CIRCULAR

PRICE RANGE AND METHODS FOR EVALUATING FEES OF ON-DEMAND MEDICAL EXAMINATION AND TREATMENT SERVICES PROVIDED BY STATE-OWNED MEDICAL EXAMINATION AND TREATMENT ESTABLISHMENTS

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 Decree No. 95/2022/ND-CP dated November 15, 2022 of the Government on functions, tasks, powers, and organizational structures of Ministry of Health;

Pursuant to Decree No. 60/2021/ND-CP dated June 21, 2021 of the Government on financial autonomy of public service providers;

Pursuant to Decree No. 177/2013/ND-CP dated November 14, 2013 of the Government elaborating the Law on Prices amended by Decree No. 149/2016/ND-CP dated November 11, 2016 of the Government;

Pursuant to Circular No. 25/2014/TT-BTC dated February 17, 2014 of the Minister of Finance on general evaluation methods for goods and services;

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The Minister of Health promulgates Circular on price range and evaluation methods for fees of on-demand medical examination and treatment services provided by state-owned medical examination and treatment establishments.

Article 1. Scope and regulated entities

This Circular prescribes:

1. Price range of on-demand medical examination and treatment services provided by state-owned medical examination and treatment establishments affiliated to Ministry of Health, ministries, central departments, and local governments (hereinafter referred to as “medical establishments”) under Appendix attached hereto.

2. Methods for evaluating fees of on-demand medical examination and treatment services (hereinafter referred to as “on-demand medical services”) provided by medical establishments.

Article 2. Types of on-demand medical services

1. On-demand medical services provided by state-owned medical establishments include:

a) Medical examination;

b) Hospital beds;

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2. On-demand medical services provided by state-owned medical establishments at residence: Conform to Circular No. 21/2019/TT-BYT dated August 21, 2019 of the Minister of Health.

Article 3. Rules in providing on-demand medical services

1. Conform to regulations of the Communist Party, policies and law of the Government, satisfy diverse demand and payment capability of service users. Prices of services shall accurately and adequately cover reasonable costs, facilitate reinvestment and development, conform to socialism-oriented market regulations.

2. Publicize list, price, and availability of on-demand medical services to enable the general public and patients to acknowledge and choose services based on negotiation and willingness between service users and medical establishments; ensure that patients receive medical examination and treatment in accordance with promulgated treatment regimen.

3. Medical establishments providing on-demand medical services shall adhere to their functions, tasks, regulations on organization and operation, satisfy requirements to provide medical services as per the law, and fulfill assigned tasks and functions.

4. Medical establishments providing on-demand medical services are responsible for managing, using, applying public property use standards and norms in accordance with public property management and use laws.

5. Medical establishments must record, monitor revenues and expenditure separately, and accurately reflect in accounting books and financial statements; produce and utilize public property depreciation excerpt in accordance with public property management and use laws; fulfill obligations to the Government as per the law.

Article 4. Methods for evaluating on-demand medical service fees

1. Medical establishments shall choose any of the 2 methods under Clause 1 Article 5 of Circular No. 25/2014/TT-BTC dated February 17, 2014 of the Minister of Finance to develop on-demand medical service price range.

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3. If extra costs arise as a result of inviting domestic personnel (other than full-time employees stationing at establishments and wards providing on-demand services) and foreign personnel: service fees shall include personnel hiring costs under contract, costs for travel, allowance, accommodations, hiring translators, reasonable costs relating to personnel hiring on the basis of agreement and willingness of service users.

4. If technical specialized services are provided at residence, additional reasonable costs shall be added to total service fee (if any).

Article 5. Costs and evaluation methods thereof to determine on-demand medical service fees

1. Direct costs:

a) Direct costs for service provision include:

- Medicine, chemicals, medical equipment, consumables, replacements (including preservation and depreciation costs as per the law);

- Electricity, water, fuel, waste treatment, environment hygiene, bacterial contamination control costs;

- Equipment maintenance, inspection, calibration, replacement tool, equipment purchase costs;

- Other direct costs as per the law.

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- Costs under Point a of this Clause shall be determined by depreciation norms developed, promulgated by medical establishments and based on depreciation norms promulgated or publicized by competent authority (if any).

- Unit price of medicine, materials, chemicals, and direct costs (including VAT) shall be the price when they arrive at medical establishments which is determined by published price (if any) or price on invoice according to applicable laws at the time in which pricing is determined plus (+) costs for transporting to medical establishments or winning bid as per the law.

2. Costs for salaries:

a) Costs for salaries include all monetary costs which medical establishments must pay to employees, including:

- Salaries; allowance; donations depending on regulations (including donations made by the establishments) of employees and employers;

- Wages and payments relating to service provider personnel as per the law;

- Costs for outsourced personnel, domestic and foreign invited experts according to agreements signed with experts.

b) Evaluation methods

- Regarding services where the number of people and time for service provision have been regulated: medical establishments shall rely on the regulation and practical situation to decide on labor depreciation depending on work days;

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- Unit labor costs per work day shall be determined by salaries, wages, allowance, donations (including donations made by the establishments) depending on payrolls and employment contracts.

