Circular No. 37/2014/TT-BYT guiding registration for initial medical examination and treatment and referral for medical examination and treatment under health insurance

CIRCULAR

Guidelines for registering initial medical examination and treatment and transferring for medical examination and treatment under health insurance

 transfer for medical examination and treatment under health insurance

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Pursuant to the Health Insurance Law No. 25/2008/QH12 dated November 14, 2008 and the Law Amending and Supplementing Certain Provisions of the Health Insurance Law No. 46/2014/QH13 dated June 13, 2014;

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

and cryptographic personnel

This Circular prescribes procedures for receiving, providing health care for domestic violence victims and statistical reports on domestic violence victims at medical facilities.

The Minister of Health issues the Circular guiding registration for initial medical examination and treatment and transfer for medical examination and treatment under health insurance.

PART I

PRIMARY MEDICAL EXAMINATION AND TREATMENT HEALTH INSURANCE REGISTRATION FACILITIES

INITIAL MEDICAL TREATMENT UNDER HEALTH INSURANCE

Article 1. Primary healthcare facilities at the commune level and equivalent

1. Commune health stations.

2. Medical stations, health stations, and health departments of agencies, units, and organizations.

3. Independent private family doctor clinics.

4. Military-civilian health stations; Military-civilian clinics.

5. Military health units at battalion level and equivalent.

Article 2. Medical examination and treatment facilities at the district level and equivalent

1. District general hospitals classified as Class III, Class IV, and unranked.

2. Traditional medicine hospitals classified as Class III, Class IV, and unranked.

3. Specialized hospitals classified as Class III, Class IV, and unranked with outpatient departments.

4. District health centers with medical examination and treatment functions.

5. Outpatient departments; regional outpatient departments.

6. Provincial Public Security Hospital.

7. Military-civilian health centers.

8. Military-civilian hospital; Military hospital.

9. Hospitals classified as Class III, Class IV, and unranked under the Ministry of National Defense.

10. Military-civilian hospitals classified as Class III, Class IV, and unranked.

Article 3. Medical examination and treatment facilities at the provincial level and equivalent

1. General hospitals classified as Class II and below directly under the Ministry of Health.

2. General hospitals classified as Class I, Class II directly under the Department of Health or under various Ministries and Sectors (excluding Class I hospitals directly under the Department of Health assigned by the Ministry of Health to be the final level in specialized technical fields and hospitals under the Ministry of National Defense).

3. Specialized hospitals classified as Class II under the Ministry of Health, specialized hospitals classified as Class I, Class II under the Department of Health with outpatient departments.

4. Children's hospitals, maternity and children's hospitals classified as Class I, Class II directly under the Department of Health that are not assigned by the Ministry of Health to be the final level in specialized technical fields.

5. Private general hospitals classified as Class I or equivalent, Class II or equivalent.

6. Traditional medicine hospitals classified as Class I, Class II directly under the Department of Health, other Ministries and Sectors.

7. Private traditional medicine hospitals classified as Class I or equivalent, Class II or equivalent.

8. Outpatient departments under the Provincial Cadre Health Care Board.

9. General hospitals classified as Class II under the Ministry of National Defense.

10. Military-civilian hospitals classified as Class II.

Article 4. Medical examination and treatment facilities at the central level and equivalent

1. Central general hospitals classified as Special Class, Class I directly under the Ministry of Health.

2. General hospitals classified as Class I directly under the Department of Health or under various Ministries and Sectors

assigned by the Ministry of Health to be the final level in specialized technical fields.

3. Specialized hospitals classified as Class I directly under the Ministry of Health with outpatient departments (excluding the Central Children's Hospital).

4. Vietnam Friendship Hospital, Thong Nhat Hospital, and Da Nang Hospital directly under the Ministry of Health.

5. Central general hospitals classified as Special Class, Class I directly under the Ministry of National Defense.

6. Military Traditional Medicine Institute.

Article 5. Conditions for primary medical examination and treatment health insurance facilities

1. Medical examination and treatment facilities must have operating licenses in accordance with the law.

2. Medical practitioners must have practice certificates in accordance with the law.

3. Medical examination and treatment facilities specified in Clauses 1, 2, 4, and 5 of Article 1 of this Circular: Must meet conditions regarding human resources, infrastructure, equipment, ensuring the ability to provide routine medical examinations and treatments, initial emergency care, and dispensing medications within their defined scope of expertise.

4. Independent family doctor clinics: Must meet the conditions prescribed by the Ministry of Health for issuing permits to operate independent family doctor clinics.

5. Outpatient Departments:

a) Must have at least two internal and surgical specialties; For outpatient departments providing medical services to children, in addition to the two specialties mentioned above, there must be a pediatric specialty;

b) Number of full-time doctors (permanent staff) as prescribed;

c) Conduct medical examinations, treatments, initial emergency care, and perform medical procedures within the approved scope of expertise;

d) Organize the supply and distribution of medicines, chemicals, and medical supplies to support medical examinations and treatments under health insurance according to regulations.

