Tuberculosis (TB) is a contagious air-borne disease caused by a bacterial infection in the human lungs. It is caused by the ‘Mycobacterium tuberculosis’ bacteria, which spreads when a healthy person comes in close contact with a TB patient. In severe cases, the infection can also spread to other body parts, like the kidneys, spine, and brain.
Tuberculosis has three stages - primary infection, latent infection and active TB infection. When the TB bacteria enters the body, it is considered the primary infection stage. If a person gets infected with TB but doesn’t show any symptoms, as the TB bacteria remain dormant, it is called the latent TB or inactive TB infection stage. But when the person develops TB symptoms, the infection enters the active TB infection stage. An active TB infection can turn fatal if no treatment is taken.
Listed below are some of the most common symptoms of tuberculosis: Persistent cough (that lasts longer than 2 weeks); Chest pain while breathing; Fatigue; Night sweats; Weight loss; Appetite loss; Coughing up blood or mucus; Chills; Fever.
Tuberculosis can be life-threatening for people of all ages, especially those with a weaker immune system. Besides, the treatment is lengthy, as it takes months to complete the entire course of medications so that the disease does not relapse. Tuberculosis causes 4000 deaths every day globally, the highest among infectious diseases.
Over the past few years, the cost of hospitalization has increased drastically in both rural and urban areas. When it comes to TB, severe cases often require hospitalization. However, getting admitted for TB for even a few days can cost lakhs of rupees, depending on the city and the type of hospital. Getting a comprehensive health insurance policy is the only solution to cope with such exorbitant medical expenses.
Many countries in the Asia Pacific region have made steady progress towards UHC coverage through sustained political commitments and fiscal policy aligned with their commitment. By 2020, 27 countries had implemented a SHI financing mechanism, which typically includes open enrollment for the full population along with partial or full subsidization of healthcare costs for vulnerable groups. 
Vietnam’s first SHI scheme was piloted in 1989 and grew through successive pilots and expansions. In 2009 the national-level Health Insurance Law (HIL) went into effect, uniting the existing health insurance programs and schemes for the poor. Amendments to the HIL effective in 2015 made SHI compulsory for all and pooled risk by re-structuring registration around the household unit. A household in Vietnam is defined by inclusion in the ‘family book’, the national system of family and address registration.

Access to SHI in Vietnam increased rapidly, principally through subsidization of premiums. Specific groups were enrolled automatically with full subsidy, including vulnerable populations (e.g., households classified as ‘poor’, children aged < 6, people aged > 80), pensioners and meritorious groups (e.g., veterans). Partial premium subsidization was also available for students, households classified as ‘near-poor’ and some farmers. More than half of SHI members are entitled to 80% coverage with a 20% co-payment for services. However, co-payments are reduced to 5% or are eliminated for subsidized groups (e.g., households classified as ‘poor’ and ‘near-poor’, children < 6).
By 2023, Vietnam recorded a 93,3% national SHI coverage rate. Those remaining uninsured mainly consisted of informally employed individuals. 
Vietnam continues to transition to domestic financing of healthcare from donor financing by expanding the breadth of the national SHI. The Ministry of Health and Vietnam Social Security (VSS) have begun to close service gaps and integrate vertical health programs (e.g., those with stand-alone budget allocations and/or direct donor financing) into SHI financing. The costs for antiretroviral therapy (ART) were transitioned from donor funding to SHI in 2019, COVID-19 treatments were covered by SHI in 2020, and financing for tuberculosis (TB) care was fully transitioned to SHI in 2022.
Until this financing transition, anti-TB medications and consultations were provided free of charge in the public sector, funded by a mixture of domes

tic and international funding. Since July 2022, TB health facilities that met certain conditions could register with VSS and receive reimbursements for TB consultations, diagnostics and anti-TB medications. The financing for drug-resistant (DR-)TB tests and medications remains largely unchanged, co-financed by the Global Fund and domestic budgets.

This transition of the TB financing model in Vietnam is a large undertaking and the SHI benefits package is already considered to be generous, and the sustainability of the SHI fund is a concern.
As Vietnam continues to expand SHI financing for the TB program, it is now vital for people with TB to have SHI. Those without SHI coverage will need to finance their care out of pocket (OOP) or purchase SHI and make co-payments for their care to be subsidized. 
Maintaining the pace of health insurance growth amid people's difficult living conditions has once again affirmed the steadfastness and determination of the political system in general and the social insurance sector in particular in effectively implementing the universal health insurance roadmap.