The health insurance policy was implemented by the Party and State in 1992. In 2008, the 12th National Assembly approved the Law on Health Insurance.

On June 16, 2009, the Prime Minister issued a Decision to make July 1 the National Health Insurance Day. This is an opportunity to speed up information dissemination and mobilise people to contribute to effectively implementing the Law on Health Insurance with the roadmap of universal health insurance coverage for the health of each citizen, their families and the community, and for the country’s social security.

This is also the opportunity to raise public awareness of the position, role and meaning of the health insurance policy – an important part of the national medical financial policy and one of the measures to mobilise contributions from citizens to support the State in creating a financial source for activities to take care of people’s health.

Vietnam Social Security Director General Nguyen The Manh said health insurance always plays a key role and develops sustainably in the social security system, ensuring people’s health.

Together with the development and improvement of the health insurance policy, the rate of people participating in health insurance keeps increasing year after year, helping to gradually fulfill the target of universal health insurance coverage. The health insurance coverage rate increased from 57 per cent of the population in 2009 to 74.7 per cent in 2015 and 91 per cent in 2021.

Health examination and treatment for health insurance card holders have also been promoted. Each year, more than 100 million health insurance card holders benefit from health examination and treatment. In 2020-2021, the Health Insurance Fund together with the State budget played an important part in helping to deal with the consequences of the COVID-19 pandemic.

The benefits of health insurance participants have been expanded as follows:

Regarding payment from the Health Insurance Fund (for inpatient treatment)

When participating in health insurance, people will be fully funded when paying for costs of medical care covered by health insurance as regulated without any limitations relating to age, the number of treatment days and the total costs of medical examination and treatment covered by health insurance.

The Law on Health Insurance regulates that all people have the right to participate in health insurance and enjoy the same benefits, including costs covered by the health insurance fund such as costs of medical examination and treatment, rehabilitation, regular pregnancy check-ups and birth; and transferal of patients from district-level hospitals to higher-level hospitals for eligible persons as regulated and costs of initial medical care for employees, students, pupils and children under six years old.

The list of medicine paid by the Health Insurance Fund meets the medical examination and treatment demand of health insurance card holders with over 1,000 active pharmaceutical chemicals and biological products and hundreds of traditional medicines and herbal medicines, including drugs treating cancers, rare diseases and hemophilia. Patients are prescribed for long-term use and even life-long treatment if necessary.

 People undergo medical examination and treatment covered by health insurance

Apart from costs relating to medicine, health insurance participants will also have costs relating to technical services (with more than 9,000 services) and medical materials covered, including surgeries with high costs such as robotic surgery, joint replacement surgery and spinal cushion replacement. There are some medical materials paid for by the Health Insurance Fund with a total cost of hundreds of millions of Vietnamese dong.

Regarding costs relating to inpatient beds, the Health Insurance Fund will pay for the costs depending on the type of hospitals and beds that patients use. The fund will pay for average inpatient treatment of six days with the average amount of money paid for beds of VND1.2-1.3 million for each treatment. For special cases, the fund will pay for up to tens of millions of dong for each treatment.

At present, the Health Insurance Fund covers treatment for all critical diseases such as cancer. These groups of diseases require long-term or life-long treatment with huge costs. Many health insurance card holders have been paid hundreds of millions or billions of dong for their medical examination and treatment by the Health Insurance Fund, helping many poor patients to continue their treatment.

Although medicines used to treat critical illness are expensive, worth tens of millions of dong, they are still covered by the Health Insurance Fund. The list of medicine covered by the fund at present basically meets treatment demands for critical diseases.

Health insurance benefit levels (for inpatient treatment)

Health insurance participants will have 100 per cent, 95 per cent or 80 per cent of their medical care costs covered by the health insurance fund depending on different insured persons.

Those patients who are eligible for the payment of 95 per cent or 80 per cent of medical costs will get full payment for their medical costs (within the scope of their benefits) if the patients have paid health insurance premiums for five consecutive years or more and have the costs paid for medical care in the year six times higher than their basic salaries.  

In order to create conditions for health insurance participants to get medical examination and treatment, the law also has the following policies: 

From January 1, 2016, the insured people that register for primary medical care at commune-level health centers, polyclinics or district-level hospitals may receive health insurance-covered medical care at the benefit levels prescribed in Clause 1 of this Article at commune-level health centers, polyclinics or district-level hospitals in the same province.

From January 1, 2021, the health insurance fund shall cover inpatient treatment costs at the benefit levels prescribed in Clause 1 of this Article for the insured who receive medical care at improper provincial-level medical care providers nationwide.

When receiving medical care at hospitals of improper levels, the insured people that are ethnic minority people and members of poor households who are living in areas with difficult or exceptionally difficult socio-economic conditions; and the insured who are living in island communes or districts may be covered by the health insurance fund for medical care costs at district-level hospitals, and for inpatient treatment costs at provincial-level hospitals at the benefit levels as prescribed by the law.

The health insurance card is like a friend for sharing during difficulties and diseases

For a health insurance card holder who receives medical care at a hospital of an improper level, the health insurance benefits shall be paid by the health insurance fund at the following levels:

- At central-level hospitals, 40 per cent of the costs for inpatient treatment;

- At provincial-level hospitals, 100 per cent of the costs for inpatient treatment;

- At district-level hospitals, 100 per cent of the costs for medical care.

It can be seen that participating in the health insurance scheme is considered a form of saving to help ease the economic burden for people in case of illness. Participants can get access to basic medical care without depending on their payment capacity. Therefore, people should be aware of the benefits of participating in health insurance, helping to mitigate financial risks for themselves and their families as well as sharing difficulties with the community if someone gets sick./.