social insurance agency and medical facilities

1. Determining the number of inpatient treatment bed days for payment of hospitalization fees:

a) The number of inpatient treatment days equals the discharge date minus (-) the admission date plus (+) 1: applicable to cases where:

- In the case where a seriously ill patient is undergoing inpatient treatment, their condition has not improved, they have died, or their condition has worsened, but the family requests discharge or transfer to a higher-level facility;

- In the case where a patient has been treated at a higher-level facility through the emergency phase but still requires continued inpatient treatment and is transferred back to a lower-level facility or to another medical facility;

b) The number of inpatient treatment days equals the discharge date minus (-) the admission date: applicable to all other cases;

c) In the case where a patient is admitted to and discharged from the hospital on the same day (or admitted the previous day and discharged the next day) with a treatment time exceeding four hours but less than twenty-four hours, it shall be counted as one day of treatment.

In the case where a patient enters the emergency department without going through the outpatient department, with an emergency treatment and care time of four hours or less (including cases of discharge, admission, or transfer, death), the payment for outpatient examination fees, medication, medical equipment, and technical services shall be made, but there will be no payment for intensive care unit bed occupancy costs.

d) In the case where a patient is admitted to and discharged from the hospital with a treatment time of four hours or less, the payment for outpatient examination fees, medication, medical equipment, and technical services used by the patient shall be made, but there will be no charge for inpatient bed occupancy costs.

2. In the case where a patient transfers between two departments on the same day, each department shall only count half a day. In the case where a patient transfers among three or more departments on the same day, the service price for bed occupancy on that day shall be calculated as the average of the bed occupancy cost at the department with the longest stay over four hours and the highest bed occupancy cost, and at the department with the longest stay over four hours and the lowest bed occupancy cost.

3. The service price for bed occupancy in surgical departments and burn departments: applies a maximum of ten days after surgery. From the eleventh day after surgery onwards, the bed occupancy cost for internal medicine departments shall apply according to the corresponding departments specified in Section 3 of Appendix II issued together with this Circular.

4. The service price for bed occupancy is calculated for one person per bed. In the case where two people share one bed at the same time, only half of the bed occupancy service price will be paid. In the case where three or more people share one bed, only one-third of the bed occupancy service price will be paid.

5. The service price for bed occupancy in Intensive Care Units (ICUs) can only be applied in the following cases:

a) For special-class, Class I, or Class II hospitals that have established ICUs, detoxification departments, ICU-detoxification departments, and these departments meet all the conditions for operation as stipulated in Decision No. 01/2008/QD-BYT dated January 21, 2008, of the Minister of Health on the issuance of emergency, intensive care, and detoxification regulations (hereinafter referred to as Decision No. 01/2008/QD-BYT);

b) In the case where separate areas or emergency rooms (with ICU beds or postoperative beds for special surgeries) are arranged in the Emergency Department, Anesthesia Recovery Department, Pediatrics Department, Neonatal Department, Infectious Diseases Department, meeting the requirements for infrastructure, equipment, and personnel as stipulated in the Emergency, Intensive Care, and Detoxification Regulations issued together with Decision No. 01/2008/QD-BYT;

c) Patients lying in these beds must be cared for, treated, and monitored according to emergency, intensive care, and detoxification regulations. Other cases will only apply the service price for ICU bed occupancy and other types of beds as specified in Appendix II issued together with this Circular.

6. For clinical departments with intensive care unit beds: apply the service price for intensive care unit bed days as stipulated in Service Number 2 of Appendix II issued together with this Circular.

Example: the pediatric department with pediatric emergency ICU beds, neonatal or special care departments for premature infants;

7. Hospitals classified as Class III, Class IV, or unranked but approved by competent authorities to perform special surgeries: apply the highest service price for surgical ward bed days at that hospital.

Example: At Hospital A, which has been approved to perform special surgeries, if the hospital is ranked as Class III, it shall apply the service price for surgical ward bed days after Level 1 special surgery at a Class III hospital; if the hospital is ranked as Class IV or unranked, it shall apply the service price for surgical ward bed days after Level 1 special surgery at a Class IV hospital.

