CIRCULAR

PRICE RANGE OF MEDICAL EXAMINATION AND TREATMENT SERVICES PROVIDED BY STATE-OWNED MEDICAL EXAMINATION AND TREATMENT ESTABLISHMENTS AND GUIDELINES FOR APPLICATION OF PRICES AND PAYMENT FOR MEDICAL EXAMINATION AND TREATMENT IN CERTAIN CASES

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

Pursuant to the Law No. 11/2012/QH12 on Prices dated June 20, 2012;

Pursuant to Government's Decree No. 177/2013/ND-CP dated November 14, 2013 on elaboration of and guidelines for implementation of some Articles of the Law on Prices amended by the Government’s Decree No. 149/2016/ND-CP dated November 11, 2016;

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

Pursuant to Government’s Decree No. 24/2023/ND-CP dated May 14, 2023 on statutory pay rate for officials, public employees and the armed forces;

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

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The Minister of Health promulgates Circular on price range of medical examination and treatment services provided by state-owned medical examination and treatment establishments and guidelines for application of prices and payment for medical examination and treatment in certain cases.

Article 1. Scope and regulated entities

This Circular prescribes price range of medical examination and treatment services (services covered by health insurance and services not covered by health insurance that are not on-demand medical examination and treatment services) provided by state-owned medical examination and treatment establishments; and guidelines for application of prices and payment for medical examination and treatment in certain cases.

Article 2. Price range of medical examination and treatment services

Price range of medical examination and treatment services:

1. Medical examination, health check-up price range specified in Appendix I issued together with this Circular;

2. Per-day bed price range specified in Appendix II issued together with this Circular;

3. Price range of medical technical and clinical laboratory services specified in Appendix III issued together with this Circular;

4. Notes on certain technical services which are similarly ranked by the Ministry of Health in its Decisions and specified in the Appendix IV issued together with this Circular.

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The price range of medical examination and treatment services referred to this Circular shall be set on the basis of direct costs and salaries in order to ensure medical examination, care and treatment services provided to patients and implementation of technical healthcare services. To be specific:

1. Direct costs constituting the price of medical examination service:

a) Costs of clothes, head covers, face masks, bed sheets, cushions, foam mattresses, mats, office stationery, gloves, cotton, bandages, rubbing alcohol, gauze pads, saline solutions, and other consumables which serve medical examination;

b) Costs of electricity, water bills; fuel; disposal of domestic and medical wastes (in a liquid or solid form); laundry, drying, disinfection of fabrics and appliances used for examination; cleaning and environmental hygiene services; sterilization and disinfection supplies, chemicals used for examination;

c) Costs of repair and maintenance of facilities and equipment, purchase of replacements for property, appliances and instruments, including air conditioners, computers, printers, dehumidifiers, fans, desks, chairs, beds, cabinets, lights and other toolkits necessary for examination activities.

2. Direct costs constituting the price of the per-day bed service:

a) Costs of clothes, head covers, face masks, blankets, bed sheets, cushions, foam mattresses, mosquito nets, mats; office stationery; gloves used for examination, injection and infusion, cotton, bandages, alcohol, gauze pads, sterile saline solutions and other consumables for daily use in medical care and treatment activities (including costs of change of wound covering bandages, post-surgery dressings for inpatients, except in case where patients are entitled to payments exceeding the per-day bed price specified in Clause 4 and 5 of Article 7 herein); electrodes, ECG cables, blood pressure measuring armbands and SPO2 sensor cables used in patient monitoring systems at emergency care and intensive care beds.

b) Costs referred to in Points b and c of Clause 1 of this Article that are paid for care and treatment of patients under medical requirements.

c) Costs of medicines, qualified blood and blood products, intravenous fluids and other medical supplies (except for the aforesaid medical supplies); syringes, hypodermic needles, dispensing needles used in injection, infusion and feeding; catheters, connecting tubes, extension tubes used in electric syringe infusion pumps, infusion pumps used for injection and infusion activities; oxygen supplies, oxygen nasal cannulas, oxygen masks (except in case where breathing equipment is indicated for patients), which have not yet been listed in the price structure of per-day bed service, shall be paid on the basis of patients’ actual uses.

