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

JOINT CIRCULAR

JOINT CIRCULAR NO. 31/2000/TTLT-BTC-BYT OF THE MINISTRY OF FINANCE AND THE MINISTRY OF HEALTH ON GUIDELINES FOR THE ESTABLISHMENT AND MANAGEMENT MECHANISMS OF SEMI-PUBLIC HEALTH CARE FACILITIES

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

I. GENERAL PROVISIONS:

1. Semi-public health care facilities include two types:

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

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

2. Principles for establishing semi-public health care facilities:

- Semi-public hospitals and multi-specialty clinics shall be established based on cooperation between state organizations and non-state organizations, individuals from all economic sectors within the country to establish new facilities or convert entire public health care facilities into joint investment in infrastructure, medical equipment, and management of all operations according to the law.

- Public hospitals with semi-public departments and multi-specialty clinics with semi-public departments: this involves collaboration between public health care facilities and non-state organizations, individuals from all economic sectors within the country to build and upgrade material infrastructure and equipment for a department, a ward, or several wards of the hospital and manage the semi-public department according to the law.

- The establishment of semi-public health care facilities must be based on the needs determined by the Ministry of Health according to the planning of the health care network and the health care needs of the people nationwide.

- The establishment of semi-public health care departments within public health care facilities must be based on the health care needs of the people in the local area.

3. Semi-public health care facilities implement professional technical regulations and other relevant laws as public health care facilities.

4. Semi-public health care facilities provide health care services to those who voluntarily pay for medical services as stipulated in this Circular.

5. The application scope of this Circular includes semi-public health care facilities. Private and individual health care facilities operate according to the Private Medical Practice Law dated September 30, 1993, and related implementing documents.

6. Private, semi-private, and public health care facilities are subject to the policy of encouraging socialization as stipulated 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, health care, culture, and sports.

II. SPECIFIC PROVISIONS

A. STANDARDS AND CONDITIONS FOR ESTABLISHING SEMI-PUBLIC HEALTH CARE FACILITIES:

1. Meeting the voluntary health care needs of the people.

2. Having a sufficient number of medical staff with appropriate qualifications as prescribed by the Ministry of Health.

3. Ensuring modern infrastructure and medical equipment; properly handling solid, liquid, and gas waste; maintaining a clean environment without pollution and implementing environmental protection measures.

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

B. DOCUMENTATION, PROCEDURES, AND AUTHORITY TO APPROVE THE ESTABLISHMENT OF SEMI-PUBLIC HEALTH CARE FACILITIES:

1. Documentation for establishing semi-public health care facilities includes:

1.1. Application for establishment

1.2. The proposal for establishment must include the following contents:

- The necessity of establishing a semi-public health care facility

- The composition of participating investors

- Total investment capital including each party's contribution

- Financial management mechanism

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

- Specialized equipment list: value of each piece of equipment, total investment in equipment

- Management structure, personnel (number, professional qualifications)

- Board of Directors structure and list

- Scope of practice

- Economic and financial feasibility analysis

2. Procedures for establishment: The Ministry of Health will issue separate guidance for semi-public health care facilities.

3. Authority to approve establishment, merger, division, dissolution, and cessation of operations of semi-public health care facilities:

3.1. Establishment authority:

- The Minister of Health submits to the Prime Minister for approval to establish large-scale semi-public hospitals equivalent to national and international Group A projects.

- The Minister of Health approves the establishment of semi-public health care facilities under the Ministry of Health.

The Minister, head of a ministry-level agency, or government agency approves the establishment of semi-public health care facilities under their respective ministries or sectors. However, converting public hospitals under their respective ministries or sectors into semi-public health care facilities requires written consent from the Minister of Health.

- The Director of the Department of Health submits to the Chairman of the People's Committee of the province or centrally-administered city for approval to establish semi-public health care facilities under local management. However, converting public health care facilities under local management into semi-public health care facilities requires written consent from the Minister of Health.