Chapter II

REGISTRATION FOR PRIMARY HEALTH INSURANCE MEDICAL EXAMINATION AND TREATMENT

Article 6. Registration for initial health insurance medical examination and treatment at commune-level and district-level medical facilities

Participants in health insurance have the right to register for initial health insurance medical examination and treatment (hereinafter referred to as initial medical examination and treatment) at one of the medical facilities specified in Articles 1 and 2 of this Circular, regardless of administrative boundaries.

Article 7. Registration for initial health insurance medical examination and treatment at provincial-level and central-level medical facilities

1. Participants in health insurance have the right to register for initial medical examination and treatment at a district hospital that has been classified as a Class I or Class II hospital located where the participant resides.

2. Participants in health insurance may register for initial medical examination and treatment at one of the medical facilities specified in Clauses 1, 2, 3, 4, 5, 6, 7, 9, and Clause 10 of Article 3 and Article 4 of this Circular in the following cases:

a) Persons who are registered residents, temporary residents with a fixed term, or working in a district, town, city under a province without medical facilities as specified in Articles 1 and 2 of this Circular or those facilities cannot meet the requirements for initial medical examination and treatment for health insurance participants according to the Director of the Provincial Health Department after consultation with the Director of the Social Insurance Department of the province or centrally-administered city.

b) Persons who are registered residents, temporary residents with a fixed term, or working in a district, town, city under a province may register for initial medical examination and treatment at medical facilities specified in Clauses 1, 2, 3, 4, 5, 6, 7, 9, and Clause 10 of Article 3 and Article 4 of this Circular according to the regulations of the Director of the Provincial Health Department after consultation with the Director of the Social Insurance Department of the province or centrally-administered city.

3. Participants in health insurance may register for initial medical examination and treatment at one of the medical facilities specified in Article 6, Clause 1, and Clause 2 of Article 7 of this Circular and may also register for initial medical examination and treatment at another health insurance medical facility in the following cases:

a) Subjects managed and protected for health care according to Guideline No. 52 HD/BTCTW dated December 2, 2005 of the Central Organization Department of the Communist Party of Vietnam on adjusting and supplementing subjects for medical examination and treatment at certain central medical facilities may register for initial medical examination and treatment at the Friendship Hospital, Thong Nhat Hospital, Da Nang Hospital C under the Ministry of Health, and other medical facilities specified in Article 3 (except Clause 4) and Article 4 of this Circular;

b) Subjects under the management and protection of health care for cadres at the provincial level may register for initial medical examination and treatment at clinics under the Cadre Health Care Board of the province or medical facilities specified in Clauses 1, 2, 3, 5, 6, 7, 9, and Clause 10 of Article 3 of this Circular;

c) Persons who have rendered meritorious service to the revolution and persons aged 80 years or older may register for initial medical examination and treatment at medical facilities specified in Clauses 1, 2, 3, 5, 6, 7, 9, and Clause 10 of Article 3, Clauses 1, 2, 3, and Clause 6 of Article 4 of this Circular;

d) Children under six years old may register for initial medical examination and treatment at medical facilities specified in Clause 1, 2, and Clause 4 of Article 3 of this Circular;

đ) Persons who have retired from military service may register for initial medical examination and treatment at health insurance medical facilities specified in Clause 9 and Clause 10 of Article 3, Clause 5 and Clause 6 of Article 4 of this Circular.

4. Participants in health insurance residing on island communes or island districts may register for initial medical examination and treatment at the most convenient medical facility on the mainland if there are no medical facilities as specified in Articles 1, 2, 3, and Article 4 of this Circular on such island communes or districts.

Chapter III

TRANSFER FOR PRIMARY HEALTH INSURANCE MEDICAL EXAMINATION AND TREATMENT

Article 8. Transfer for medical examination and treatment under health insurance

1. Patients with health insurance cards may be transferred for medical examination and treatment according to the regulations of the Ministry of Health on transfer between healthcare facilities.

2. Insured persons who register for initial medical examination and treatment at commune-level healthcare facilities and are transferred to district hospitals ranked as Class I or Class II hospitals within their place of residence shall be considered as being within the correct transfer level.

3. From January 1, 2016, insured persons who register for initial medical examination and treatment at commune-level healthcare facilities, multi-purpose clinics, or district-level hospitals may seek medical examination and treatment under health insurance at health stations, multi-purpose clinics, or district-level hospitals within the same province.

4. In emergency cases, after the emergency treatment phase, patients may be admitted for inpatient treatment at departments of the healthcare facility that received them or may be transferred to another healthcare facility for continued treatment based on professional requirements.

Article 9. Procedures for transferring for medical examination and treatment under health insurance

1. Healthcare facilities shall implement transfer procedures according to the regulations of the Ministry of Health on transfer between healthcare facilities.