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a) Costs of clothes, head covers, face masks, bed sheets, cushions, foam mattresses, mats, fabrics; office supplies; medicines, intravenous fluids, chemicals, consumables and replacement supplies used during the period of implementation of medical services and techniques;

b) Costs referred to in Points b and c of Clause 1 of this Article that are paid for implementation of medical services and techniques under medical requirements.

4. Costs for wages and salaries which constitute the prices of medical examination, per-day beds and other medical services and techniques:

a) Salaries based upon salary scale, grade or job title, allowances, contributions under state policies applied to public service providers and statutory pay rate prescribed in the Government's Decree No. 24/2023/ND-CP dated May 14, 2023 on statutory pay rate for officials, public employees and the armed forces;

b) Regular task allowances or allowances paid in case of operations or surgeries under the Prime Minister’s Decision No. 73/2011/QD-TTg dated December 28, 2011 on particular policies of subsidies paid to officials, public employees and employees working for public healthcare establishments, and allowances paid for prevention and control of epidemics.

5. Costs for wages or salaries constituting the prices of services referred to in Clause 4 of this Article shall not include state budget-funded expenses stipulated in the following documents:

a) Policies on preferential allowances, attraction allowances, benefits and other incentives applicable to medical officials, public employees, employees under employment contracts, and military medical workers directly performing medical tasks in state-owned healthcare establishments in areas with extremely difficult socio-economic conditions;

b) Policies on attraction allowances, seniority allowances, some benefits and travel expenses applicable to officials, public employees and salaried persons working as members of armed forces (people's army and people's public security) in areas with extremely difficult socio-economic conditions;

c) Specific policies on allowances paid to officials and public employees working for Huu Nghi hospital, Thong Nhat hospital, Hospital C – Da Nang affiliated to the Ministry of Health, Central Health Protection Centers 1, 2, 2B, 3 and 5, Department A11 of Military Central Hospital 108 and Department A11 of Military Hospital of Traditional Medicine;

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Article 4. Principles of and authority over decision on prices of medical examination and treatment services that are not covered by health insurance and not on-demand services.

1. Competent authorities stated in Clauses 2 and 3 of this Article shall decide specific prices of medical examination and treatment services provided by healthcare establishments within their jurisdiction which are not in excess of the ceilings of the range of prices of medical examination and treatment services referred to herein.

2. Provincial People’s Councils shall decide specific prices of medical examination and treatment services provided by healthcare establishments under their jurisdiction and decide specific prices or impose prices of medical examination and treatment services in certain cases according to the following principles:

a) Hospitals with medical beds, provincial medical centers providing medical examination and treatment services; district-level medical centers providing both disease prevention and medical examination or treatment which have already been ranked, shall adopt the prices applied to hospitals of similar rank;

b) Healthcare establishments which have not yet been ranked shall adopt the prices applied to hospitals ranked IV;

c) Regarding regional general clinics:

- If they are licensed or fall into cases stipulated in Clause 1 of Article 11 of the Government’s Decree No. 155/2018/ND-CP dated November 12, 2018 on amendments to certain regulations related to investment and business conditions under state management of the Ministry of Health, the prices applied to rank-IV hospitals shall be adopted;

- If they only provide emergency care, outpatient medical examination and treatment services, the prices applied to rank-IV hospitals shall be adopted.  In case a regional general clinic is subject to the decision of the Department of Health on whether it has inpatient beds, the price shall be equal to 50% of the price of a per-day bed at a class-3 department of a rank-IV hospital. The maximum number of days during which payments may be made for medical beds shall be 03 days/patient/treatment period. The payment of medical examination costs will not be required if the payment of inpatient bed costs has been made.

d) Regarding healthcare stations at communes, wards or towns

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- In case a health station is subject to the decision of the Department of Health on whether it has inpatient beds, the price shall be equal to 50% of the price of a per-day bed at a class-3 department of a rank-IV hospital.

e) Maternity homes shall adopt the prices applied to hospitals ranked IV.  The price for a sick bed shall be equal to 50% of the price of a per-day bed at a class-3 department of a rank-IV hospital.