8. In cases where a surgery is classified differently according to various specialties (except pediatrics) as prescribed in Circular No. 50/2014/TT-BYT dated December 26, 2014, issued by the Minister of Health on the classification of surgeries, procedures, and staffing levels for each surgery and procedure (hereinafter referred to as Circular No. 50/2014/TT-BYT): apply the service price for surgical ward bed days or burn bed days based on the lowest surgery classification.

9. Surgeries classified by the Ministry of Health as equivalent to those specified in this Circular but classified differently according to specialties as prescribed in Circular No. 50/2014/TT-BYT: apply the service price for surgical ward bed days or burn bed days based on the surgery classification.

10. Surgeries not classified according to the provisions of Circular No. 50/2014/TT-BYT: apply the service price for surgical ward bed days of Level 4 at the corresponding hospital class.

11. For Traditional Medicine Hospitals under the Ministry of Health classified as Class I: apply the service price for bed days according to the respective departments corresponding to the bed types at a Class I hospital, without applying the prices of specialized hospitals under the Ministry of Health in Hanoi and Ho Chi Minh City.

12. For departments within Traditional Medicine Hospitals (excluding those specified in Clause 11 of this Article) and rehabilitation hospitals:

a) Intensive Care Unit (ICU) ward bed service price: as stipulated in Clause 5 of this Article;

b) Emergency Intensive Care ward bed service price: as stipulated in Clause 6 of this Article;

c) Ward bed service price for departments specializing in oncology and pediatrics: apply the level 1 internal ward bed service price;

d) Ward bed service price for treating spinal cord injury, stroke, and brain trauma: apply the level 2 internal ward bed service price;

d) The service price for bed days in other departments: apply the service price for internal ward bed days of Level 3.

13. For healthcare facilities organizing departments in a multi-specialty format: apply the service price for internal ward bed days corresponding to the hospital class where the patient is treated. If a patient is treated for multiple diseases simultaneously, apply the service price for bed days in the primary treatment department.

14. Only in cases of overcapacity, healthcare facilities may add extra beds beyond the planned number of beds allocated to serve patients and these will be included in the settlement with the social insurance agency as stipulated in Clause 16 of this Article.

15. In cases where patients lie on stretchers or foldable beds: apply a rate equal to 50% of the service price for bed days according to the specialty categories specified in Appendix II issued together with this Circular.

16. The quarterly settlement of bed day fees between the social insurance agency and healthcare facilities shall be carried out as follows:

a) Determine the actual number of beds used in the quarter (year) = Total number of inpatient treatment days in the quarter (year) divided by the actual number of days in the quarter (year being 365 days), wherein the inpatient treatment days are converted according to the principle: stretcher beds, foldable beds, two-person shared beds: two days of converted beds equal one day; three-person or more shared beds: three days of converted beds equal one day;

b) In cases where the healthcare facility's actual number of beds used in the quarter is lower than or equal to 120% of the planned number of beds allocated: pay 100% of the total amount according to the actual number of bed days and the service price for bed days as prescribed;

c) In cases where the healthcare facility's actual number of beds used exceeds 120% of the planned number of beds allocated in the year:

- For healthcare facilities assigned planned beds before 2015, the healthcare facility and the social insurance agency may agree on a method to determine the quarterly bed utilization rate (hereinafter referred to as the bed utilization rate), which equals the actual number of beds used in the quarter divided by the actual number of beds used in 2015 multiplied by 100%.

- In cases where the actual bed utilization rate (including the calculation method mentioned above):

+ Is less than or equal to 130%: the health insurance agency shall pay the healthcare facility 100% of the total amount according to the actual number of bed days and the service price for bed days as prescribed;

+ Exceeds 130% to 140%: the health insurance agency shall pay the healthcare facility 97% of the total amount according to the actual number of bed days and the service price for bed days as prescribed;

+ Exceeds 140% to 150%: the health insurance agency shall pay the healthcare facility 95% of the total amount according to the actual number of bed days and the service price for bed days as prescribed;

+ Exceeds 150%: the health insurance agency shall pay the healthcare facility 90% of the total amount according to the actual number of bed days and the service price for bed days as prescribed.

d) In cases where healthcare facilities are consistently overloaded due to objective reasons (for example, expansion of administrative boundaries, increase in health insurance cards for initial medical care...), the Department of Health shall report to the provincial People's Committee for consideration and allocation of additional beds and job positions to ensure the quality of medical services provided.

e) In cases where healthcare facilities put construction projects, renovation, expansion, upgrading, or new construction into operation but have not been authorized to allocate additional beds, the Department of Health and the social insurance agency shall agree on the additional number of beds in this area to be added to the previously allocated planned number of beds by the competent authority to implement the settlement as stipulated in this clause.

