Thông tư liên tịch 37/2015/TTLT-BYT-BTC

JOINT CIRCULAR

UNIFYING PRICES FOR MEDICAL EXAMINATION AND TREATMENT SERVICES COVERED BY MEDICAL INSURANCE AMONG HOSPITALS OF THE SAME LEVEL ACROSS THE COUNTRY

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 on amendments to a number of the Law on Medical Insurance dated June 13, 2014;

Pursuant to the Government’s Decree No. 85/2012/ND-CP dated October 15, 2012 on operational and financial regimes applicable to non-business medical providers and fees for medical examination and treatment services by public medical examination and treatment facilities;

Pursuant to the Government’s Decree No. 16/2015/ND-CP dated February 14, 2015 providing for autonomy mechanism of public service providers;

Pursuant to the Government's Decree No. 63/2012/ND-CP dated August 31, 2012 defining the functions, tasks, powers and organizational structure of the Ministry of Health;

Pursuant to the Government's Decree No. 215/2013/ND-CP dated December 23, 2013 defining the functions, tasks, entitlements and organizational structure of the Ministry of Finance;

The Minister of Health and the Minister of Finance promulgate the joint circular unifying prices for medical examination and treatment services covered by medical insurance among hospitals of the same level across the country.

Article 1. Governing scope

1. This joint circular provides for prices for medical examination and treatment services (herein ‘medical services’) covered by medical insurance among hospitals of the same level across the country.

2. Price frame and authority to stipulate prices for medical services not covered by medical insurance fund shall be instructed in the Law on Prices, the Law on Medical examination and treatment and relevant written instructions.

Article 2. Regulated entities

Medical facilities, units, organizations and individuals that engage in medical examination and treatment, payment, financial settlement of prices for medical services covered by medical insurance.

Article 3. Prices for medical services covered by medical insurance

1. Prices for medical services include:

a) Prices for medical examination as prescribed in Annex I enclosed herewith;

b) Prices for in-patient services as prescribed in Annex II enclosed herewith;

c) Prices for technical services as prescribed in Annex III enclosed herewith;

2. Prices for medical services as prescribed in Clause 1, this Article include:

a) Direct expenses:

- Expenses for medicine, intravenous fluids, chemicals, consumable materials, substitute items;

Medicine, blood, intravenous fluids, chemicals, consumable materials, substitute items that are not included in prices for medical services as prescribed in Annex III enclosed herewith shall be paid for on the basis of actual quantity used on patients, prices, scope and benefits as prescribed.

- Expenses for electricity, water, fuel, waste treatment and environmental hygiene;

- Expenses for maintenance and care of equipment, purchase of instruments, tools for replacement;

b) Permanent allowances, allowances for surgeries, maneuvers (hereinafter referred to as ‘peculiar allowances’) as prescribed in the Prime Minister’s Decree No. 73/2011/QD-TTg dated December 28, 2011 providing for peculiar allowances for officials and civil servants, employees in public medical facilities and allowances for epidemic fighting;

c) Salaries, allowances, contributions as prescribed in respect of public service providers except for expenses as prescribed in Clause 3, this Article

3. Prices for medical services as prescribed in Clause 1, this Article shall not include expenses covered by state budget as prescribed in following documents:

a) Governmental Decree No. 64/2009/ND-CP dated July 30, 2009 providing for policies on medical staff working in the areas facing socio-economic difficulties;

b) Governmental Decree No. 116/2010/ND-CP dated December 24, 2010 providing for policies on officials, civil servants and paid armed force staff working in the areas facing socio-economic difficulties;

c) Governmental Decree No. 46/2009/QD-TTg dated March 31, 2009 on peculiar allowances for officials, civil servants working in Friendship Hospital, Unified Hospital, C Hospital, Central Health Protection Divisions 1, 2, 2B, 3 and 5, Department A11 of 108 Hospital and Department A11 of Military Institute of Traditional Medicine (herein ‘Decision No. 46/2009/QD-TTg) and the Prime Minister’ Decision No. 20/2015/QD-TTg dated June 18, 2015 on amendments and supplements to a number of articles of Decision No. 46/2009/QD-TTg;

d) Point a, Clause 3, Article 6 of Governmental Decree No. 204/2004/ND-CP dated December 14, 2004 on salaries paid to cadres, civil servants, officials, and armed force personnel and Governmental decree No. 76/2009/ND-CP dated September 15, 2009 on amendments and supplements to a number of articles of Decree No. 204/2004/ND-CP;

4. Expenses as prescribed in Clause 2, this Article shall be defined on the basis of limits prescribed by the Ministry of Health.