3. Healthcare establishments affiliated to the Ministry of Health and special-rank or first-rank hospitals of Ministries and central regulatory bodies shall adopt the minimum prices under hospital ranks specified in Appendices attached to this Circular.  As for the rest of healthcare establishments affiliated to Ministries and central regulatory bodies, the prices of medical examination and treatment services shall comply with the following regulations:

a) Healthcare stations of entities or organizations, military-civilian healthcare stations, military-civilian healthcare clinics shall adopt the prices of medical examination and treatment services applied at healthcare stations of communes, wards and towns of local jurisdictions.

b) Military-civilian infirmaries shall adopt the prices of medical examination and treatment services applied at regional general clinics at local jurisdictions.

c) Rank-II, III and IV hospitals (including military-civilian hospitals) shall adopt the prices of medical services applied at healthcare establishments of same rank at local jurisdictions.

d) Other healthcare establishments shall adopt the prices of medical services applied at rank-IV healthcare establishments at local jurisdictions.

4. If healthcare establishments affiliated to Ministries or central regulatory bodies render technical services which have not yet specified in regulations on prices of medical examinational and treatment services at local jurisdictions, healthcare establishments shall formulate pricing plans and then report such plans to the Ministry of Health for consideration and decision.

5. If the range of prices of new technical services referred to in the Law on Medical Examination and Treatment and other technical services (except those ranked the same in terms of technical issues and service costs) has not yet been regulated,

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b) Every 6 months (on the fourth week of June and that of December every year), entities and local authorities shall submit general reports to the Ministry of Health for consideration and decision;

c) Procedures and documents on pricing plans shall comply with regulations in the law on prices.

Article 5. Guidelines for application of medical examination prices

The number of times of use of and prices of medical examination services shall be determined as follows:

1. If a patient comes to an outpatient department to receive his/her health check-up and then is advised to be hospitalized for inpatient treatment services to meet medical requirements, the payment of medical examination fees shall comply with regulations in Clause 3 of this Article. In case where that patient does not register at the outpatient department but receives medical examination and inpatient treatment services at other clinical departments according to medical requirements, he/she is not required to pay medical examination fees.

2. With respect to healthcare establishments having specialized exam rooms in clinical departments, if a patient registers at outpatient departments and receives medical examination at these specialized exam rooms, it is considered that he/she uses medical examination services provided by outpatient departments.  Calculation of costs and the number of times of use of medical examination services shall follow instructions given in Clause 3 of this Article.

3. At the same time of use of medical examination services at a healthcare establishment (maybe on the same day or for objective reasons or medical requirements, medical examination services have not yet been finished in the first day and shall be continued in the next day), if a patient needs to come to another department after visiting the first department, the price of the second or later time of use of medical examination services shall be 30% of the price of the single time of use of medical examination services and the maximum amount of payment of medical examination costs shall not be 2 times greater than the price of the single time of use of medical examination services.

4. If a patient visits a healthcare establishment where he/she has used medical examination services and received medicines, but then finds abnormal signs and immediately returns to that healthcare establishment within the same day to check his/her health again, this use of medical examination services shall be considered as the second or later time of use of medical examination services within the same day.  The payment shall be made according to instructions given in Clause 3 of this Article;

Article 6. Determination of the number of days of use of medical beds and application of per-day bed service prices

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a) The number of days of use of inpatient treatment services is determined by the day of dehospitalization minus (-) the day of hospitalization plus (+) 1. This formula shall be applied in the following cases:

- Pathological conditions of a seriously-ill patient currently using inpatient treatment services have not been alleviated, he/she is dead or faces serious health problems and his/her family asks for permission to take him/her home or refer to another higher-level healthcare establishment;

- A patient has been successfully cured by a higher-level healthcare establishment over the emergency care stage, but still needs to continue to use inpatient care services and he/she is referred to another lower- or similar-level healthcare establishment;

b) The number of days of use of inpatient care services is determined by the day of dehospitalization minus (-) the day of hospitalization. This formula shall be applied to other cases.

