Chương VII Nghị định 96/2023/NĐ-CP: Điều kiện bảo đảm cho hoạt động khám bệnh, chữa bệnh

Chapter VII

PRECONDITIONS FOR HEALTHCARE OPERATIONS

Section 1. FUNDING FOR TRAINING, SCHOLARSHIPS AND LIVING EXPENSES

Article 113. Policies for grating support and scholarships to students majoring in psychiatry, anatomic pathology, forensic medicine, forensic psychiatry, infectious diseases or resuscitation in emergency care medicine

1. Eligible students:

a) Tuitions and living expenses of students who are attending postgraduate courses for master’s degree, doctorate degree, level-I or level-II specialty qualification, and specialty resident physicians majoring in psychiatry, anatomic pathology, forensic medicine, forensic psychiatry, infectious diseases or resuscitation in emergency care medicine (hereinafter referred to as “students”) at health training institutions shall be funded by the State;

b) Students at public health training institutions who are displaying good learning and training results, or better, and are not disciplined by reprimand or any severer form during the scholarship awarding period shall be eligible to incentive scholarships granted by the State.

Incentive scholarships granted to students of private health training institutions shall comply with regulations of law in force;

c) Students who are working for health facilities located in poor or extremely poor local areas shall be eligible to social service grants offered by the State;

d) The State solicits organizations and individuals to offer grants or scholarships or financial aid to students.

2. Procedures for considering and awarding scholarships; principles for supporting and awarding scholarships shall comply with regulations of law in force.

3. Rates of support and scholarships:

a) Support for tuitions:

- Financial support for tuitions shall be granted in accordance with the Government’s Decree No. 81/2021/ND-CP dated August 27, 2021 prescribing collection and management of tuitions by training institutions included in the national educational network and policies for tuition exemption and reduction, and funding for learning expenses, and service prices in education and training sector (hereinafter referred to as “Decree No. 81/2021/ND-CP”);

- Students of a private health training institution shall pay the difference between the tuition actually collected by that private health training institution and support amount granted by the State.

b) Financial support for living expenses shall be granted in accordance with the Government’s Decree No. 116/2020/ND-CP dated September 25, 2020 introducing policies for granting financial support for tuitions and living expenses of pedagogy students (hereinafter referred to as “Decree No. 116/2020/ND-CP”).

c) Values of incentive scholarships shall comply with the provisions of the Government’s Decree No. 84/2020/ND-CP dated July 17, 2020 elaborating the Law on Higher Education (hereinafter referred to as “Decree No. 84/2020/ND-CP”).

d) Values of social service scholarships:

- For students who are working for health facilities located in poor local areas: the scholarship shall equal 80% of the statutory pay rate per month;

- For students who are working for health facilities located in extremely poor local areas: the scholarship shall equal 100% of the statutory pay rate per month.

4. Funding sources, preparation of cost estimates, allocation of funding for granting financial support and scholarships, management, use and statement of funding, reimbursement of funding, procedures for application for financial support for tuitions, living expenses and scholarships shall comply with provisions of the Decree No. 84/2020/ND-CP, Decree No. 116/2020/ND-CP, and Decree No. 81/2021/ND-CP.

Article 114. Determination of training, task assignment, order placement or bidding demands

1. Every year, each provincial People's Committee shall review the calculation and determination of demands for recruitment and training of postgraduate students for master’s degree, doctorate degree, and specialty qualifications in psychiatry, anatomic pathology, forensic medicine, forensic psychiatry, infectious diseases or resuscitation in emergency care medicine for the enrolment year, and send review results to licensed training institutions by January 31 every year, and also publish the same on mass media.

2. Based on the enrolment target determined annually as prescribed, training institutions shall publicly inform such enrolment target to local areas, organizations and individuals in need of training teachers, and publish the same on the web portal of the Ministry of Education and Training of Vietnam and websites of teacher training institutions.

3. Based on the annually determined enrolment target of training institutions and local training demands, the authority in need of task assignment, order placement or bidding shall decide to assign tasks, place order or conduct bidding for training in one of the following forms:

a) Assign tasks of postgraduate training for master’s degree, doctorate degree, and specialty qualifications in psychiatry, anatomic pathology, forensic medicine, forensic psychiatry, infectious diseases or resuscitation in emergency care medicine to its affiliated training institutions;

b) Place orders for postgraduate training for master’s degree, doctorate degree, and specialty qualifications in psychiatry, anatomic pathology, forensic medicine, forensic psychiatry, infectious diseases or resuscitation in emergency care medicine to licensed training institutions;

c) Organize bidding for selecting qualified training institutions to provide postgraduate training for master’s degree, doctorate degree, and specialty qualifications in psychiatry, anatomic pathology, forensic medicine, forensic psychiatry, infectious diseases or resuscitation in emergency care medicine.