3. Administrative costs:

a) Administrative costs include costs of management and administrative departments of medical establishments and indirect costs serving service provision, including:

- Costs for electricity, water, fuel; costs for telecommunication and post services; costs for renting information technology, renting services, management software; costs for maintaining patient security and safety; costs for maintaining hygiene, environment, waste treatment; other costs for hiring and purchase;

- Costs for maintaining, inspecting, calibrating property, procuring equipment, tools, instruments, and stationery serving management departments, indirect operation and general operation of the establishments;

- Costs for hiring translators, interpreters; costs for procuring, printing, photocopying documents and publications;

- Costs for uniform, outfit, PPE, occupational safety and hygiene assurance, employee health protection, HIV infection prevention, and immunization for employees and officials;

- Costs for media, advertising affairs;

- Fees and charges; land use tax/land levies for business, service operations (if any); liability insurance in medical examination and treatment, property insurance; costs for fire prevention and fighting; costs for quality control; costs relating to preservation, loss, disposal of medicine and instruments; costs for selling and disposing property as per the law;

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- Loan interests (if any);

- Other costs.

b) Evaluation methods:

- Costs relating to materials, chemicals and other costs of management, administration departments shall be determined the same manner as direct costs are under Clause 1 of this Article;

- Establishments shall develop solutions for allocating administrative and operational costs for each service appropriate to each establishment's practical situations.

4. Property depreciation costs including property used solely for on-demand services and property used both for operations within functions and tasks of establishments and on-demand services: comply with applicable regulations on depreciation.

5. Risk provision.

6. Accumulations for reinvestment, technical development, expected turnovers (if any).

Article 6. Entitlement to approve specific fees of on-demand medical services

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2. In regard to on-demand medical services originating from joint-venture capital, public-private partnerships (PPP):

On-demand medical service fees that are fees proposed under scheme for using public property for the purpose of joint-venture or in PPP projects shall be approved by competent authority, in which:

a) The Minister of Health shall approve schemes for using public property for the purpose of joint venture or in PPP projects of entities affiliated with the Ministry of Health;

b) Ministers, heads of central departments shall approve schemes for using public property for the purpose of joint venture or in PPP projects of entities under management of ministries, central departments;

c) People’s Committees of provinces shall approve schemes for using public property for the purpose of joint venture or in PPP projects of entities within the province, other than those under Point a and Point b of this Clause.

3. In regard to on-demand medical services originating from loan capital or mobilized capital:

a) The Minister of Health shall approve specific fees of on-demand medical services of entities affiliated with the Ministry of Health and classified under category 3 or category 4 autonomy;

b) Ministers, heads of central departments shall approve schemes for joint venture or PPP projects of entities affiliated with ministries and central departments;

c) People’s Committees of provinces shall approve specific fees of on-demand medical services of entities in the province, except those under Points a, b, and d of this Clause;

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4. In regard to fees of on-demand medical services that do not utilize state budget and do not fall under cases of Clause 2 and Clause 3 of this Article: Heads of entities shall approve specific fees of on-demand medical services of the entities under Clause 2 Article 6 of Decree No. 60/2021/ND-CP dated June 21, 2021 of the Government.

Article 7. Requirements of medical establishments providing on-demand medical services

In addition to satisfying requirements pertaining to facilities, medical equipment, and personnel in accordance with regulations on medical examination and treatment; medical establishments providing on-demand medical services must also satisfy quality standards below:

1. In regard to medical examination services:

a) Minimum area of a medical examination space must equal medical examination space under National Standards TCVN 4470:2012;

b) Each doctor, specialist shall examine, advise no more than 45 patients/working day of 8 hours.

2. In regard to services relating to hospital beds: Each on-demand treatment room shall contain no more than 4 beds and satisfy minimum floor area/bed according to the TCVN 4470:2012.

Article 8. Organizing implementation

1. Medical establishments are responsible for:

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b) strictly adhering to regulations on healthcare profession, especially indicating patients for in-patient treatment; referring, indicating services, medicine, medical equipment in accordance with treatment regimen and appropriate to patient’s conditions;

c) ensuring that the number of hospital beds for on-demand medical services at any given time does not exceed 20% of total average hospital beds of preceding year (except hospital beds for on-demand services invested via mobilized capital, loan, joint venture, PPP projects by entities to invest in on-demand medical examination and treatment areas separate from regular medical examination and treatment areas);

d) ensuring that skilled experts and physicians of entities spend a definite amount of time (at least 70%) on examining, treating patients possessing health insurance card, patients lacking health insurance card and not using on-demand services, and supporting lower levels;

dd) declaring fees in accordance with Decree No. 177/2013/ND-CP dated November 14, 2013 of the Government and guiding documents;

e) publicly posting lists and fees of on-demand medical services;

g) contributing to funds in a manner that utilizes surplus of on-demand medical service revenues and satisfies principles below:

- Increasing percentage of contributions made to Professional operation development fund in order to invest in both regular medical examination, treatment sector and on-demand medical examination, treatment sector;

- Contributing and increasing percentage of contributions towards Medical examination and treatment support fund; developing regulations to support patients during medical examination and treatment process.

2. Departments of Health of provinces and central-affiliated cities are responsible for:

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b) directing medical establishments in their province and city to strictly comply with professional regulations, synchronously implement solutions for improving medical service quality.

Article 9. Implementation

1. This Circular comes into force from August 15 , 2023.

2. Medical facilities providing on-demand medical examination and treatment wards that have been operating before the effective date hereof are responsible for reviewing, investing, upgrading facilities, procuring additional equipment, recruitment personnel to satisfy requirements under Article 7 hereof, and re-approving fees before December 31, 2024.

3. If documents and regulations referred to in this Circular are amended or replaced, the amending or replacing versions shall prevail.

Difficulties that arise during the implementation of this Circular should be reported to the Ministry for consideration./.

PP. MINISTER
DEPUTY MINISTER




Le Duc Luan

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