Joint Circular No. 37/2015/TTLT-BYT-BTC stipulates uniform prices for medical examination and treatment services under health insurance between hospitals of the same level nationwide.

JOINT CIRCULAR

Article on unifying the prices of medical examination and treatment services under health insurance between hospitals of the same level nationwide

among hospitals of the same grade nationwidespecialized agency under the People's Committee of the province/city.

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Pursuant to the Law on Medical Examination and Treatment dated November 23, 2009;

Pursuant to the Law on Prices dated June 20, 2012;

Pursuant to the Law Amending and Supplementing Certain Provisions of the Health Insurance Law on June 13, 2014;

Pursuant to Decree No. 85/2012/ND-CP dated October 15, 2012 of the Government on the mechanism of operation and financial mechanism for public health institutions and service fees for medical examination and treatment at public medical facilities;

Pursuant to Decree No. 16/2015/NĐ-CP dated February 14, 2015 of the Government stipulating the self-management mechanism of public service units;

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

Pursuant to Decree No. 215/2013/NĐ-CP dated December 23, 2013, promulgated by the Government stipulating the functions, tasks, powers, and organizational structure of the Ministry of Finance;

The Minister of Health and the Minister of Finance issue this Joint Circular to unify the service fee for medical examination and treatment under health insurance among hospitals of the same grade nationwide.

Article 1. Scope of Regulation

1. This Joint Circular stipulates the service fee for medical examination and treatment under health insurance among hospitals of the same grade nationwide.

2. For medical examination and treatment services not within the scope of payment from the health insurance fund, the price range and authority to determine specific prices shall be implemented according to the Price Law, Medical Examination and Treatment Law, and related guiding documents.

Article 2. Applicability

Healthcare facilities, units, organizations, and individuals involved in the process of medical examination and treatment and settlement of medical examination and treatment costs under the health insurance regime.

Article 3. Service Fee for Medical Examination and Treatment Under Health Insurance

1. The service fee for medical examination and treatment includes:

a) The service fee for medical examination as specified in Appendix I attached hereto;

b) The service fee for hospital bed days as specified in Appendix II attached hereto;

c) Technical service fees as specified in Appendix III attached hereto.

2. The service fee for medical examination and treatment as stipulated in Clause 1 of this Article includes the following costs:

a) DIRECT COSTS:

- Costs for medicines, infusions, chemicals, consumable materials, and replacement materials.

For certain types of medicines, blood, infusions, chemicals, consumable materials, and replacement materials not included in the service fee for medical examination and treatment as specified in Appendix III attached hereto: reimbursement will be based on actual usage, purchase price, and the scope and level of benefits prescribed by law.

- COSTS FOR ELECTRICITY, WATER, FUEL, WASTE MANAGEMENT, ENVIRONMENTAL SANITATION;

- MAINTENANCE AND REPAIR COSTS FOR EQUIPMENT, PURCHASE OF REPLACEMENT TOOLS AND UTENSILS.

b) Allowance for continuous duty, surgical allowance, procedural allowance (hereinafter referred to as special allowance) as prescribed in Decision No. 73/2011/QD-TTg dated December 28, 2011 of the Prime Minister regarding certain special allowances for civil servants, employees, and workers in public healthcare institutions and anti-disease allowances;

c) Salary costs based on rank, position, allowances, and contributions under state regulations for public institutions, excluding costs regulated in Clause 3 of this Article.

3. The service fee for medical examination and treatment as stipulated in Clause 1 of this Article does not include costs covered by the state budget as prescribed in the following documents:

a) Decree No. 64/2009/ND-CP dated July 30, 2009 of the Government on policies for medical staff working in areas with extremely difficult economic and social conditions;

b) Decree No. 116/2010/NĐ-CP dated December 24, 2010 of the Government on policies for cadres, civil servants, employees, and personnel receiving salaries working in areas with extremely difficult economic and social conditions;

c) Decision No. 46/2009/QĐ-TTg dated March 31, 2009 of the Prime Minister on special allowances for cadres and employees working at the Vietnam Friendship Hospital, Thong Nhat Hospital, Da Nang Hospital C under the Ministry of Health, Central Protection Departments 1, 2, 2B, 3, and 5, and Department A11 of the Military Central Hospital 108 and Department A11 of the Military Traditional Medicine Institute (hereinafter referred to as Decision No. 46/2009/QĐ-TTg) and Decision No. 20/2015/QĐ-TTg dated June 18, 2015 of the Prime Minister amending and supplementing certain provisions of Decision No. 46/2009/QĐ-TTg;

d) Point a Clause 8 Article 6 of Decree No. 204/2004/NĐ-CP dated December 14, 2004 of the Government on salary system for cadres, civil servants, employees, and armed forces and Decree No. 76/2009/NĐ-CP dated September 15, 2009 of the Government amending and supplementing certain provisions of Decree No. 204/2004/NĐ-CP.