4. Task assignment decisions or training contracts between authorities that assign tasks, place orders or conduct bidding and training institutions must be established or made on the basis of annual demands and plan for postgraduate training in psychiatry, anatomic pathology, forensic medicine, forensic psychiatry, infectious diseases or resuscitation in emergency care medicine, and in conformity with the educational development plan, and local annual and long-term health personnel training plans.

5. Task assignment, order placement or bidding for postgraduate training for master’s degree, doctorate degree, and specialty qualifications in psychiatry, anatomic pathology, forensic medicine, forensic psychiatry, infectious diseases or resuscitation in emergency care medicine shall comply with provisions of the Government’s Decree No. 32/2019/ND-CP dated April 10, 2019 prescribing task assignment, order placement or bidding for provision of public services and products funded by state budget-derived funding for covering recurrent expenditures.

Section 2. WAYS TO CALL FOR SOCIAL INVESTMENTS IN HEALTHCARE

Article 115. Borrowing funds for investment in infrastructure and medical devices

1. Health facilities that are classified as group-1, 2 or 3 units according to regulations on financial autonomy of public administrative units may borrow funds for making investments in infrastructure and medical devices which are used to serve their operations.

2. Health facilities shall submit reports to get opinions from their supervisory authorities on borrowing funds for making investments. Where management board, school board or university board is available, reports shall be submitted to these boards for getting their opinions on borrowing funds for making investments. A report submitted to a supervisory authority shall, inter alia, include:

a) Necessity;

b) Objectives;

c) Scale and location of the project funded by borrowed funds;

d) Form of operation;

dd) Personnel plan for performing activities using medical devices or facilities invested using borrowed funds;

e) Project duration: investment and construction duration, and operating duration of the project;

g) Feasibility of the borrowing plan;

h) Socio-economic effectiveness of the project.

3. Borrowing procedures shall be followed in accordance with regulations of law on credit institutions and relevant documents.

4. Assets established from borrowed funds may be provided as collateral in accordance with provisions of the Civil Code and relevant laws.

5. Use of borrowed funds for making investments in accordance with relevant laws.

Article 116. Private sector involvement in healthcare

1. Public health facilities may lease or let out assets that are infrastructure facilities or medical devices to serve professional activities within the ambit of their assigned functions and tasks or to provide on-demand healthcare services. Leasing or letting out assets shall comply with regulations of law on management and use of public property; selection of lessees and lessors shall comply with regulations of law on bidding. Lease period shall not be longer than the depreciation period of assets as prescribed by law or shall not be longer than the life cycle of assets.

2. Leasing or letting out clinical services, sub-clinical services, non-medical services, pharmacy services or hospital management and operation services shall comply with provisions of the law on bidding and the law on management and use of public property.

Article 117. Buying under deferred or installment payment terms, and borrowing medical devices

1. Buying under deferred or installment payment terms:

a) Public health facilities shall, based on standards and norms on medical devices and their funding sources, decide to buy medical devices under deferred or installment payment terms;

b) Purchase of medical devices shall comply with regulations of the law on bidding, in which the payment method that is deferred or installment payment must be specified in bidding documents for purchase of medical devices.

2. Borrowing medical devices shall comply with regulations of the Civil Code.

3. Costs of use of medical devices in the forms specified in clauses 1 and 2 of this Article for providing healthcare services may be included in costs of healthcare services to be paid by patients or the health insurance fund in accordance with regulations of law on health insurance.

Article 118. Grants or aid from domestic and foreign organizations and individuals

1. Health facilities may receive financial aid, technical assistance and in-kind aid from international authorities and organizations and foreigners to serve their provision of healthcare services in accordance with regulations of law on management and use of official development assistance (ODA) and concessional loans from foreign sponsors, non-refundable aid which is not considered as ODA granted by foreign authorities, organizations and individuals to Vietnam.

2. Health facilities may receive grants or donations in cash, assets, materials and in kind from domestic and foreign authorities, organizations and individuals to service their provision of healthcare services in accordance with regulations of the law on anti-corruption, the law on management and use of public property and relevant laws.