3.2. Authority to decide on mergers, divisions, dissolutions, and cessation of operations of semi-public health care facilities: The management level that has the authority to approve the establishment of semi-public health care facilities also has the authority to decide on mergers, divisions, dissolutions, and cessation of operations of these facilities after obtaining the agreement of relevant functional agencies.

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

C. MANAGEMENT AND SPECIALIZED ACTIVITIES OF PUBLIC-SERVICE-ORIENTED MEDICAL FACILITIES:

- Public-service-oriented medical facilities are subject to state management by the health sector and are responsible for implementing hospital regulations, professional and medical technology regulations, and other relevant legal provisions.

- The director of the public entity that has a public-service-oriented medical facility must be responsible for inspecting, supervising, and being accountable to the State for all activities of the public-service-oriented medical facility under their unit.

- The agency deciding to permit the establishment of a public-service-oriented medical facility has the right to revoke the license for those medical facilities operating contrary to the law.

- The health sector is responsible for inspecting and supervising the professional activities of public-service-oriented medical facilities and handling violations according to the law.

D. FINANCIAL MANAGEMENT REGIME FOR PUBLIC-SERVICE-ORIENTED MEDICAL FACILITIES:

1. Sources of Operating Capital:

- Capital from the State budget;

- Supplement from annual financial results;

- Depreciation of fixed assets (from the State budget's contribution left to the facility);

- Revenue from liquidation of assets (from the State budget source);

- Financial support, aid, donations, 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 organizations;

- Other sources of capital.

2. Content of Financial Receipts and Expenditures:

2.1. Receipts:

- Hospital fees;

- Bank deposit interest;

- Funding allocated to implement programs, objectives, topics, and projects approved by the competent authority;

- Other receipts generated during the operation of the public-service-oriented medical facility.

2.2. Expenditures:

- Salaries, wages, and allowances (if applicable). For staff working full-time for the public-service-oriented medical facility, they shall receive salary benefits according to the production and business sector's regulations; for staff from the public medical facility working part-time for the public-service-oriented section, they shall be paid on a fee-for-service basis depending on their level of involvement.

- Contributions according to established regulations (social insurance, health insurance, trade union fees for workers).

- Medicine, blood, infusion fluids, chemicals, medical supplies, and equipment consumed directly for patients' treatment (based on the purchase price of the public-service-oriented facility).

-后勤补给费用，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，直接服务于诊疗工作。

- 固定资产维护保养和经常性修理费用，用于专业服务和基础设施工程。

- 设备租赁费用。

- 国内外专家租赁费用（如有）。

- 提取固定资产折旧。属于国家出资的固定资产折旧资金留作再投资给公营医疗设施，属于贷款和筹集的资金用于偿还本金和贷款。管理使用折旧基金按照现行法律规定执行。在特殊情况下，公营医疗设施的负责人和设有公营部分的公营医疗设施的负责人可以决定适用与患者支付能力相适应的快速折旧率。

- 支付贷款和出资利息（如有）。

- 其他费用。

- 应缴纳的税款（如有）。

2.3. 公营医疗设施每年的财务结果基于年度总收入和总支出之间的差额，在完成法定纳税义务后确定。差额处理如下：

- 至少提取30%补充运营资本，并加强公营医疗设施和设有公营部分的公营单位的基础设施建设（补充运营资本的比例由董事会决定）。

- 剩余部分由董事会决定分配比例，用于以下内容：

+ 对公营医疗设施、设有公营部分的公营单位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住院费用。

+ 按照国家、集体和个人在公营医疗设施中的出资比例分配收益。从国家预算出资中获得的收入留作单位增加基础设施投资并计入国家预算出资。

3. 财务管理制度：

3.1. 对于国家出资的部分，包括：货币资金（超出支出的收入留存部分）、物资和固定资产（房屋、土地、机器设备、运输工具和其他资产），这些是国家预算最初配置并在运营过程中移交的：