17. Bed days for surgical ward after performing "Phaco Cataract Surgery": apply the service price for surgical ward bed days or burn bed days of Level 3 corresponding to the hospital class as stipulated in Appendix II issued together with this Circular.

Article 7. Application of prices and payment conditions for certain special technical services

1. Technical services shall be applied in the following order:

a) For specific technical services whose prices have been specified in the annex attached to this Circular: apply the specified price;

b) For technical services that have not been specified in the annex attached to this Circular but have been classified as equivalent in terms of technical level and implementation costs: apply the price of the service classified as equivalent by the Ministry of Health in terms of technical level and implementation costs;

c) In cases where there is overlap between different specialties, the technical service performed in a particular specialty shall be applied at the price of the technical service in that specialty.

2. For technical services that have been approved by competent authorities (Ministries and central agencies for units under central management, Provincial Health Departments for units under local management) in their service catalogues (excluding care services already included in the cost of hospitalization days and procedures that are part of another service's cost), but which have not yet had prices set; and for technical services that were ordered but could not be completed due to the patient's condition or disease progression: payment shall be made based on the actual quantity of medicines and materials used for the patient and the purchase price as prescribed by law.

3. In cases where multiple interventions are performed during a single surgery: payment shall be made according to the highest-priced complex surgery, and other technical services arising outside the surgical procedure shall be paid as follows:

a) At 50% of the price of the additional surgeries if they are still performed by the same surgical team:

b) At 80% of the price of additional surgeries if a different surgical team is required;

c) If the additional service is a procedure, it will be reimbursed at 80% of the price of the additional technical service.

4. For the service "Changing bandages for wounds or incisions up to 15 cm long":

a) Payment shall be made for inpatients in the following cases: infected wounds or incisions; wounds with fluid or blood leakage in skin avulsion injuries or exposed skin areas larger than 6 cm; wounds with gauze packing; foot wounds with drainage tubes leaking fluid; multiple wounds or incisions; or after one surgery but requiring two or more incisions;²; the wound has been packed with gauze; the drainage from the wound on the leg is excessive; multiple wounds or surgical incisions; or after surgery but requires two or more incisions;

b) Not applicable for changing dressings in the following cases: laparoscopic surgery, routine wound dressing changes, or umbilical cord dressing changes for newborns.

5. For the service "Changing bandages for incisions longer than 15 cm to 30 cm" in inpatient treatment, it shall only be applied in the following cases:

a) Infected incisions, gastrointestinal fistulas, bile fistulas, urinary fistulas;

b) Incisions after contaminated surgery (peritonitis or osteomyelitis or abscess), incisions after digestive tract, urinary system, bile duct, or abdominal ascites surgery;

c) Incisions after surgery requiring two or more incisions;

d) In cases of cesarean section surgery: apply this price but not more than three times.

6. For blood transfusion compatibility testing at 37°C using anti-human globulin serum (indirect Coombs test): Reimburse according to the price of the "Compatibility reaction using human anti-globulin" service with code 1340 or 1341 as stipulated in Appendix III issued together with this Circular.

6. For immunological crossmatching tests at 37°C using anti-globulin serum (indirect Coombs test) in blood transfusions: payment shall be made according to the price of the "Crossmatching Service Using Anti-Human Globulin" service with code 1340 or 1341 as stipulated in Annex III attached to this Circular.

7. The quarterly settlement of certain technical services such as: conventional X-ray imaging, digital X-ray imaging (for diagnosis), CT scans up to 32 slices (for diagnosis, service codes 42, 43 as stipulated in Annex III attached to this Circular), ultrasound (service codes 1, 2 as stipulated in Annex III attached to this Circular), MRI (service codes 67, 68 as stipulated in Annex III attached to this Circular) between health insurance agencies and healthcare facilities shall be carried out as follows:

a) Determine the maximum number of cases that the social health insurance agency will pay according to the price specified in this Circular by dividing the average case volume according to the pricing standard by 8, then multiplying the result by the actual working hours of the unit, then multiplying by the actual working days in the quarter, then multiplying by the actual number of machines operating in the healthcare facility in the quarter, and finally multiplying by 120%;