5. Prices for medical services as prescribed in annexes enclosed herewith shall be reviewed and adjusted by the Ministry of Health and the Ministry of Finance as price components change.

Article 4. Application of prices for medical services covered by medical insurance in some cases

1. For medical services the prices for which are not stipulated hereof, apply the prices for medical services ranked as equivalent in technique and implementation cost by the Ministry of Health.

2. For surgeries, maneuvers not ranked by the Ministry of Health and the prices for which are not stipulated hereof, apply the prices for each surgery, maneuver in section “other surgeries, maneuvers” of each specialty as prescribed in Annex III enclosed herewith.

3. New technical services as prescribed in Clauses 1, 2, Article 69 of the Law on Medical examination and treatment and other remaining technical services for which the prices are not stipulated hereof, apply the prices stipulated by the Ministry of Health after the Ministry of Finance’s approval.  Sequence, time limit for making decision on prices and documentation of pricing plan shall be instructed in the Laws on Prices.

4. For institutes with patient beds, medical centers of provincial level providing medical services; graded medical centers of rural district level providing preventive healthcare and medical services, apply the prices by hospitals of similar level;

5. For institutes with patient beds, army medical infirmaries, ungraded medical treatment groups, polyclinics, maternity wards, family clinics, traditional medicine treatment clinics, medical centers of rural district level that are separated from hospitals yet provide medical services, medical stations of communes, wards and towns, medical clinics of agencies, units, organizations and schools, army medical clinics, civil-military medical clinics, infirmaries, ungraded hospitals and other medical facilities, apply the prices issued by hospitals of IV level as prescribed in annexes enclosed herewith;

6. Private medical clinics:

a) For medical treatment services, in-patient services, medical insurance providers shall agree with private medical clinics on application of the prices issued by any of graded hospitals as prescribed in Annexes I and II enclosed herewith;

b) For medical services outside Point a, this Clause, medical insurance providers shall agree with private medical clinics on application of the prices as prescribed in Annexes III enclosed herewith;

Article 5. Implementation roadmap

1. The prices including direct expenses and peculiar allowances shall take effect since March 01, 2016.

2. The prices including direct expenses, peculiar allowances and pays shall take effect since July 01, 2016. Timing of implementation by units, localities shall be reviewed and decided by the Ministry of Health.

3. Medical facilities classified by competent agencies as the units that cover their regular expenses and expenses for investment may apply the prices including direct expenses, peculiar allowances and pays since March 01, 2016.

Article 6. Responsibility for implementation

1. The Ministry of Health shall be responsible for stipulating the lists of medical services equivalent in technique and implementation cost as foundations for application of the prices as prescribed in Clause 1, Article 4 hereof.

2. The Ministry of Health shall preside over and cooperate with the Ministry of Finance, Vietnam Social Security in organizing implementation and inspection and monitoring the implementation of this joint circular.

3. The Ministry of Finance shall cooperate with the Ministry of Health, Vietnam Social Security in organizing inspection and monitoring the implementation of this joint circular.

4. Vietnam Social Security shall direct local social security authorities, social security authorities of the Ministry of National Defense, social security authorities of People’s Public Security of Vietnam in carrying out payment of expenses for medical services covered by medical insurance as prescribed hereof; cooperate with the Ministry of Health and the Ministry of Finance in inspecting and monitoring the implementation of this joint circular.

5. The state budget shall assure expenses under benefit policies as prescribed in the documents specified in Clause 3, Article 3 hereof.

6. Public medical facilities' receipts earned from medical services covered by medical insurance shall be used by the facilities themselves as prescribed.

Article 7. Terms of reference

Any amendment or supplement that has been made to documents referred to in this joint circular shall prevail over previous amendments or supplements made thereto.

Article 8. Implementary provisions

This joint circular takes effect since March 01, 2016

Article 9. Transitional provisions

For patients receiving medical services starting before and ending after the effective date of this joint circular, apply prices for medical services covered by medical insurance as prescribed by competent authorities at the time preceding the effective date of the prices as prescribed in Article 5 hereof until discharge from the hospital or end of outpatient treatment.

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