4. The costs as stipulated in Clause 2 of this Article are determined based on standards issued by the Ministry of Health.

5. The price levels of medical examination and treatment services as specified in the Appendices attached to this Joint Circular shall be reviewed and adjusted by the joint ministries of Health and Finance when factors forming the price change.

Article 4. Application of service prices for medical examination and treatment under health insurance in certain cases

1. Medical services not specified with specific prices in this Joint Circular: apply the prices of similar services classified by the Ministry of Health according to technical level and actual costs.

2. Surgical procedures and interventions not classified by the Ministry of Health according to technical level and actual costs and not specified with specific prices: apply the corresponding prices for each type of surgical procedure and intervention listed under the section "Other surgical procedures and interventions" of Appendix III issued together with this Joint Circular.

3. New medical techniques as stipulated in Clause 1 and Clause 2, Article 69 of the Law on Medical Examination and Treatment and other medical techniques not yet priced: apply the prices set by the Ministry of Health after obtaining the consensus of the Ministry of Finance. The procedures, deadlines for pricing decisions, and documentation for pricing proposals shall be carried out in accordance with the laws on pricing.

4. Hospitals with beds, provincial health centers with functions of medical examination and treatment; district health centers performing both preventive and curative functions that have been ranked: apply the prices of hospitals of equivalent rank.

5. Hospitals with beds, military field hospitals, unranked treatment teams; multi-specialty clinics, specialty clinics, midwifery houses; family doctor clinics; traditional medicine clinics; district health centers where hospitals have been separated but still provide medical examination and treatment; commune, ward, town health stations; health care for agencies, units, organizations, schools; military clinics, military-civilian clinics, military-civilian field hospitals; field hospitals; unranked hospitals and other medical examination and treatment facilities: apply the prices of fourth-class hospitals as stipulated in the Appendices issued together with this Joint Circular.

6. Private medical examination and treatment facilities:

a) Prices for medical examinations and daily bed charges for treatment: health insurance organizations shall agree with private medical examination and treatment facilities to apply the prices of one of the hospital ranks specified in Appendices I and II issued together with this Joint Circular;

b) Medical services not covered by Point a of this Clause: health insurance organizations shall agree with private medical examination and treatment facilities to apply the prices specified in Appendix III issued together with this Joint Circular.

Article 5. Implementation timeline

1. Prices including direct costs and special allowances shall be implemented from March 1, 2016.

2. Prices including direct costs, special allowances, and salaries shall be implemented from July 1, 2016. The specific implementation time for units and localities shall be decided by the Ministry of Health after consideration.

3. Medical examination and treatment facilities classified by competent authorities as self-sustaining units for regular expenses, self-sustaining units for regular expenses and investment expenses shall implement prices including direct costs, special allowances, and salaries from March 1, 2016.

Article 6. Implementation Organization

1. The Ministry of Health shall be responsible for specifying the list of equivalent services according to technical level and actual costs of service provision as the basis for applying prices as stipulated in Clause 1, Article 4 of this Joint Circular.

2. The Ministry of Health shall be responsible for leading and coordinating with the Ministry of Finance and the Vietnam Social Security to organize the implementation and monitor the execution of this Joint Circular.

3. The Ministry of Finance shall be responsible for coordinating with the Ministry of Health and the Vietnam Social Security to organize monitoring of the implementation of this Joint Circular.

4. The Vietnam Social Security shall instruct local social security offices, the Social Security of the Ministry of National Defense, and the Social Security of the Ministry of Public Security to implement health insurance payments for medical examination and treatment according to this Joint Circular; coordinate with the Ministry of Health and the Ministry of Finance to monitor the implementation of this Joint Circular.

5. The state budget shall ensure funds according to the regulations stipulated in the documents mentioned in Clause 3, Article 3 of this Joint Circular in accordance with current budget regulations and budget decentralization.

6. Revenue from health insurance medical examination and treatment services of public health facilities shall be retained by the unit for use according to regulations. In cases where the financial resources of the unit cannot ensure regular operations, and the unit is classified as a public institution partially self-financing regular expenses or a public institution fully financed by the state for regular operations, the state budget shall continue to ensure funding according to current budget decentralization.

Article 7. Reference Provisions

In cases where the referenced documents in this Joint Circular are replaced or amended, implementation shall follow the replacement or amended documents.

Article 8. Implementation clause

This Joint Circular takes effect from March 1, 2016.

Article 9. Transitional Provisions

For patients whose treatment period starts before and ends after the implementation of the prices stipulated in Article 5 of this Joint Circular: apply the health insurance payment prices as prescribed by the competent authority at the time immediately preceding the implementation of the prices stipulated in Article 5 of this Joint Circular until discharge or completion of outpatient treatment.

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