b) Pricing standard (number of cases per machine per 8-hour working day): ultrasound services are 48 cases; conventional X-ray and digital X-ray services are 58 cases; CT scans up to 32 slices are 29 cases; MRI services are 19 cases;

c) If the number of cases proposed for payment is less than or equal to the maximum number calculated according to point a of this clause, the social health insurance agency will pay according to the actual number of cases and the price specified in this Circular;

d) If the number of cases proposed for payment exceeds the maximum number calculated according to point a of this clause: for the number of cases equal to the maximum number calculated according to point a of this clause, the social health insurance agency will pay according to the price specified in this Circular. For the number of cases exceeding the maximum number calculated according to point a of this clause, the social health insurance agency will pay according to the price excluding labor costs, with the specific payment price as follows:

- Conventional X-ray; Digital X-ray: 85% of the prescribed price;

- Ultrasound diagnostic service: 55% of the specified price:

- Magnetic Resonance Imaging (MRI) service: 97% of the prescribed price.

- CT scan up to 32 slices service: 95% of the specified price:

The maximum number of cases that the health insurance agency will pay according to the X-ray price specified in this Circular is: (58:8) X 9 X 3 X 78 X 120% = 18,322.2 cases.

If the total number of X-ray cases proposed for payment by the facility in the third quarter of 2018 is less than or equal to 18,322 cases, it will be paid according to the price specified in this Circular.

Example: Healthcare Facility A has 3 operational X-ray machines, with actual working hours of 9 hours (1 extra hour per day); the healthcare facility organized outpatient services on Saturdays in Quarter III/2018, with 92 days, and 78 working days in the quarter;

If the healthcare facility proposes to pay more than 18,322 cases, for example 20,000 cases, the social health insurance agency will pay 18,322 cases according to the price specified in this Circular, and the remaining 1,678 cases (= 20,000 cases - 18,322 cases) will be paid by the social health insurance agency at 85% of the price specified in this Circular.

8. The provisions of Clause 8 of this Article, Clause 6 of Article 5, and Clause 16 of Article 6 of this Circular shall only apply to payments between social health insurance agencies and healthcare facilities and shall not be used to calculate patient co-payments.

10. Specialized pediatric technical services but performed for adults or technical services performed for pediatric patients but have the same name as those for adults without specific pricing: shall apply the technical service prices according to the list in this Circular and other decisions on technical procedures and costs. Technical services listed only under pediatric specialties but performed for patients over 16 years old: shall apply the technical service prices as if they were for pediatric patients.

Article 8. State budget guarantee for costs not included in the price of medical examination and treatment services

1. Ministries and central agencies shall aggregate and report to the Ministry of Finance; Provincial Health Departments shall aggregate and report to the provincial People's Committees to continue ensuring the budget according to the budget classification and current regulations on funding for salary reform policy for:

a) Expenses as prescribed in the documents mentioned in Clause 5, Article 3 of this Circular;

b) The state budget guarantees to implement salary reform policies according to the Government's regulations on the basic wage for civil servants, public officials, and armed forces personnel.

2. In cases where the revenue of the unit does not ensure regular operations, the unit classified by the competent authority as a public service entity partially self-financing its regular expenses or a public service entity fully funded by the state for regular expenses: the unit will continue to be guaranteed by the state budget for the remaining regular expenses necessary to ensure the benefits for employees and normal operation of the unit according to the current budget management classification.

Article 9. Implementation Organization

1. Responsibilities of the Ministry of Health:

a) The Department of Planning and Finance shall coordinate with relevant units of the Ministry of Finance to promptly review, adjust, and supplement the prices of medical examination and treatment services when new factors affecting the cost structure are added according to the schedule, when the state adjusts salary policies, economic-technical norms, or changes in the costs of cost-forming factors; it shall also coordinate with relevant units to organize the implementation, inspection, interim summary, and final assessment of this Circular nationwide;

b) The General Department of Medical Examination and Treatment shall coordinate with relevant units to direct healthcare facilities to strictly implement professional regulations, comprehensively implement measures to improve service quality; organize inspections, audits, and supervision of professional activities related to service utilization, drug prescriptions, material usage, patient admission for inpatient treatment, and other professional activities;

c) The Department of Health Insurance shall coordinate with relevant units to organize inspections, supervision, or direct the Health Departments and health management agencies of ministries and sectors to organize inspections and supervision of healthcare facilities and related organizations in implementing this Circular;

d) The Inspectorate of the Ministry of Health shall lead and coordinate with relevant units to organize inspections or direct the Health Departments and health management agencies of ministries and sectors to organize inspections of healthcare facilities and related organizations in implementing this Circular.

