Circular No. 10/2009/TT-BYT of August 14, 2009, guiding the registration of primary medical care and transferal of health insurance-covered medical care lines đã được thay thế bởi Circular No. 37/2014/TT-BYT guiding the registration for initial medical care và được áp dụng kể từ ngày 01/01/2015.
Nội dung toàn văn Circular No. 10/2009/TT-BYT of August 14, 2009, guiding the registration of primary medical care and transferal of health insurance-covered medical care lines
THE MINISTRY OF HEALTH | SOCIALIST REPUBLIC OF VIET NAM |
No. 10/2009/TT-BYT | Hanoi, August 14, 2009 |
CIRCULAR
GUIDING THE REGISTRATION OF PRIMARY MEDICAL CARE AND TRANSFERAL OF HEALTH INSURANCE-COVERED MEDICAL CARE LINES
THE MINISTRY OF HEALTH
Pursuant to November 14, 2008 Law No. 25/2008/QH12 on Health Insurance;
Pursuant to the Government's Decree No. 188/2007/ND-CP of December 27, 2007. defining the functions, tasks, powers and organizational structure of the Ministry of Health;
Pursuant to the Government's Decree No. 62/2009/ND-CP of July 27, 2009, detailing and guiding a number of articles of the Law on Health Insurance;
Pursuant to Joint Circular No. 09/2009/TTLT-BYT-BTC of August 14, 2009, of the Ministry of Health and the Ministry of Finance, providing guidance on health insurance;
The Ministry of Health guides the registration of primary medical care and transferal of health insurance-covered medical care lines as follows:
I. ESTABLISHMENTS REGISTERING TO PROVIDE HEALTH INSURANCE-COVERED PRIMARY MEDICAL CARE
Article 1. Commune- and equivalent-level medical care establishments
1. Health stations of communes, wards and townships.
2. Health stations and health sections of agencies, units and schools.
Article 2. District- and equivalent-level medical care establishments
1. District health centers (with the function of providing medical care) and general hospitals of urban districts, rural districts, towns and provincial cities.
2. Health centers having patient beds, infirmaries of provincial-level Police Departments, infirmaries of army units. grade-Ill or -IV or ungraded general hospitals attached to health sections of ministries and branches (including state business groups, enterprises and corporations).
3. Health centers having patient beds. grade-Ill or -IV or ungraded general hospitals attached to specialized medical institutes or schools.
4. Private grade-Ill or -IV or ungraded general hospitals.
5. Regional general clinics attached to district health centers or district hospitals.
6. General clinics attached to agencies, units, schools or health centers of ministries and branches.
7. Private general clinics.
Article 3. Provincial- and equivalent-level medical care establishments
1. General hospitals of provinces and centrally run cities.
2. Regional general hospitals under provincial-level Health Departments.
3. Specialized hospitals under provincial-level Health Departments which have medical examination departments with the function of providing general medical examination.
4. Grade-II general hospitals of specialized medical institutes and schools.
5. Private grade-Il general hospitals.
6. Grade-II general hospitals of ministries and branches.
7. Clinics of officials' health protection and care committees of provinces and cities.
Article 4. Central- and equivalent-level medical care establishments
1. General hospitals under the Ministry of Health.
2. Specialized hospitals under the Ministry of Health which have medical examination departments with the function of providing general medical examination.
3. Grade-I general hospitals of specialized medical institutes and schools.
4. Grade-I general hospitals of ministries and branches.
5. Private grade-I general hospitals.
6. Hint Nghi Hospital. Thong Nhat Hospital and Da Nang Hospital C under the Ministry of Health.
Article 5. Conditions on providers of health insurance-covered primary medical health care
1. Medical care establishments defined in Clause 2, Article 1 of this Circular must satisfy all the conditions of personnel, material foundations and equipment meeting ordinary medical care needs in internal medicine, surgery and first-aid within the prescribed professional scope.
2. Medical care establishments defined in Clauses 6 and 7, Article 2 of this Circular must satisfy all the conditions of personnel, material foundations and equipment meeting ordinary medical care needs in internal medicine, surgery, dermatology and venereology, ophthalmology, otorhinolaryngology. odontology and first-aid.
3. Medical care establishments defined in Clause 3, Article 3 and Clause 2, Article 4 of this Circular must have medical examination departments with the function of providing general medical examination (as prescribed by competent state agencies).
II. HEALTH INSURANCE PARTICIPANTS' REGISTRATION OF PRIMARY MEDICAL CARE
Article 6. Registration of primary medical care at medical care establishments of commune, district and equivalent levels
1. Health insurance participants may register primary medical care at any of medical care establishments defined in Articles 1 and 2 of this Circular.
2. Health insurance participants who have to do mobile jobs or temporarily reside in other localities may receive primary medical care at medical care establishments in these localities which are of technical lines equivalent to medical care establishments indicated in their health insurance cards.
Article 7. Registration of primary medical care at provincial- and central-level medical care establishments
1. Health insurance participants may register health insurance-covered primary medical care at any of medical care establishments defined in Clauses 1 thru 6, Article 3 and Clauses 1 thru 5, Article 4. of this Circular in the following cases:
a/ They permanently reside, temporarily reside for a definite period or work in urban districts, rural districts, towns or provincial cities without medical care establishments defined in Clauses 1 and 2 of this Circular or with such establishments which cannot provide primary medical care to health insurance participants:
b/ They permanently reside, temporarily reside for a definite period or work in urban districts, rural districts, towns or provincial cities with medical care establishments defined in Clauses 1 thru 6, Article 3 and Clauses 1 thru 5, Article 4. of this Circular may register health insurance-covered primary medical care at these establishments under regulations of directors of provincial-level Health Departments.
