Circular No. 43/2013/TT-BYT detailing the classification of medical technical specialties for the healthcare facility system

CIRCULAR

Regulations on detailed specialization and technical level demarcation for the medical examination and treatment facility system

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

Based on Decree No. 63/2012/NĐ-CP dated August 31, 2012 of the Government stipulating functions, tasks, powers, and organizational structure of the Ministry of Health;

At the proposal of the Director of the Department of Medical Examination and Treatment;

The Minister of Health issues this Circular to provide detailed regulations on specialization and technical level demarcation for the medical examination and treatment facility system.

Article 1. Scope of Regulation and Applicability

This Circular specifies the specialization and technical levels, the list of techniques, the demarcation of specialization and technical levels, and the authority to approve the list of techniques for the medical examination and treatment facility system.

This Circular applies to state-owned and private medical examination and treatment facilities nationwide, except those managed by the Ministry of National Defense.

Article 2. Principles for specialization and technical level demarcation for the medical examination and treatment facility system

1. Specialization and technical level demarcation in medical examination and treatment (hereinafter referred to as Technical Level Demarcation) categorizes medical examination and treatment facilities into the specialization and technical levels specified in Article 81 of the Law on Medical Examination and Treatment.

2. Technical Level Demarcation is based on the requirements for the scope of specialized activities, scale of operations, physical infrastructure, equipment, human resources, and technical implementation capacity of medical examination and treatment facilities.

3. Technical Level Demarcation does not limit the development of techniques at medical examination and treatment facilities.

Article 3. Specialization and technical levels

1. Central level (hereinafter referred to as Level 1) includes the following medical examination and treatment facilities:

a) Special class hospitals;

b) Class I hospitals directly under the Ministry of Health;

c) Class I hospitals directly under provincial health departments (hereinafter referred to as Provincial Health Departments) or under other ministries and sectors designated by the Ministry of Health as the final level for specialized technical activities.

2. Provincial and centrally-administered city level (hereinafter referred to as Level 2) includes the following medical examination and treatment facilities:

a) Hospitals ranked Class II and below directly under the Ministry of Health;

b) Class I and Class II hospitals under Provincial Health Departments or other ministries and sectors, excluding hospitals specified in Point c Clause 1 of this Article.

3. District, urban district, town, and centrally-administered city district level (hereinafter referred to as Level 3) includes the following medical examination and treatment facilities:

a) Class III and Class IV hospitals, unranked hospitals, district health centers with medical examination and treatment functions in areas without district hospitals or public security hospitals;

b) Multi-specialty clinics, specialty clinics, maternity homes.

4. Commune, ward, town level (hereinafter referred to as Level 4) includes the following medical examination and treatment facilities:

a) Commune Health Stations;

b) Health stations of agencies, units, organizations;

c) Family doctor clinics.

5. Specialization and technical level demarcation for private medical examination and treatment facilities:

a) Based on the technical implementation capacity, scope of specialized activities, organizational form, scale of operations, physical infrastructure, equipment, and human resources of private medical examination and treatment facilities, the competent state agency (Ministry of Health or Provincial Health Department) issuing the operating permit for private medical examination and treatment facilities decides (in writing) the appropriate specialization and technical level for such facilities in accordance with the provisions of this Circular.

Article 4. List of medical technical specialties in diagnosis and treatment

1. The accompanying Circular hereby promulgates the List of medical technical specialties in diagnosis and treatment (hereinafter referred to as the Technical List), which includes 28 specialties and fields structured as follows:

a) Column 1: Record the serial number from 01 to the end of the Technical List.

b) Column 2: Record the names of technical specialties, names of techniques.

c) Column 3: Classify technical levels into four sub-columns:

- Column 3A: Techniques performed at Level 1.

- Column 3B: Techniques performed at Level 2.

- Column 3C: Techniques performed at Level 3.

- Column 3D: Techniques performed at Level 4.

2. The Technical List promulgated with this Circular is the permitted medical technical specialties for diagnosis and treatment in Vietnam. A technique may be performed by multiple specialties and fields, but in this Circular it is arranged under the most suitable specialty or field.

3. The Technical List classified by technical level reflects the technical standard at each technical level. Medical facilities must be able to perform the majority of techniques according to their corresponding technical level.

4. Encourage medical facilities to develop their technical expertise and implement techniques from higher levels. Higher-level medical facilities should limit performing techniques that lower-level medical facilities can already perform.

Article 5. Construction of the Technical List of medical facilities

1. Based on the Technical List promulgated with this Circular, medical facilities shall establish their own Technical List to be submitted to the competent state authority specified in Article 6 of this Circular for review and approval based on the following conditions:

a) The scope of professional activities, organizational form, and scale of operations of the medical facility approved by the competent state authority.

b) Actual conditions regarding infrastructure, equipment, human resources, and professional qualifications of the medical facility.

 Article 6. Authority to Approve the Technical List of medical facilities 

1. The Minister of Health:

a) Approves the initial and supplementary Technical Lists of medical facilities directly under the Ministry of Health, medical facilities of other ministries and sectors, and private medical facilities licensed by the Ministry of Health.

b) Approves the Technical List of medical facilities in cases stipulated in Point b Clause 2 of this Article.

2. Director of the Department of Health:

a) Approves the initial and supplementary Technical Lists of medical facilities under the Department of Health, medical facilities of other ministries and sectors within the jurisdiction, and private medical facilities licensed by the Department of Health, except those specified in Point b Clause 1 of this Article.

b) In cases where the Technical List falls within the approval authority of the Director of the Department of Health but the Department lacks the capability to assess the technical expertise, the Department shall request the Ministry of Health to conduct the assessment and approval.