3. Health facilities are allowed to receive grants, aid and support in property from domestic and foreign organizations and individuals to serve their epidemic prevention and control regardless of standards and norms for use of property. After announcing the end of the epidemic, such property shall be handled in accordance with regulations of law on management and use of public property.

4. Assets, materials and goods (hereinafter referred to as “assets”) which are received as grants but for which procedures for establishing all-people ownership are yet to be completed shall be used for provision of healthcare services. Costs of healthcare services provided with use of these assets shall be paid by patients or the health insurance fund in accordance with regulations of law on health insurance. Health facilities shall assume responsibility for quality of their healthcare services provided with use of these assets and may use their own funding for maintaining and repairing these assets during their use.

Section 3. Prices of healthcare services and funding for other activities in healthcare sector

Article 119. Prices of healthcare services

1. Price of healthcare services means total amount payable for each healthcare services, including:

a) Price of medical examination;

b) Price of hospital bed per day;

c) Price of technical service in healthcare. In case a patient needs to use drugs, medical devices, whole blood and blood products meeting the required standards when performing technical services, reasonable and legitimate expenses related to the performance of technical services (if any) shall be paid by the patient and the social insurance agency as prescribed.

2. Prices of healthcare services classified by service users include:

a) Prices of healthcare services paid by the health insurance fund;

b) Prices of healthcare services paid by state budget;

c) Prices of healthcare services which are not included in list of healthcare services covered by the health insurance fund and are not on-demand healthcare services;

d) Prices of on-demand healthcare services.

3. Total prices of healthcare services shall be composed of the factors specified in clause 2 Article 110 of the Law on Medical Examination and Treatment. To be specific:

a) Personnel costs:

- Personnel costs included in prices of healthcare services paid by the health insurance fund, prices of healthcare services paid by state budget, and prices of healthcare services which are not included in list of healthcare services covered by the health insurance fund and are not on-demand healthcare services include: salaries, wages, allowances and compulsory contributions of public employees, workers and outsourced personnel (if any), including direct and indirect personnel; specific costs which shall not exceed 50% of salaries and salary-based allowances to be paid to experts and outstanding physicians working at health facilities;

- Personnel costs included in prices of on-demand healthcare services shall equal wages paid to employees/ workers. The head of the health facility shall decide specific wages paid for specific tasks according to its internal spending regulations or collective bargaining agreement or adopting comparison method.

b) Direct costs:

Expenses incurred during the provision of healthcare services and those incurred by departments/wards providing such healthcare services may be considered as direct costs (except depreciation costs and personnel costs), including:

- Costs of drugs, chemicals, blood, blood products, and costs of raw materials, supplies, tools, instruments directly used (including costs of maintenance and losses thereof) for performing technical services;

- Costs of fuels and energy used, including electricity, water, fuels, waste treatment, environmental sanitation, and infection control;

- Other direct costs, including: costs of maintenance, repair, inspection and calibration of medical devices; costs of maintenance and repair of fixed assets; costs of replacement of tools, instruments and equipment directly used for performing technical services; costs of application or leasing of IT services; and other direct costs.

c) Depreciation costs of medical devices and fixed assets as prescribed. Only medical devices qualified as fixed assets may be depreciated.

d) General and administrative costs are those costs of indirect management units serving the provision of healthcare services and costs of general activities of a health facility, including:

- Costs of maintenance and repair of medical devices and fixed assets; costs of inspection and calibration of assets, purchase of devices, tools, instruments, materials, supplies and office stationery serving operation of management departments, indirect and general activities of the health facility;

- Costs of environmental protection, infection control, quality control; costs of uniforms, clothing, labor protective equipment, assurance of occupational safety and health, protection of workers’ health, prevention of HIV infection, and vaccination for officials, public employees and workers;

- Costs of training, scientific research; receipt of transfer of techniques, training for improvement of professional capacity;

- Costs of electricity, water and fuels; costs of telecommunication and postal services; costs of application or leasing of IT services or leasing of management services or software programs; assurance of security and safety of patients; hygiene, environmental protection and waste treatment; other costs of leasing and purchasing serving the provision of healthcare services;

- Costs of hiring interpreters and translators; costs of purchasing, printing and photocopying of documents and publications used in professional activities; costs of mass media and promotion of the health facility’s image and brand as prescribed;

- Fees, charges and taxes (including land use levies), costs of renting land used in business and service provision (if any); liability insurance in medical examination and treatment, asset insurance costs; costs of fire prevention and fighting; costs of quality management; costs of storage, loss and destruction of drugs and materials; risk prevention costs; costs associated with liquidation or disposal of assets as prescribed;

- Loan interests (if any) and other management expenses.

