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Improving the Institutional Framework to Establish a Legal Foundation for Universal HI

In recent years, Viet Nam’s HI policy framework has continued to be refined toward expanding coverage, enhancing participants’ benefits, and strengthening the sustainability of the HI fund. The promulgation by the National Assembly of Law No. 51/2024/QH15 amending and supplementing a number of articles of the HI Law has provided an important legal basis for further adjusting contribution mechanisms, benefit entitlements, and medical cost reimbursement, while also improving regulations related to fund management and the responsibilities of stakeholders involved in policy implementation.

One notable amendment is the introduction of the concept of a “reference level” as a basis for determining contribution rates and benefit levels for certain beneficiary groups. This addition helps improve policy flexibility, making implementation more responsive to socio-economic conditions in different periods, while also facilitating broader HI coverage across society.

In addition, a number of new provisions concerning referral procedures for medical examination and treatment, expanded reimbursement coverage, and adjusted benefit levels for specific groups continue to reflect a policy orientation focused on safeguarding participants’ rights. These measures constitute an important foundation for strengthening public confidence and maintaining sustainable participation rates.

Enhancing the Effectiveness of State Management to Ensure Synchronized and Efficient Implementation

Alongside institutional improvement, state management capacity in HI needs to be further strengthened in a coordinated and consistent manner from the central to local levels. Priority should be given to improving forecasting quality and developing participation plans that are aligned with population characteristics, labor structures, and economic conditions in each locality.

Assigning HI coverage targets to each level of local government should be accompanied by clearly defined responsibilities for management agencies, while the implementation results of universal HI should become one of the criteria for evaluating local social governance performance. In practice, many localities have incorporated HI development targets into their annual socio-economic development plans, thereby enhancing initiative in policy implementation.

At the same time, stronger inspection and supervision of HI policy implementation at medical facilities are becoming increasingly important. As the number of insured medical visits continues to rise, tighter control over expenditures, prevention of fund abuse, and compliance with reimbursement regulations are required. Coordination mechanisms among Viet Nam Social Security, the Ministry of Health, and local authorities play a crucial role in ensuring effective management and policy enforcement.

Innovating Implementation Methods Toward a Modern and Sustainable HI System

One of the current key requirements is to continue innovating HI policy implementation methods in a modern, transparent, and citizen-friendly direction. The application of digital technology in managing participant data, assessing medical treatment costs, and integrating electronic health records is gradually bringing about clear improvements in HI fund governance.

An interconnected electronic data system between social insurance agencies and healthcare facilities needs to be further improved to enhance transparency in the prescription of technical services, the use of medicines and medical supplies, and reimbursement procedures for medical treatment costs. Digital transformation not only improves fund governance efficiency but also helps reduce administrative procedures and shorten the time required for benefit processing.

In addition, improving the quality of HI-covered medical services is an important factor in strengthening public trust in the policy. When HI benefits are closely associated with actual service quality, the likelihood of sustained participation increases significantly.

In the long term, the goal of universal HI extends beyond expanding coverage rates; it also requires building an effective governance mechanism capable of adapting to demographic changes, evolving disease patterns, and growing healthcare cost pressures. Therefore, strengthening state management capacity, improving implementation mechanisms, and enhancing service quality remain essential conditions for ensuring the sustainability of HI policy in the new period.