c) If a patient hospitalized and dehospitalized in the same day (or hospitalized in the previous day and dehospitalized in the following day) is treated from more than 04 hours to under 24 hours, it is considered that the treatment lasts 01 day. If that patient is received in the emergency care department without registering at the outpatient department, and has the emergency care and treatment duration of 04 hours or less (even in the case of dehospitalization, hospitalization, referral or death), he/she shall be entitled to payments for medical examination services, medicines, medical supplies and other technical services, but shall not be entitled to coverage of fees for his/her per-day emergency bed;

d) If a patient is hospitalized and dehospitalized in the same day and is treated for the maximum duration of 04 hours, he/she shall be entitled to payments for medical examination services, medicines, medical supplies and other technical services that he/she has used, but shall not be entitled to coverage of fees for his/her per-day emergency bed.

2. If a patient is referred to 02 departments in the same day, it is considered that his/her treatment lasts a half of day. If that patient is referred to 03 departments or more, the price of per-day bed in that day shall be determined by the arithmetic mean of per-day bed fees arising at the department where he/she is treated for more than 04 hours and is charged at the highest price of per-day bed and at the department where he/she is treated for more than 04 hours and is charged at the lowest price of per-day bed.

3. The price of a per-day bed provided by the surgery or burns department shall be valid for the duration of 10 days or fewer after each surgery. From the 11^th day onwards, the price of a per-day bed shall be the price of per-day internal treatment bed at respective departments prescribed in Section 3 of the Appendix II hereto.

4. The price of per-day bed shall be applicable to only 01 patient per 01 bed.  In case where, at the same time, sharing a bed between 02 patients is required, a half price of per-day bed shall be applied.  If a bed is shared by 03 patients or more, the one-third price of bed per the number of treatment days shall be applied.

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a) at special-rank, rank-I or rank-II hospitals with intensive care departments, antitoxic departments or centers, intensive care – antitoxic departments that fully meet operational requirements under the Decision No. 01/2008/QD-BYT dated January 21, 2008 of the Minister of Health on issuance of emergency treatment, intensive care and antitoxic regulations (hereinafter referred to as Decision No. 01/2008/QD-BYT).

b) in case where there are beds for intensive care in the Emergency Department, Anesthesiology Department, Neonatal Department, Infectious Diseases Department and Department of Pediatrics; beds for postoperative care after special surgery that meet the requirements of intensive care beds specified in regulations on emergency, intensive care and poison prevention issued together with Decision No. 01/2008/QD-BYT dated January 21, 2008 of the Minister of Health;

c) if patients using these beds suffer from pathological conditions that need care, treatment and monitoring according to emergency care, intensive care and antitoxic regulations.  In cases other than those mentioned above, the prices of emergency treatment bed and other beds referred to in Appendix II hereto shall be applied.

6. Clinical treatment departments with emergency treatment beds (for example, the pediatrics department with pediatric intensive care beds, the neonatology or immature infant intensive care department) shall be allowed to apply the price of intensive care bed as stipulated in the service no.2 of the Appendix II hereto.

7. Rank-III, rank-IV hospitals or hospitals that have not yet been ranked but obtained the competent authority’s approval for performance of special surgeries may apply the highest price of surgical treatment bed at hospitals where such medical services are implemented.

Example: At Hospital A obtaining approval for performance of special surgeries, If it is a rank-III hospital, it may be entitled to apply the price of the bed used after the class-I surgery is performed at the rank-III hospital; if it is ranked IV or it has not yet been ranked, it may apply the price of the bed used after the class-I surgery is performed at the rank-IV hospital.

8. If a surgery is classified in different manners by departments (except pediatrics department) in the Circular No. 50/2014/TT-BYT dated December 26, 2014 of the Minister of Health on classification of surgeries, operations and manning requirements in each medical surgery or operation (hereinafter referred to as Circular No. 50/2014/TT-BYT), the price of per-day bed for surgical or burn treatment classified as the lowest-level surgery shall be applied.