2. Use of transfer certificates for patients with health insurance cards:

a) In cases where patients are transferred to another healthcare facility, only the transfer certificate from the healthcare facility directly transferring the patient is required;

b) In cases where patients go to a healthcare facility that is not their initial health insurance facility and are then transferred to another healthcare facility, only the transfer certificate from the healthcare facility directly transferring the patient is required;

c) The transfer certificate is valid for 10 working days from the date of issuance;

d) For patients with health insurance cards suffering from diseases, disease groups, and cases specified in the annex attached to this Circular, the transfer certificate is valid until the end of the calendar year (December 31 of that year). If the patient is still undergoing inpatient treatment at the healthcare facility by December 31 of that year, the transfer certificate remains valid until the end of that inpatient treatment period.

3. Use of appointment cards for rescheduling appointments: Each rescheduling appointment card can only be used once according to the time indicated on the rescheduling appointment card issued by the healthcare facility.

4. In emergency cases: The emergency status is assessed and determined by the receiving personnel (doctors, medical assistants) and recorded in the medical records and case files.

5. In cases where patients transferred for medical examination and treatment have other accompanying diseases discovered or developed beyond those listed on the transfer certificate, the healthcare facility receiving the patient shall conduct medical examination and treatment for these diseases within its scope of expertise, which shall be considered as correct-line medical examination and treatment.

6. In cases where insured persons travel, study, work temporarily, or reside for less than 12 months in another locality, they may seek medical examination and treatment at healthcare facilities in that locality equivalent to the technical level of the initial healthcare facility indicated on their health insurance card. If there is no equivalent healthcare facility in that locality, the insured person may choose another healthcare facility that provides initial health insurance medical examination and treatment services.

Chapter IV

IMPLEMENTING PROVISIONS

Article 10. Responsibilities of the Department of Health

1. Take the lead and coordinate with the Social Insurance of the province/city under the central government, medical establishments under the Ministry of Health, and other ministries and sectors located within the administrative region to implement:

a) Identify and compile a list of healthcare facilities that meet the conditions to organize initial health insurance medical examination and treatment as stipulated in this Circular;

b) Guide the registration for initial medical examination and treatment for the subjects specified in Clause 4, Article 7 of this Circular;

c) Guide the transfer between healthcare facilities for insured patients according to the regulations.

2. Take the lead and coordinate with the Social Insurance of the province/city under the central government, healthcare facilities under the Ministry of Health, and other Ministries and Sectors to define the target groups, group structure, and number of people participating in health insurance for initial medical examination and treatment registration as stipulated in Articles 6 and 7 of this Circular, in accordance with the actual conditions of the locality and the capacity of healthcare facilities.

3. Direct healthcare facilities under their jurisdiction to implement the provisions of this Circular.

Article 11. Responsibilities of Healthcare Facilities

1. Carry out medical examination and treatment, transfer between healthcare facilities, and ensure the rights of insured patients according to the regulations.

2. Based on the organizational conditions of the unit, the head of the healthcare facility assigns a person responsible for promptly confirming the reception of patients transferred during working hours or outside working hours.

Article 12. Responsibilities of Health Departments of Ministries and Sectors

1. Military Medical Service - Ministry of National Defense:

a) Direct and guide military healthcare facilities meeting the conditions to organize initial medical examination and treatment to register with the provincial Department of Health;

b) Guide the organization of health insurance medical examination and treatment for military and civil-military healthcare facilities under the Ministry of National Defense.

2. Health Service - Ministry of Public Security: Direct healthcare facilities under the Ministry of Public Security meeting the conditions to organize initial medical examination and treatment to register with the provincial Department of Health.

3. Other Health Departments of Ministries and Sectors:

a) Direct medical establishments under the Ministry and Sector that meet the conditions for organizing primary healthcare services to register with the local Department of Health;

b) Guide the implementation of registration for primary healthcare services and organization of health insurance medical services in accordance with the regulations.

Article 13. Responsibilities of the Social Insurance of Provinces/Cities Under the Central Government

1. Organize the signing of health insurance medical service contracts with medical establishments that meet the conditions for organizing primary healthcare services according to the list approved by the Department of Health.

2. Coordinate with the Department of Health to guide insured individuals to register or change their initial medical examination and treatment registration at healthcare facilities within the province/city under the central government in accordance with the provisions of Clause 1 and Clause 2, Article 10 of this Circular.

3. Guide the provision of health insurance medical examination and treatment for individuals holding health insurance cards as specified in Clause 6, Article 9 of this Circular.

Article 14. Transitional Provisions

Insured individuals who have registered for initial medical examination and treatment at the healthcare facility indicated on their health insurance card before the effective date of this Circular shall continue to receive initial medical examination and treatment at that facility until there is a change in their initial medical examination and treatment registration according to the guidance provided in this Circular.

Article 15. Effective Date

1. This Circular takes effect from January 1, 2015.

2. Circular No. 10/2009/TT-BYT dated August 14, 2009, issued by the Minister of Health, guiding the registration for initial medical examination and treatment and the transfer of medical examination and treatment under health insurance, becomes invalid from the date this Circular takes effect.

During the implementation process, if there are difficulties or obstacles, please report them to the Ministry of Health for consideration and resolution./.