Expanding benefits must go hand in hand with ensuring the balance of the HI Fund

Expenditure on HI-covered medical examination and treatment continues to increase. In 2025, the country recorded approximately 195.1 million visits for MET covered by HI, with total expenditure exceeding VNĐ166 trillion.

During the first nine months of 2026, the number of visits exceeded 147.7 million, while the total expenditure for expenditure reached VNĐ133.418 trillion, up VNĐ13.703 trillion compared with the same period last year.

These figures demonstrate the increasingly important role of HI in sharing the financial burden of healthcare costs. However, the rising number of medical visits and associated expenditure also highlights the need for effective management and use of the fund to ensure its long-term financial balance.

In practice, HI policies already provide mechanisms to help reduce patients' out-of-pocket expenses.

Accordingly, patients who seek medical examination and treatment under regulations and whose expenses for a single visit are lower than 15 % of the base salary are exempt from co-payment. This means the HI Fund covers 100 % of expenses within the scope of benefits. With the base salary set at VNĐ2.53 million/ month from July 1, 2026, this threshold is equivalent to VNĐ 379,500/ medical visit.

In addition, people who have participated in HI for five consecutive years or more and whose annual co-payments exceed six times the base salary (equivalent to VNĐ15.18 million from July 1, 2026) are also entitled to 100 % of expenses within the prescribed scope and coverage rate are paid by the HI Fund.

The HI Fund is financed through contributions from participants, employers, the State budget and other lawful sources, with the aim of ensuring medical examination and treatment benefits for the community. Therefore, any proposal to expand benefits must be comprehensively assessed on scientific grounds and in consideration of the fund's financial capacity, rather than being based solely on an individual case.

For example, if the payment rate for a particular group of medicines is increased, the additional funding required must be clearly calculated. Possible sources include adjusting premium contributions, increasing State budget support, negotiating lower medicine prices or combining several measures. Each option has certain implications for citizens, businesses and the State budget.

Consideration of expanded coverage must also ensure fairness among different groups of patients.

Illustrative image

People with psoriasis have legitimate treatment needs that deserve attention. However, patients with cancer, kidney disease, cardiovascular conditions and other chronic illnesses must also be guaranteed access to essential healthcare services.

Therefore, adding medicines to the coverage list or increasing payment rates for a particular medicine must be based on treatment effectiveness, medical necessity, professional criteria and the impact on the collective interests of all HI participants.

Increasing the payment rate may help reduce the financial burden on a particular group of patients, but it cannot resolve all difficulties without a thorough assessment of available resources and the impact on the entire system. The challenge is to expand benefits appropriately while ensuring fairness and the sustainability of the HI Fund.

Policy assessments must be based on comprehensive evidence

Determining patients' HI entitlements must be based on the scope of coverage, the conditions for MET, and the payment regulations applicable to each expense, including fee for services. Therefore, medical records, lists of covered medicines and relevant regulations must be carefully cross-checked against before concluding that payments for HI Fund are unreasonable. Such conclusions should not be based only on the amount patients have to pay out of pocket.

Comments and assessments of HI policies should be grounded in a proper understanding of benefit entitlements, coverage rates and specific legal provisions. Generalisations based on an unverified case should be avoided, as they may lead to incomplete assessments of the entitlements of tens of millions of HI participants.

HI policies can only maximise sustainable results when the entitlements of the insured are guaranteed in accordance with regulations, the fund is effectively managed and utilised, and proposals to expand the scope of coverage are considered on the basis of scientific evidence, fairness and the financial sustainability of the entire VSS.