9. Surgeries which are ranked by the Ministry of Health and equal to one of surgeries specified in this Circular, but which are classified into different surgeries by specific departments as provided in the Circular No. 50/2014/TT-BYT, may apply the price of per-day bed for surgical or burn treatment according to the classification of these surgeries.

10. Surgeries which have not yet been classified under regulations of the Circular No. 50/2014/TT-BYT may apply the price of class-4 bed for surgical treatment at the equivalent-rank hospital.

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12. Departments of traditional medicine hospitals (except those specified in Clause 11 of this Article) and medical care and rehabilitation hospitals:

a) ICU beds shall be priced as per Clause 5 of this Article;

b) Emergency intensive care beds shall be priced as per Clause 6 of this Article;

c) Prices of beds for patients treated at oncology and pediatrics departments shall be the same as the prices of class-1 per-day beds for internal treatment;

d) Each patient treated for one of the diseases, including spinal cord trauma, cerebral vascular accident or traumatic brain injury, may be charged at the price of class-2 per-day bed for internal treatment;

dd) Patients treated at other departments may be charged at the prices of class-3 per-day beds for internal treatment.

13. Healthcare establishments with joint departments may apply the prices of per-day beds for internal treatment at departments where patients are receiving treatment in relation to ranks of hospitals. If a patient receives treatment for multiple diseases at the same time, the price of per-day bed at the department where he/she is receiving treatment for the main disease shall be applied.

14. If a patient rests on stretcher or foldable bed, the price of bed shall be 50% of the price of per-day bed specific to each department as provided in Appendix II hereto.

15. The price of per-day bed after the “phacoemulsification cataract surgery” shall be the same as the price for “Per-day bed in surgery and burn department” of type 3 respectively according to the hospital rank of the Appendix II issued together with this Circular.

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1. Medical technical services shall be priced in the following order:

a) Specific services of which prices have been prescribed in Appendices to this Circular shall be priced in accordance with regulations in force.

b) Medical technical services of which prices have not been regulated in Appendices to this Circular, but which are ranked equal in terms of technical contents and costs, may apply the prices of services ranked equal by the Ministry of Health in terms of technical contents and costs.

c) If there is any overlap between different departments, medical technical services performed at a department shall apply the prices of services rendered at that department.

3. If multiple medical actions are taken in the same surgery, fees for such actions shall be paid at the price of the most complicated surgery which is highest. Meanwhile, payments for other medical technical services arising outside the aforesaid surgical procedures shall be made as follows:

a) Be equal to 50% of the prices of additional surgeries if these additional surgeries are still performed by the same surgical team;

b) Be equal to 80% of the prices of additional surgeries if these additional surgeries are performed by another substitute surgical team;

c) If additional services are medical procedures, 80% of the prices of these additional services shall be paid.

4. With regard to the service called “Changing a medical bandage or surgical dressing at the length of ≤15 cm”:

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b) That price shall not be applied to bandage change with respect to an endoscopic surgery, change of a common incision dressing, wound bandage or umbilical bandage.

5. The price of the medical service called “Changing a surgical incision dressing at the length ranging from more than 15 cm to 30 cm” for an inpatient shall be applied:

a) In case of infected surgical incision, gastrointestinal, bile duct or urinary tract leak;

b) In case a post-surgery incision is infected (peritoneal membrane infection, bone infection or abscess), an incision is made after a surgery of intestinal tube, genitourinary or abdominal ascite;

c) In case of a surgery making at least two incisions;

d) In case of an obstetric surgery which is performed no more than 03 times.

6. The price of immunocompatibility test performed at temperature of 37ºC with anti-globulin serum (indirect test Coombs) for blood transfusion shall be the same as the price of the medical service called “Immunocompatibility reaction using anti-human globulin serum” numbered 1340 or 1341 in the Appendix III issued together with this Circular.

7. With regard to technical services that belong to the pediatrics department but are provided for adults or technical services provided for pediatric patients whose names are the same as adults’ names without specific prices, the prices of technical services under the Appendix in this Circular and decisions on techniques and costs shall be applied.

