General Director Le Hung Son

Increased Cost Pressure During the High Coverage Period of Health Insurance

HI policy is one of the important pillars of the social security system, with a wide scope of impact and directly linked to people's lives. As the HI rate increases, the HI policy shifts its goal from development to sustainable expansion of the number of participants, especially improving the quality of services, benefits, and satisfaction of beneficiaries. By 2025, Viet Nam aims to achieve HI coverage of 95.1% of the population, approaching the goal of universal health insurance. In addition, 195.5 million health insurance-covered medical examinations and treatments were paid for by the Health Insurance Fund, with a total requested payment of nearly 161.6 trillion VND, an increase of 14.3% compared to 2024. These figures demonstrate the important role of the Health Insurance Fund in caring for and protecting the health of the people, creating conditions for all citizens, especially vulnerable groups, to access, participate in, and enjoy the practical and humane benefits of our HI policy.

Notably, the rate of increase in HI medical examination and treatment costs is much higher than the increase in the number of medical examinations and treatments (approximately 6.5%). This trend indicates that the average cost per HI-covered medical examination and treatment is increasing. This is due to the expanding benefits for HI participants, the increasing demand for healthcare in the context of an aging population, as well as the increasing use of modern medical technology services and expensive medicines and medical supplies for diagnosis and treatment.

Meanwhile, the HI contribution rate has remained unchanged in recent years at 4.5% of the basic salary (the current basic salary is 2,340,000 VND/month). However, adjusting the HI contribution rate needs to be done very cautiously to avoid creating an additional burden on our citizen and to prevent a reduction in the competitive environment of businesses. The Fund's resources are limited, but the demand for healthcare is ever-increasing – this is a central, long-term challenge in the management of the Health Insurance Fund, requiring fundamental and sustainable governance solutions.

Health Insurance Fund from a Public Finance Perspective

In recent years, the Communist Party of Viet Nam has issued many resolutions that emphasized the need to strengthen discipline, order, transparency, and accountability in the management and use of public resources, including Social Insurance Fund and Health Insurance Fund. In this spirit, the Law amending several articles of the Health Insurance Law No. 51/2024/QH15 and the Social Insurance Law No. 41/2024/QH15 further refines the legal framework, ensuring the rights of participants and enhancing the efficiency and sustainability of fund management.

In particular, from March 1, 2025, Viet Nam Social Security has become a specialized unit under the Ministry of Finance. This restructuring not only has significance in terms of organizational structure but also affirms the Party's viewpoint and direction in linking social security policies with fiscal policies, strengthening the effectiveness and efficiency of state management of financial funds.

Following this approach, the Health Insurance Fund is identified as an important component of the public financial system, ensuring the payment of medical benefits to participants while managing the Fund tightly, effectively, safely, and sustainably in the long term, thereby contributing to strengthening people's trust in the HI policy.

Financial discipline - the foundation for protecting patients' rights

In practice, many believe that increased cost control could negatively impact the rights of patients seeking medical treatment. However, experience in managing the Health Insurance Fund shows that only when financial discipline is ensured can patients' rights be maintained stably and sustainably.

In 2025, Viet Nam Social Security continued to promote the application of information technology in HI claims assessment, implement electronic claims assessment, gradually implement electronic medical records, and link data with medical examination and treatment facilities. These solutions help to detect and prevent unreasonable costs early, limit abuse and exploitation of the Fund, thereby focusing resources on medical examination and treatment for seriously ill patients, chronic diseases, and cases that are truly necessary. Experience shows that the Health Insurance Fund covered many cases with high treatment costs in 2025. The highest payment reached nearly 6.7 billion VND (card code: BT29595212XXXXX, born in 2000, residing in Chau Thoi commune, Ca Mau province) with the main diagnosis being "hereditary factor VIII deficiency". In addition, the Fund also paid over 3.3 billion VND for two cases of child patients: one with card code TE13636227XXXXX (born in 2020, residing in Y Yen commune, Ninh Binh province) with the main diagnosis of "glycogen storage disease; influenza caused by an identified virus" and the other with card code TE10101318XXXXX (born in 2021, residing in Co Do commune, Hanoi city) with the main diagnosis of "glycogen storage disease; other pneumonia, unidentified microorganism..."

Simultaneously, specialized inspections of social insurance and health insurance, and unempoyment insurance have been strengthened in a proactive, focused, and targeted manner. Unreasonable HI medical examination and treatment costs, such as falsified medical records, fictitious prescriptions, or adding quantities or types of drugs, medical supplies, technical services, hospital bed fees, and other expenses not actually used by the patient... are promptly detected and refused payment according to regulations. Strict management of the Health Insurance Fund is not intended to "tighten" patients' rights, but to protect the Fund from loss and abuse, thereby safeguarding the legitimate rights of HI participants in the long term.

Ensuring Health Insurance Benefits in Difficult Situations

The effectiveness of managing the Health Insurance Fund is not only reflected in the balance of revenue and expenditure figures, but also in the ability to ensure patients' rights in unusual and unpredictable situations. In 2025, when many localities are severely affected by natural disasters, storms, and floods, the Health Insurance Fund was consistently used effectively, flexibly, and in accordance with regulations to ensure uninterrupted access to medical examination and treatment for the citizens.

The comprehensive measures implemented by Viet Nam Social Security, such as renewing HI cards, providing long-term medication for people with chronic diseases, assigning staffs to be on duty at healthcare facilities in areas affected by natural disasters, have helped people access timely and safe medical services. It can be said that the Health Insurance Fund and the humanitarian nature of that policy have played a crucial role in ensuring social security, especially in situations of natural disasters and emergencies.

Reforming the management of Health Insurance Fund: An Essential Requirement in the new era

Practical experience shows that continuing to innovate and modernize the management method of Health Insurance Fund is an essential requirement in the new development time. Accordingly, linking efficiency with IMPROVING the quality of healthcare services is identified as a crucial solution, contributing to the efficient and balanced use of Health Insurance Fund in the long term.

In this context, digital transformation and data mining should be considered pillars in the management, auditing, and utilization of Health Insurance Fund. Improving mechanisms and institutions, such as issuing basic healthcare service packages, advanced HI packages, standard treatment protocols for some common diseases, and sharing clinical test results between healthcare facilities, along with raising awareness among healthcare facilities and HI participants about their responsibility to use the fund efficiently and in accordance with regulations, is absolutely essential. After all, the Health Insurance Fund is a common fund of the community, formed from contributions from the entire society.

Given limited resources, the effective management and utilization of the Health Insurance Fund is key to ensuring the sustainable rights of patients and further enhancing its pivotal role in the social security system. This is a crucial "social security lever," contributing to socio-economic stability and strengthening public confidence in health insurance policies during this new development time.