2. Health insurance participants who are managed and entitled to health protection under Guideline No. 52/HD-BTCTW of December 2. 2005. of the Party Central Committee's Organization Commission, adding medical care recipients to a number of central-level health establishments, may choose to register primary medical care at Huu Nghi Hospital, Thong Nhai Hospital or Da Nang Hospital C.
3. Those who are managed and entitled to officials" health protection by provinces or cities may register primary medical care at clinics of officials' health protection and care committees or general hospitals of these provinces or cities.
4. People with meritorious services to the revolution and people aged 85 years or older may choose to register primary medical care at any of health insurance-covered medical care establishments defined in Clauses 1 thru 6, Article 3 and Clauses 1 thru 5, Article 4. of this Circular.
5. Under-6 children may receive primary medical care at general hospitals or pediatric hospitals of provinces or cities.
III. TRANSFERAL OF HEALTH INSURANCE-COVERED MEDICAL CARE LINES
Article 8. Transferal of health insurance-covered medical care lines
1. Health insurance card holders may be transferred to different medical care lines, depending on the seriousness of their diseases and suitable to the professional scope and classification of technical lines in medical care under the Health Minister's regulations.
2. In case technical services already approved for medical care establishments cannot be provided due to objective causes, these medical care establishments may transfer patients to other health insurance-covered medical care establishments capable of providing such technical services for treatment.
3. In case patients still need further supervision and treatment after emergency and treatment measures have been applied but medical care establishments have insufficient material foundations for providing treatment services (falling into the state of patient overload), these establishments may transfer the patients to other health insurance-covered medical care establishments capable of providing emergency and treatment services to the patients.
4. In case patients who have recovered from illnesses need further treatment after supervision or care emergency and treatment measures have been applied, they shall be transferred back to the health insurance-covered medical establishments which have transferred the patients or to the health insurance-covered primary medical care establishments or other health insurance-covered medical establishments which agree to receive and give treatment to the patients.
5. Cases of line transferal between medical care establishments in adjacent localities shall be decided by directors of provincial-level Health Departments.
Article 9. Line transferal procedures
1. Medical care establishments shall carry out transferal procedures under the Health Minister's regulations.
2. In case of line transferal at the request of patients, medical care establishments which have transferred the patients shall provide the patients with information on benefits and payable health insurance-covered medical care expenses in case medical care is provided not at prescribed technical lines.
IV. IMPLEMENTATION PROVISIONS
Article 10. Responsibilities of provincial-level Health Departments
1. To assume the prime responsibility for. and coordinate with provincial-level Social Insurance agencies in:
a/ Identifying medical care establishments capable of providing health insurance-covered primary medical care as defined in Clause 2, Article 1; Clauses 6 and 7, Article 2: and Clause 3, Article 3. of this Circular:
b/ Making lists of medical care establishments capable of providing health insurance-covered primary medical care in provinces and cities as a basis for provincial-level Social Insurance agencies to sign health insurance-covered primary medical care contracts;
c/ Prescribing the transferal of health insurance-covered medical care lines for medical care establishments within provinces and cities:
d/ Reaching agreement on and providing for line transferal for a number of medical care establishments in adjacent localities within provinces and between provinces, ensuring suitability with technical lines, capability of medical care establishments, convenience for patients, and compliance with provincial-level Social Insurance agencies' payment of medical care expenses.
2. To direct medical care establishments in providing medical care to health insurance participants under current regulations and regulations on transferal of technical lines between medical care establishments in provinces and cities for health insurance-covered patients.
3. Based on local practical conditions and capability of medical care establishments, provincial-level Health Departments shall assume the prime responsibility for. and coordinate with provincial-level Social Insurance agencies in. providing for health insurance participants and the number of these participants who may register health insurance-covered primary medical care under Point b. Clause 1, Article 7 of this Circular in order to ensure the quality of medical care and avoid patient overload.
Article 11. Responsibilities of health sections of ministries and branches
1. The Military Health Department of the Ministry of National Defense and the Health Department of the Ministry of Public Security shall direct their attached medical care establishments capable of providing health insurance-covered primary medical care to register with provincial-level Health Departments.
2. Health sections of other ministries and branches shall:
a/ Direct their attached medical care establishments in provinces and cities, based on their assigned tasks and professional capability, to register with provincial-level Health Departments in order to be recognized to be capable of providing health insurance-covered primary medical care;
b/ Coordinate with provincial-level Health Departments and Social Insurance agencies in guiding the registration of health insurance-covered primary medical care, and provide health insurance-covered medical care under regulations.
Article 12. Responsibilities of provincial-level Social Insurance agencies
1. To sign health insurance-covered medical care contracts with medical care establishments capable of providing health insurance-covered primary medical care which are on the lists approved by provincial-level Health Departments.
2. To guide health insurance participants in registering primary medical care at or changing medical care establishments in provinces and cities, ensuring that the number of health insurance participants registering medical care at each medical care establishment suits the capability of that establishment.
Article 13. Transitional provisions
1. To create favorable conditions for health insurance participants and reduce expenses for renewing health insurance cards, health insurance participants who had registered primary medical care at health establishments indicated in their cards before the effective date of this Circular may continue to receive primary medical care at these establishments till the expiry date indicated in the cards.
2. Persons who participate in health insurance or have their health insurance cards renewed on or after October I, 2009, shall comply with the guidance in this Circular.
Article 14. Effect
This Circular takes effect on October 1, 2009.
Any problems arising in the course of implementation should be reported to the Ministry of Health for consideration and settlement.-
| FOR THE MINISTER OF HEALTH |