Prices of technical services that belong to the pediatrics department but are provided for patients aged 16 or older shall be the same as those specified in regulations of the pediatrics department.

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1. The state budget shall provide allocations under the decentralized authority for:

a) Expenses prescribed in Clause 5 of Article 3 hereof;

b) State budget's allocations for reform of pay policies in accordance with the Government’s applicable regulations on wages and salaries paid to officials, public employees and employees and members of armed forces.

c) In case the funding source of a healthcare establishment does not cover regular costs, it shall be classified by a competent authority as a public service provider covering a part of regular costs on its own or a public service provider of which regular costs are covered by the state.

2. Responsibilities of Ministry of Health:

a) Preside over and cooperate with the Ministry of Finance in unifying prices of medical examination and treatment services covered by health insurance among hospitals of the same class across the country.

b) Agree with the Ministry of Finance to consider and adjust the range of prices of medical examination and treatment services referred to in appendices hereto when supplementing pricing elements according to the roadmap, adjust economic-technical norms or costs of changed pricing elements.

3. Responsibilities of the Departments of Health:

a) Preside over and agree with the Department of Finance on preparing reports for submission to provincial People’s Committees that then present them to provincial People’s Councils for their consideration before issuing the decision on prices of medical examination and treatment services that are not covered by health insurance and not on-demand services, and effecting time with respect to healthcare establishments under local jurisdiction.

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c) Direct healthcare establishments under local jurisdiction to continue to strictly implement regulations on medical practices, and uniformly implement measures to improve service quality.

d) Report to competent authorities to approve the number of beds, decide the number of employees working for healthcare establishments under local jurisdiction in order for these healthcare establishments to have the adequate number of beds and employees to meet demands and improve the quality of medical examination and treatment services provided for the public.

4. Responsibilities of healthcare establishments:

a) Use the amount of funds equal to costs of care and maintenance of equipment, purchase for replacement of tools and instruments of which costs have already constituted the prices of medical examination and per-day bed services (those of special-rank, rank-I and rank-II hospitals equaling 5% of the predetermined price; those of rank-III, rank-IV or unclassified hospitals equaling to 3% of the predetermined price) for repair, upgradation and expansion of medical examination zones and medical treatment departments; costs of purchase for supplementation and replacement of desks, chairs, beds, cabinets, armchairs, air conditioners, fans, warming lamps, warming fans, computer sets, toolkits for medical general or specialized examination; blankets, bed sheets, cushions, foam mattresses and mats,... for satisfaction of medical conditions and requirements concerning patient hygiene, safety and improvement of quality of patient services.

b) Strictly comply with regulations on healthcare practices, especially indications of advising patients to use inpatient treatment services; referrals and indications of use of medical services, medicines and medical supplies in accordance with regulations in force.

Article 9. Implementary provision

1. This Circular comes into force from the date on which it is signed.

2. The following Circulars will cease to be effective from the effective date of this Circular:

a) Circular No. 37/2018/TT-BYT dated November 30, 2018 of the Minister of Health on ceilings of the range of prices of medical services outside of the scope of coverage by the health insurance fund at state-owned healthcare establishments and guidance on pricing and payment of costs of medical services in certain cases

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Article 10. Transition clauses

1. The list of technical services serving medical examination and treatment that are equivalent regarding technical procedures and expenses specified in Decisions of the Minister of Health on issuance of the list of equivalent technical services serving medical examination and treatment according to Circular No. 37/2018/TT-BYT shall continue to be applied.

2. While the competent authorities decide on medical examination and treatment prices specified in this Circular, healthcare establishments shall proceed with the regulated prices until the competent authorities decide on the prices specified in this Circular.

Article 11. Reference provision

In case any legislative documents referred to in this Circular are amended, supplemented, or replaced, the new documents shall prevail.

Any difficulties that arise during the implementation should be reported to the Ministry of Health for consideration and settlement./.

PP. MINISTER
DEPUTY MINISTER




Le Duc Luan

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