4. Prices of healthcare services exclude specific allowances, including allowances for health workers funded by state budget as prescribed by law.

5. Methods for pricing of healthcare services shall comply with regulations of the Ministry of Health of Vietnam. If cost method is employed, costs composing the price of a healthcare service shall be determined on the basis of technical-economic norms (if any), and appropriate costs of medical examination and treatment activities.

6. Pricing of healthcare services shall be based on the grounds specified in clause 4 Article 110 of the Law on Medical Examination and Treatment:

a) Prices of on-demand healthcare services shall include adequate cost factors specified in clause 3 of this Article;

b) Prices of healthcare services paid by the health insurance fund; prices of healthcare services paid by state budget; prices of healthcare services which are not included in the list of healthcare services covered by the health insurance fund and are not on-demand healthcare services: The Ministry of Health of Vietnam shall play the leading role and cooperate with the Ministry of Finance of Vietnam and the Ministry of Planning and Investment of Vietnam in requesting competent authorities to make consideration and decision.

7. Payment of healthcare costs:

a) Detailed declaration of cost factors included in prices of healthcare services is not required;

b) Technical economic norms and cost rates used in the compilation of prices of healthcare services shall not be used as the basis for making payment for each specific healthcare service;

c) Payment for on-demand healthcare services: The health insurance fund shall be liable for costs of healthcare services within the coverage scope (if any) as prescribed by the law on health insurance. Patients shall pay the difference between costs of on-demand healthcare services and amounts covered by the health insurance fund to health facilities.

8. Private health facilities that provide healthcare services covered by the health insurance fund shall be eligible to payment of costs of healthcare services according to the prices of healthcare services included in the list of healthcare services covered by the health insurance fund to be applied in local public health facilities with approval of provincial People’s Councils. Patients shall pay the difference between the cost of healthcare service charged by the private health facility and the price of that healthcare service specified in the list of healthcare services covered by the health insurance fund.

9. Provincial People’s Councils shall set specific prices of healthcare services as prescribed in clause 6 Article 110 of the Law on Medical Examination and Treatment and prices of the following healthcare services:

a) Services which are provided by public health facilities located within the areas under their authority and whose prices are yet to be set by the Ministry of Health of Vietnam;

b) Services which are not provided by health facilities affiliated to the Ministry of Health or other ministries but are provided by local health facilities.

Article 120. Funding for out-of-hospital emergency care

1. The funding for out-of-hospital emergency care is subject to the following provisions:

a) State budget's funding shall be provided for making investment in constructing facilities and equipment of the state-owned out-of-hospital emergency care facilities, and the system of receiving information and coordinating emergency services provided by these facilities in accordance with provisions of the Law on Public Investment;

b) State budget's funding shall be provided for paying costs of ambulance rides and charges for medical crew services on emergency ambulances in case of accidents, natural disasters, calamities or group-A infectious diseases according to service prices set by competent authorities;

c) State budget's funding for paying general and administrative expenses for management and operation of state-owned out-of-hospital emergency facilities shall be allocated in accordance with the Government’s regulations on financial sources of public administrative units.

2. Provincial People’s Committees shall:

a) organize the system of state-owned out-of-hospital emergency care facilities in local areas falling within their remit, and the system of receiving information and coordinating emergency services provided by these facilities in a manner that is suitable for the organizational model of these service providers in local areas;

b) allocate funding according to applicable regulations on hierarchical management of state budget for implementing the provisions in clause 1 of this Article;

c) mobilize social resources and adopt measures for encouraging organizations and individuals to make investment in or establish out-of-hospital emergency care facilities.

3. Preparation, allocation and implementation of estimates of costs covered by state budget’s funding, and statement thereof shall comply with regulations of the Law on public investment, the Law on state budget, the Law on accounting and their guiding documents.

