Joint Circular No. 31/2000/TTLT/BTC-BYT guides the establishment and financial management mechanism for semi-public healthcare facilities.

JOINT CIRCULAR

Guidelines for the establishment and financial management mechanism for semi-public healthcare facilities

with quasi-public healthcare facilities

Pursuant to Decree No. 73/1999/NĐ-CP dated August 19, 1999 of the Government on policies encouraging socialization in education, healthcare, culture, and sports activities; the Ministry of Finance and the Ministry of Health provide guidelines for the establishment and financial management mechanisms for semi-public healthcare facilities as follows:

I/ GENERAL PROVISIONS:

1. Semi-public healthcare facilities include two types:

Semi-public hospitals and semi-public multi-specialty clinics

Public hospitals with semi-public sections and public multi-specialty clinics with semi-public sections.

2. Principles for establishing semi-public healthcare facilities:

Semi-public hospitals and semi-public multi-specialty clinics shall be established through collaboration between state organizations and non-state organizations, individuals from all economic sectors within the country, either by setting up new facilities or by converting entire public healthcare facilities to jointly invest in infrastructure, medical equipment, and manage and operate the facilities according to the law.

Public hospitals with semi-public sections and public multi-specialty clinics with semi-public sections: These are collaborations between public healthcare facilities and non-state organizations, individuals from all economic sectors within the country to build and upgrade material and technical infrastructure for certain departments or specialties within the hospital and manage and operate the semi-public sections according to the law.

The consideration for establishing semi-public healthcare facilities must be based on the needs determined by the Ministry of Health based on the planning of the healthcare network and the healthcare needs of the population nationwide.

The consideration for establishing semi-public sections within public healthcare facilities must be based on the healthcare needs of the local population.

3.Semi-public healthcare facilities implement professional medical technical regulations like public healthcare facilities and other relevant laws.

4.Semi-public healthcare facilities serve patients who voluntarily pay for medical services as stipulated in this Circular.

5.The Circular applies to semi-public healthcare facilities. Private and individually-owned healthcare facilities shall comply with the Private Medical Practice Ordinance dated September 30, 1993, implementing circulars of the Ordinance, and other related documents.

6.All privately-owned, individually-owned, and semi-public healthcare facilities are subject to the policy of encouraging socialization as prescribed in Circular No. 18/2000/TT-BTC dated March 1, 2000, guiding certain provisions of Decree No. 73/1999/NĐ-CP dated August 19, 1999 of the Government on financial systems to encourage non-public entities in education, healthcare, culture, and sports.

II/ SPECIFIC PROVISIONS

A. Standards and conditions for establishing semi-public healthcare facilities:

1.Meeting the voluntary healthcare needs of the people.

2.Having a sufficient number of healthcare professionals with appropriate qualifications as specified by the Ministry of Health.

3.Ensuring modern infrastructure and medical equipment; properly handling solid, liquid, and gaseous waste; maintaining a clean environment that does not cause pollution and implementing environmental protection measures.

4.Possessing the ability to mobilize resources from the people and organizations across all economic sectors within the country to develop healthcare activities for the people.

B. Documentation, procedures, and authority for establishing semi-public healthcare facilities:

1. Documentation for establishing semi-public healthcare facilities includes:

1.1. Application for establishment.

1.2. The establishment proposal must include the following contents:

The necessity of establishing a semi-public healthcare facility;

Composition of participating investment parties;

Total investment capital including each party's contribution;

Financial management mechanism;

Infrastructure construction plan (renovation or new construction of semi-public hospitals, departments, semi-public clinics; scale of semi-public healthcare facilities or public facilities with semi-public sections; waste treatment projects; total construction and renovation costs; implementation schedule...);

Specialized equipment list: value of each piece of equipment, total investment for equipment;

Management and personnel structure (number, professional qualifications);

Organizational structure, list of Board of Directors;

Scope of practice;

Economic and financial analysis.

2. Procedures for establishment: The Ministry of Health will issue specific guidelines for semi-public healthcare facilities.

3. Authority to establish, merge, split, dissolve, and suspend operations of semi-public healthcare facilities:

3.1. Authority to establish:

The Minister of Health shall submit to the Prime Minister for approval the establishment of large-scale semi-public hospitals with investment equivalent to national and international Group A projects.

The Minister of Health shall decide on the establishment of semi-public healthcare facilities directly under the Ministry of Health.

The Minister, head of a ministry-level agency, or government agency shall decide on the establishment of semi-public healthcare facilities under their respective ministries or sectors. However, for the conversion of public hospitals under their respective ministries or sectors into semi-public healthcare facilities, written consent from the Minister of Health is required.