- 公营医疗机构必须组织清点评估全部国家出资转移给公营部分的资产，提交上级管理部门审核，并向同级财政部门办理国有资产和资金转移手续。

- 公营医疗设施的负责人有责任确保在运营过程中保持资金完整。

- 每年，公营医疗设施需清点评估资产价值、物资和资金，并按现行规定向上级管理和同级财政部门报告。

3.2. 对于从公营设施自身补充的资本，如：留存的固定资产折旧、年度财务成果补充，必须按照现行规定使用和管理。

3.3. For the state budget funds allocated to implement programs, objectives, topics, and projects, they must be managed and used for the approved purposes and in accordance with the current financial expenditure regulations of the State.

3.4. Semi-public healthcare facilities must ensure the proper and effective use of capital contributions from organizations and individuals of all economic sectors; bank loans and credit institutions' funds for their intended purposes, and have repayment plans (principal and interest) in accordance with commitments when raising capital.

3.5. When semi-public healthcare facilities need to transfer or liquidate assets funded by the State, such actions must be decided by the superior supervisory authority after receiving written opinions from the same-level financial agency to ensure compliance with the prescribed asset management regulations. The sale of unused or obsolete assets to recover capital must establish an appraisal board and conduct auctions according to the law. After deducting reasonable expenses for the sale process, the proceeds from the sale shall be supplemented to the operating capital of the facility and distributed according to the initial proportion of the State's capital contribution that formed the asset.

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

3.7. Semi-public healthcare facilities are responsible for maintaining accounting records to track all existing assets and capital, as well as changes in the unit's assets and capital, in accordance with the current accounting regulations.

3.8. The hospital fee pricing for each service provided by the directors of semi-public healthcare facilities must be submitted for review and approval by the respective ministries or central agencies (for semi-public healthcare facilities under central ministries and agencies) and provincial People's Committees (for local semi-public healthcare facilities).

3.9. Semi-public healthcare facilities may open accounts at the State Treasury to receive state budget funds allocated for implementing programs, objectives, topics, and projects; aid and other support funds, and may open accounts at banks to collect hospital fees and other income of the unit.

4. Budget preparation work:

Semi-public healthcare facilities 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);

- Plan for distributing revenue-expenditure differences and setting up various funds;

- Budget for expenditures from depreciation of fixed assets and income from the State's capital contribution left to semi-public healthcare facilities.

These budgets must be sent to the supervising agency for consolidation and submission to the same-level financial agency.

5. Heads of semi-public healthcare facilities are account holders and are responsible before the Board of Directors and the direct superior supervisory agency for the entire financial and asset management work of the facility.

6. Accounting and settlement organization:

- Semi-public healthcare facilities organize accounting and statistical work, maintain separate ledgers according to the Accounting and Statistics Ordinance and related documents.

- Quarterly and annually, semi-public healthcare facilities prepare final settlement reports according to the prescribed forms. For semi-public general hospitals and clinics, these reports are submitted to the superior supervisory agency for review and consolidation to submit to the same-level financial agency; for public hospitals and clinics with semi-public sections, the semi-public sections' final settlement reports are consolidated into the overall report and submitted to the direct superior supervisory agency for review and consolidation to submit to the same-level financial agency.

7. Regularly or urgently, the same-level financial agency collaborates with the supervising agency to inspect and supervise the implementation of financial systems and professional regulations by semi-public healthcare facilities.

8. Annual financial report disclosure: Based on the annual final settlement report approved by the competent authority, semi-public healthcare facilities publicly disclose the final settlement report at the staff meeting of the unit.

III. IMPLEMENTATION PROVISIONS

This Circular takes effect fifteen days from the date of issuance. During implementation, if there are difficulties or obstacles, they should be promptly reported to the Ministry of Finance - Ministry of Health for consideration, amendment, and supplementation to ensure appropriateness.