 Article 7. Documents for Initial Approval of the Technical List 1. Request letter. 

2. Minutes of the meeting of the Technical Specialty Council as prescribed in Article 9 of this Circular.

3. The proposed Technical List for approval includes:

a) Techniques currently being performed or organized to be implemented by the medical facility according to its technical level.

b) Techniques from higher levels currently being performed or organized to be implemented.

c) Documentation describing the capacity of the medical facility in terms of infrastructure, human resources, medical equipment; economic and social benefits, and implementation plans for the techniques.

The proposed Technical List table must be presented in accordance with the structure (correctly writing the specialty, technical serial number, technique name) of the Technical List as stipulated in Clause 1, Article 4 of this Circular.

The technical item list proposed for approval must be presented in accordance with the structure (correctly written specialty, technical serial number, technical name) as prescribed in Clause 1 of Article 4 of this Circular.

Article 8. Application for Approval of the Supplementary Technical Catalogue

2. Minutes of the meeting of the Technical Specialty Council as prescribed in Article 9 of this Circular.

3. The proposed Technical List for approval includes:

3. The supplementary technical catalogue to be approved includes:

a) The technical procedures specified for the specialized technical lines of medical examination and treatment facilities that need to be supplemented;

b) The technical procedures of higher-level lines that need to be supplemented which the medical examination and treatment facility already has the necessary conditions to implement.

The proposed Technical List table must be presented in accordance with the structure (correctly writing the specialty, technical serial number, technique name) of the Technical List as stipulated in Clause 1, Article 4 of this Circular.

The supplementary technical catalogue must be presented according to the correct structure (correct specialty, technical procedure number, technical procedure name) as stipulated in Clause 1, Article 4 of this Circular.

Article 9. Procedure for Approving the Technical Catalogue

1. Medical examination and treatment facilities submit one set of application dossier prescribed in Article 7 or Article 8 of this Circular to the Department of Medical Examination and Treatment - Ministry of Health or the Provincial Health Departments, depending on their jurisdiction. Medical examination and treatment facilities under the Ministry of Public Security submit one set of application dossier to the Health Service - Ministry of Public Security; medical examination and treatment facilities under the Ministry of Transport submit one set of application dossier to the Health Service - Ministry of Transport.

2. Within five working days from the date of receipt of the dossier directly or through postal service (based on the date recorded in the incoming document register), the receiving agency must examine and determine whether the dossier is valid or invalid. In case the dossier is invalid, the receiving agency must issue a notification to the medical examination and treatment facility to complete the dossier. The notification must specify the additional documents and contents that need to be modified or supplemented. The medical examination and treatment facility must supplement and modify the dossier according to the content of the notification and resubmit the completed dossier to the receiving agency. If the medical examination and treatment facility supplements the dossier but does not meet the requirements, it must continue to complete the dossier according to the provisions of this clause until the dossier meets the requirements.

3. Within twenty working days from the date of receipt of the valid dossier (based on the date recorded in the incoming document register of the receiving agency), the receiving agency must organize the review and issue a decision to approve the technical catalogue for the medical examination and treatment facility. The review will be conducted based on the dossier, and if necessary, the receiving agency may establish a specialized review board to review part or all of the technical catalogue at the medical examination and treatment facility. After the review, the Health Service - Ministry of Public Security, the Health Service - Ministry of Transport will send the review results of the medical examination and treatment facilities under their management, including the review report, review minutes, and reviewed technical catalogue to the Department of Medical Examination and Treatment - Ministry of Health or the Provincial Health Departments to request approval according to the jurisdiction stipulated in Article 6 of this Circular.

4. For technical procedures exceeding the reviewing capacity of the receiving agency, the receiving agency shall guide the medical examination and treatment facility to submit the dossier to the Department of Medical Examination and Treatment - Ministry of Health for organization of review and approval.

Article 10. Implementation Organization

1. Higher-level medical examination and treatment facilities have the responsibility to direct and support lower-level medical examination and treatment facilities with professional technical expertise to implement the provisions of Clause 3, Article 81 of the Law on Medical Examination and Treatment and according to the division of labor and directives of the Ministry of Health.

2. Medical examination and treatment facilities have the responsibility to ensure material infrastructure, equipment, and personnel with professional qualifications to implement the technical catalogue approved by the competent authority. Medical examination and treatment facilities have the responsibility to publicly announce the technical catalogue of the medical examination and treatment facility approved by the competent state authority in a suitable manner so that agencies, units, and citizens are aware.

Article 11. Transitional Provisions

The technical catalogue implemented at the unit approved according to the provisions of Decision No. 23/2005/QD-BYT dated August 30, 2005 of the Minister of Health on the issuance of the Regulations on Technical Tiering and Technical Catalogue in medical examination and treatment before the effective date of this Circular shall continue to be implemented until adjustments and supplements are made.

Article 12. Implementation Provisions

1. This Circular takes effect from February 1, 2014.

2. Decision No. 23/2005/QD-BYT dated August 30, 2005 of the Minister of Health on the issuance of the Regulations on Technical Tiering and Technical Catalogue in medical examination and treatment shall cease to be effective from the date this Circular takes effect.

3. The Director of the Department of Medical Examination and Treatment, the Directors of Provincial Health Departments, the Heads of health services of Ministries and sectors, the heads of medical examination and treatment facilities, and related organizations and individuals are responsible for implementing this Circular.

During implementation, if there are difficulties or obstacles, organizations and individuals are requested to promptly reflect them to the Ministry of Health (Department of Medical Examination and Treatment) for consideration and resolution./.