Article 121. Costs of care, nursing, medical examination and treatment for patients without families in health facilities

1. Regimes for medical examination and treatment, care and nursing services provided for patients without families include:

a) Costs of healthcare services: comply with regulations on prices of healthcare services provided by health facilities promulgated by competent authorities;

b) The monthly nursing cost of each patient during his/her treatment at the health facility shall equal the rate prescribed in clause 1 Article 25 of the Government’s Decree No. 20/2021/ND-CP dated March 15, 2021 introducing social assistance policies for social protection beneficiaries (hereinafter referred to as “Decree No. 20/2021/ND-CP”);

c) Patients without families will be provided with tools and instruments serving their daily life such as blankets, curtains, sleeping mats, summer and winter clothes, underwear, sandals, toothbrush, monthly hygiene products for females and other costs as prescribed;

d) Costs of transfer of patients from health facilities to social assistance centers. Costs of patient transfer shall be determined according to costs of fuels actually consumed by vehicles used for transferring patients.

2. Funding shall be provided in the following order:

a) The health insurance fund shall cover costs of healthcare services within the maximum coverage percentages in accordance with regulations of the Law on health insurance, if patients hold valid health insurance cards;

b) Medical support funds as prescribed in clause 2 Article 111 of the Law on Medical Examination and Treatment;

c) Grants, mobilized funding and other lawful funding sources;

d) Funding derived from state budget according to regulations on hierarchical management of state budget.

3. Cost estimation and method for payment of state budget’s funding:

Preparation, allocation and implementation of estimates of costs covered by state budget’s funding, and statement thereof shall comply with regulations of the Law on state budget, relevant laws and the following provisions:

a) For public health facilities:

- Every year, at the time of preparation of the state budget estimates, public health facilities shall make consolidated reports on their funding used for making payment of costs prescribed in clause 1 of this Article in the previous year, after deducting funding sources mentioned in points a, b, c clause 2 of this Article, and send them to their supervisory authorities;

- These supervisory authorities shall consider and aggregate such payments in their annual state budget estimates which shall be sent to finance authorities of the same level for consolidation and submission to competent authorities for making reimbursement to health facilities;

- Based on state budget estimates allocated to make reimbursement, public health facilities shall withdraw estimated funding at state treasuries for transferring to their deposit accounts on public service charges opened at state treasuries.

b) For private health facilities:

- Private health facilities that provide care, nursing, medical examination and treatment services for patients without families shall send written request to health authorities affiliated to provincial People’s Committees for reimbursement of funding used for making payments as prescribed in clause 1 of this Article in the previous year, after deducting funding sources in points a, b, c clause 2 of this Article;

- Health authorities affiliated to provincial People’s Committees shall prepare consolidated reports on funding used for making prescribed payments of private health facilities within their management, and send them to finance authorities. Finance authorities shall consider and request provincial People’s Committees to make consideration as prescribed.

c) Health facilities shall assume responsibility for the accuracy of the funding amount allocated by state budget at their request, management, use and statement thereof in accordance with regulations of law.

Article 122. Costs of burial services for death cases specified in point b clause 1, point b clause 2 Article 73 of Law on Medical Examination and Treatment and clause 2 Article 95 of this Decree

1. Costs of burial services incurred by authorities, organizations and individuals providing burial services for the death cases specified in point b clause 1, point b clause 2 Article 73 of the Law on Medical Examination and Treatment and clause 2 Article 95 of this Decree may be reimbursed at the rates prescribed in clause 3 Article 25 of the Decree No. 20/2021/ND-CP.

2. Costs of burial services specified in clause 1 of this Article and costs of embalming or hired embalming services pending actions in point b clause 1 or point b clause 2 Article 73 of the Law on Medical Examination and Treatment and clause 2 Article 95 of this Decree shall be covered by local government budget.

Section 4. PROFESSIONAL LIABILITY INSURANCE IN HEALTHCARE

Article 123. Principles for professional liability insurance in healthcare

1. Professional liability insurance in healthcare is a type of insurance used to pay indemnities for damage caused by medical accidents occurring during the course of delivery of healthcare within the insurance policy period, and legal costs related to these medical accidents, except as specified in point d clause 2 Article 100 of the Law on Medical Examination and Treatment.

2. Insurers or branches of foreign non-life insurers and health facilities may proactively reach agreements on insurance conditions, limit on insurance liability, and premiums on the basis of assessment of risks to health facilities and relevant factors as prescribed by law.

Article 124. Funding for purchasing professional liability insurance in healthcare

1. Private health facilities shall use their own funding for purchasing professional liability insurance in healthcare.

2. For public health facilities: funding for purchasing professional liability insurance in healthcare is derived from financial sources of public administrative units according to the Government’s regulations on financial autonomy of public administrative units.