A total of 186.2 million outpatient and inpatient visits were made across the country in 2024, all covered by the health insurance fund. This marks an increase of 12.2 million visits compared to the same period in 2023.

According to a report by Vietnam Social Security, the implementation of the health insurance policy in 2024 was highly effective. The system managed to tightly control and optimize the use of the health insurance fund despite limited resources. Additionally, payments for medical services were ensured to be accurate, timely, and sufficient to meet the healthcare needs of the population.

The Health Insurance Fund disbursed VND142.9 trillion (US$5.63 billion) for the medical examination and treatment of more than 186 million health-insurance participants in 2024. Illustrative Photo

The Viet Nam Social Security collaborated closely with the Ministry of Health to address challenges and obstacles in implementing health insurance policies, safeguarding the rights of participants. As a result, most of the outstanding payments from previous years, up to 2023, were settled for medical establishments registered with the health insurance fund.

This ensured that these establishments had the necessary funds to carry out medical procedures and deliver healthcare benefits to participants in accordance with the law.

This collaboration contributed to improving the quality of medical services and increasing public satisfaction.

The Viet Nam Social Security also instructed social security offices in provinces and cities to strengthen their efforts by implementing strict measures to control health insurance medical costs in line with regulations, ensuring savings and efficiency.

Regular analysis and evaluations of rising medical costs were conducted, with timely warnings issued to healthcare facilities that had abnormally high average expenses compared to similar facilities in the same tier, region, and specialty.

Then the offices in provinces and cities were tasked with working alongside local healthcare providers to make necessary adjustments in accordance with Decree No. 75/2023/ND-CP.

Additionally, monthly nationwide online conferences were held with district-level social security offices to assess and control health insurance medical costs, while reinforcing health insurance auditing.

New regulations, including the amendments to the Law on Health Insurance; the Law on Bidding, and the Law on Medical Examination and Treatment, were also consistently updated and incorporated.

Particularly, as the implementing authority of the policy, the Viet Nam Social Security remained proactive in advising and proposing amendments and improvements to the Law on Health Insurance.

Most of the suggestions made by the Viet Nam Social Security had been adopted, especially those related to protecting the legal rights and interests of policyholders and beneficiaries.

Illustrative image (internet)

The amended Law on Health Insurance, which introduced a range of reforms and improvements, was officially passed during the eight session of the 15th National Assembly, with a very high level of consensus.

The amended Law No. 51/2024/QH15, which will come into effect on July 1, 2025, introduces several significant changes to enhance benefits and simplify procedures for health insurance participants.

These include provisions for health insurance coverage when patients access medical treatment across administrative boundaries, maintaining the current benefit levels as stipulated in the existing law and expanding coverage in certain cases.

Under the new regulations, health insurance participants will receive 100 per cent coverage for medical services at any health insurance medical facility designated as a primary care provider nationwide.

Additionally, 100 per cent coverage will be provided for inpatient treatment at basic health insurance medical facilities across the country.

Patients who have been formally diagnosed with rare or critical illnesses, or conditions requiring advanced medical techniques listed in the health ministry’s catalogue, will be able to directly access specialised care without needing a referral, as is currently required.

However, the specific list of rare and critical illnesses exempt from the referral requirement is still under development by the health ministry.

Additionally, the ministry is working on implementing an electronic referral system to streamline administrative procedures and reduce the burden on patients.

The scope of benefits for health insurance cardholders is also expanded, including treatment for strabismus and refractive disorders in children under 18./.