2. Responsibilities of the Vietnam Social Security:

a) Implement this Circular, direct social insurance at all levels to timely settle payments according to current regulations and this Circular for healthcare facilities. If inappropriate prices are discovered during implementation, submit a written request to the Ministry of Health for review and adjustment;

b) Regularly (monthly, quarterly, semi-annually, and annually) inform the Ministry of Health and direct social insurance at all levels to inform provincial People's Committees, Health Departments, and health management agencies of ministries and sectors about cases of excessive service, drug, and material usage, and improper patient admission for inpatient treatment.

3. Responsibilities of the Health Departments:

a) Lead and coordinate with relevant units to organize the implementation, inspection, supervision, interim summary, and final assessment of this Circular within their jurisdiction;

b) Direct healthcare facilities under local management to strictly implement professional regulations, comprehensively implement measures to improve service quality;

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

4. Responsibilities of healthcare facilities:

a) Must use funds equivalent to maintenance and repair costs of equipment, replacement of tools and instruments already structured into the service price (for special class hospitals, class I, and II hospitals equivalent to 5% of the price, class III and IV hospitals, ungraded hospitals equivalent to 3% of the price) to repair, upgrade, and expand outpatient areas and treatment departments; purchase and replace: tables, chairs, beds, cabinets, trolleys, air conditioners, fans, heating lamps, heaters, computers, multi-specialty examination kits, bedding, quilts, pillows, mattresses, mats, and other goods and materials to ensure professional conditions, hygiene, patient safety, and improve service quality;

b) Strictly implement professional medical regulations, especially regarding patient admission for inpatient treatment; transfer referrals, and service and drug prescriptions according to regulations;

c) Develop economic-technical norms, pricing plans, propose price levels, and report to the direct management agency to send to the Ministry of Health for review and regulation of prices for the following cases:

- New technical services defined in Clause 1 and Clause 2, Article 69 of the Law on Medical Examination and Treatment;

- Technical services not yet regulated by the Ministry of Health in terms of prices (including services allowed by the Ministry of Health but not yet classified equivalently in terms of technical procedures and costs);

Article 10. Reference Provisions

In case the referenced documents in this Circular are replaced or amended, they shall be implemented according to the replacing or amended documents.

Article 11. Implementation Provisions

Article 1. This Circular takes effect from the date of issuance.

2. The following documents shall cease to be effective from the date this Circular takes effect:

a) Circular No. 39/2018/TT-BYT dated November 30, 2018 of the Minister of Health stipulating uniform prices for medical examination and treatment services under health insurance between hospitals of the same level nationwide and guiding the application and payment of costs for medical examination and treatment services under health insurance in certain cases;

b) Circular No. 13/2019/TT-BYT dated July 5, 2019 of the Minister of Health amending and supplementing some articles of Circular No. 39/2018/TT-BYT dated November 30, 2018 of the Minister of Health stipulating uniform prices for medical examination and treatment services under health insurance between hospitals of the same level nationwide and guiding the application and payment of costs for medical examination and treatment services under health insurance in certain cases.

Article 12. Transitional Provisions

1. For patients undergoing treatment at medical examination and treatment facilities before the date this Circular takes effect and discharged or concluded their outpatient treatment period after the date this Circular takes effect: they shall continue to be subject to the service price levels for medical examination and treatment as prescribed by the competent authority prior to the implementation of the price levels prescribed in this Circular until discharge or conclusion of the outpatient treatment period.

2. The Vietnam Social Security and medical examination and treatment facilities shall not retrospectively settle accounts for cases where both parties have reviewed and agreed on the settlement figures for the services listed in Appendix V attached to this Circular before the date this Circular takes effect.

In the course of implementation, if there are difficulties or obstacles, units and localities are requested to report in writing to the Ministry of Health for consideration and resolution./.