The Director of the Department of Health shall submit to the Chairman of the People's Committee at the provincial or centrally-administered city level for approval the establishment of semi-public healthcare facilities under local management. For the conversion of public healthcare facilities under local management into semi-public healthcare facilities, written consent from the Minister of Health is required.

3.2. Authority to decide on mergers, splits, dissolutions, and suspensions of operations of semi-public healthcare facilities: The management level that has the authority to establish semi-public healthcare facilities also has the authority to decide on mergers, splits, dissolutions, and suspensions of operations of these facilities after obtaining the agreement of relevant functional agencies.

4.After receiving the establishment decision from the competent authority, semi-public healthcare facilities must register with the same-level financial agency, be subject to inspection and supervision by the financial agency and specialized management agencies at various levels.

C. Management and professional activities of semi-public healthcare facilities:

Public-private partnership healthcare facilities are subject to state management by the health sector and are responsible for implementing hospital regulations, professional and medical technical regulations, and other relevant legal provisions.

The director of a public entity with a public-private partnership healthcare facility must be responsible for inspecting, supervising, and bearing responsibility before the state for all activities of the public-private partnership healthcare facility under their unit.

The authority that decides to permit the establishment of a public-private partnership healthcare facility has the right to revoke the license for those healthcare facilities operating contrary to the law.

The health sector is responsible for inspecting and supervising the professional activities of public-private partnership healthcare facilities and handling violations according to legal provisions.

D. Financial Management System for Public-Private Partnership Healthcare Facilities:

1. Sources of Operating Capital:

State budget capital allocation;

Supplement from annual financial results;

Depreciation of fixed assets (retained by the healthcare facility from the state budget contribution);

Revenue from asset liquidation (from state budget sources);

Donations, grants, support, and gifts from organizations and individuals both domestically and internationally;

Contributions from organizations and individuals for new construction, renovation, expansion, and upgrading of infrastructure and equipment;

Loans from banks and credit institutions;

Other sources of capital.

2. Financial Income and Expenditure:

2.1. Income:

Medical fees;

Interest on bank deposits;

Funding allocated to implement programs, objectives, topics, and projects approved by competent authorities;

Other income generated during the operation of the public-private partnership healthcare facility.

2.2. Expenditure:

Salaries, wages, and allowances (if applicable). For staff working full-time at the public-private partnership healthcare facility, they shall receive salaries according to the regulations of the production and business sector; for staff from public healthcare facilities working part-time at the private sector, they shall be paid wages based on the level of their participation in work.

Social insurance, health insurance, and trade union fees as prescribed.

Costs of medicines, blood, infusions, chemicals, supplies, and medical equipment directly used for patients as directed by doctors (based on the purchase price of the public-private partnership healthcare facility).

后勤服务费用，包括电力、水、环境卫生、燃料、办公用品、信息、宣传、通信、差旅费和会议费等。

科研和培训费用，直接服务于医疗工作。

固定资产维护、保养和维修费用，用于专业活动和基础设施工程。

设备租赁费用。

国内外专家聘用费用（如有）。

固定资产折旧费用。国家出资形成的固定资产折旧资金可用于再投资于公私合营医疗机构；贷款和筹集的资金可用于偿还本金和利息。管理与使用折旧基金应遵循现行法律规定。在特殊情况下，公私合营医疗机构的负责人和设有私营部门的公立医疗机构的负责人可根据患者的支付能力决定采用快速折旧率。

支付贷款和出资（如有）的组织和个人的利息。

Other expenses.

应缴纳的各项税费（如有）。

公私合营医疗机构每年的财务结果基于年度总收入与总支出之间的差额，在完成法定纳税义务后确定。差额处理如下：

至少将30%补充为运营资本，并加强公私合营医疗机构和设有私营部门的公立医疗机构的基础设施（国家出资补充的比例由董事会决定）。

剩余部分由董事会决定分配给以下内容的比例：

对公私合营医疗机构、设有私营部门的公立医疗机构及其直接合作对象的员工进行奖励和福利。

建立医疗救助基金，用于减免政策对象、贫困人员和革命功臣的医疗费用。

按照国家、集体和个人出资比例分配给参与公私合营医疗机构的成员。从国家预算出资中获得的收入可用于增加投资基础设施并增加国家出资。

3. Financial Management System:

3.1. Regarding the portion of state capital contributions including monetary capital (the difference between revenue and expenditure retained from the state capital contribution); materials, goods, and fixed assets (buildings, land, machinery, transportation equipment, and other assets) initially provided and transferred by the state budget during operations:

Public healthcare facilities must organize an inventory and revaluation of the entire portion of state capital contributions transferred to the public-private partnership healthcare facility, submit it to the superior management authority for approval, and then to the same-level finance authority to process the transfer of state assets and capital to the public-private partnership healthcare facility.

The director of the public-private partnership healthcare facility is responsible for preserving the capital during operations.

Each year, public-private partnership healthcare facilities must conduct an inventory and revaluation of the value of assets, materials, and capital, and submit them to the higher-level management authority and the same-level finance authority according to current regulations.

3.2. Regarding self-supplemented capital sources such as retained depreciation of fixed assets and supplements from annual financial results, they must be used and managed according to current regulations.

3.3. Regarding state budget funds allocated for implementing programs, objectives, topics, and projects, they must be managed and used for the approved purpose and in accordance with the current national financial expenditure system.

3.4. Public-private partnership healthcare facilities must ensure the proper and effective use of capital contributions from various economic sectors, loans from banks and credit institutions, and have repayment plans (principal and interest) consistent with the commitments made when raising funds.

3.5. State-owned public health facilities with semi-private status, when there is a need to transfer or liquidate assets funded by state capital contributions, must be decided by the superior management authority after receiving written opinions from the same-level financial agency to ensure compliance with regulations governing the management of state assets. The sale of unused or obsolete assets for capital recovery requires the establishment of an appraisal board and the organization of auctions in accordance with the law. Proceeds from the sale of assets, after deducting reasonable expenses incurred in the sale process, shall be added to the operational funds of the facility and distributed according to the initial proportion of state capital contributions that formed such assets.

3.6. Assets pledged or mortgaged to borrow funds from credit institutions must comply with current legal provisions.

3.7. State-owned public health facilities with semi-private status have the responsibility to maintain accounting records to monitor all existing assets and capital, as well as changes in asset and capital conditions of the unit, in accordance with current accounting regulations.

3.8. The fee collection price for each service provided by state-owned public health facilities with semi-private status shall be established by the directors of these facilities and submitted to the relevant ministries or central agencies (for state-owned public health facilities with semi-private status under central ministries or agencies) and provincial People's Committees (for local state-owned public health facilities with semi-private status) for review and approval.

3.9. State-owned public health facilities with semi-private status may open accounts at the State Treasury to receive state budget funds for implementing programs, objectives, research topics, projects; foreign aid and other support, and may also open bank accounts to collect hospital fees and other income of the unit.

4. Budget preparation work:

State-owned public health facilities with semi-private status must prepare annual and quarterly budgets for all activities of the unit, including:

Revenue and expenditure budget for hospital fees, services, and other sources of income (if applicable)

Distribution plan for revenue and expenditure differences and the establishment of reserve funds;

Budget for expenditures from depreciation of fixed assets and income from remaining state capital contributions to state-owned public health facilities with semi-private status.

The above budget shall be submitted to the supervising authority for consolidation and submission to the same-level financial agency.

5. Heads of state-owned public health facilities with semi-private status are account holders and are responsible before the Board of Directors and the direct superior management authority for all financial and asset management activities of the facility.

6. Accounting and settlement organization:

State-owned public health facilities with semi-private status organize accounting and statistical work, maintaining separate books in accordance with the Accounting and Statistics Ordinance and related documents.

Quarterly and annually, state-owned public health facilities with semi-private status prepare final settlement reports according to prescribed forms. For semi-private general hospitals and multi-specialty clinics, these reports are submitted to the superior management authority for review and consolidation and then sent to the same-level financial agency; for public hospitals and multi-specialty clinics with semi-private sections, the semi-private sections' final settlement reports are consolidated into a comprehensive report and submitted to the direct superior management authority for review and consolidation and then sent to the same-level financial agency.

7. Regularly or unexpectedly, the same-level financial agency will cooperate with the supervising authority to inspect and supervise the implementation of financial systems and professional regulations by state-owned public health facilities with semi-private status.

8. Annual financial report disclosure: Based on the annual final settlement report approved by the authorized agency, state-owned public health facilities with semi-private status shall publicly disclose the final settlement report to the staff meeting of the unit.

III/ IMPLEMENTATION PROVISIONS

This Circular takes effect fifteen days from the date of issuance. During implementation, if difficulties arise, they should be promptly reported to the Ministry of Finance - Ministry of Health for consideration, revision, and supplementation as appropriate./.