The health ministry stated that after 15 years of implementation, the Law on Health Insurance has become an integral part of people’s lives, confirming its effectiveness, suitability, and accomplishment of significant results. The State management and execution of health insurance policies have been significantly strengthened, with a focus on widespread of dissemination and legal education on health insurance, which has garnered the involvement of the entire political system.

By the end of 2023, Vietnam boasted 93.628 million health insurance participants, covering an impressive 93.35 per cent of the population. The rights and benefits of the participants have been carefully tailored to meet their medical needs, ensuring access to satisfactory medical examination and treatment. Notably, the procedures for settling health insurance-based medical costs have seen significant enhancements. This progress has resulted in improved healthcare access for  impoverished individuals and those entitled to the State preferential policies, and children under six years old, aligning with the healthcare services stipulated by the State.

However, the implementation of the Law on Health Insurance unveils difficulties and shortcomings that need to be addressed.

The regulation that the household is "a group of people participating in health insurance" is not compatible with the grouping of participants according to "responsibility to pay health insurance premiums". At the same time, the regulation of household participants based on the list of members in the household registration book does not reflect the relationship between the members and the responsibility of household members in implementing health insurance. The contribution rate and the reduction of contribution rates for household members participating in health insurance is not really fair compared to other groups, including students. The participation of students in health insurance does not ensure flexibility, nor does it ensure the rights of students who are also members of households, leading to a higher contribution level for students when compared to their contribution level as household members.

People have health insurance-based medical examination and treatment. Photo courtesy of the Ministry of Health

For foreigners, the Law on Health Insurance specifies the scope of regulation as "foreign agencies, organisations, individuals related to health insurance". This regulation is not specific, unclear about the subjects, the rates and the methods of paying health insurance premiums, leading to difficulties in implementation.

Along with that, some medical services within the scope of examination and treatment are not covered by health insurance such as health management, medical check-up and diagnosis for risk assessment and early treatment of some diseases, regular health check-ups, radiotherapy treatment, assisted reproduction techniques, medical supplies used in functional recovery, and medical nutrition therapy, etc.

The regulations regarding the basic medical service package covered by health insurance are not clear, and do not reflect the specific reality of Vietnam as well as demonstrate the nature of the basic medical service package as being balanced in terms of the scope of benefits and the payment capacity of the Health Insurance Fund. The Law on Health Insurance has regulations on the scope of rights and benefits of health insurance, and at the same time, stipulates that the Minister of Health shall assume the prime responsibility for, and coordinate with related ministries and sectors in, promulgating lists and rates of, and payment conditions for, medicines, chemicals, medical supplies and technical medical services to be enjoyed by the insured. These regulations have defined the basic rights and scope for health insurance participants to access medical examination and treatment needs for most diseases at all levels, in all specialties, at all specialized technical levels, and the remaining costs are shared by the patients. In practice, it is not possible to provide guidance on the basic healthcare service package for all levels. In the specific conditions of Vietnam, the basic healthcare service package corresponds to medical services, drugs, and medical supplies that meet the initial healthcare and medical examination and treatment needs at grassroots healthcare facilities.

Regarding the initial registration for medical examination and treatment, hospital transferal, the law regulating the initial registration for medical examination and treatment at healthcare facilities according to administrative boundaries is appropriate, but it has not created conditions for people to be able to seek medical examination and treatment at all healthcare facilities covered by health insurance at an equivalent or lower level within the province for certain diseases; in special cases such as people with rare diseases, and critical diseases have not been able to seek medical examination and treatment at the higher level while the lower-level facilities do not have sufficient professional capacity and all have to be referred. Some chronic diseases have not been transferred to grassroots healthcare for management and medication supply, thereby limiting the rights of health insurance participants and unnecessary transferal procedures.

The Law on Health Insurance only stipulates transferal among medical service providers at commune, ward, and town levels without mentioning other district-level medical examination and treatment facilities such as medical centers, polyclinics, military hospitals, police hospitals, civilian hospitals, and organisations’ health facilities. Referral for medical examination and treatment covered by health insurance to provincial-level  facilities with a 100 per cent inpatient treatment cost reimbursement increases the number of medical examinations and treatments at the upper level and reduces the number of medical examinations and treatments at commune-level health facilities.

Besides, currently, the Law on Medical Examination and Treatment No 15/2023/QH15 issued in 2023, stipulates three levels of professional and technical expertise replacing the professional and technical levels, hospital grades are no longer the basis for setting prices of medical examination and treatment services. Therefore, it is necessary to amend and adjust the contents related to the professional and technical levels, hospital grades in the Law on Health Insurance to harmonise with the Law on Medical Examination and Treatment to ensure the management of health insurance and the appropriate payment of health examination and treatment expenses covered by health insurance.

 The Ministry of Health states the necessity to amend and supplement certain articles of the Law on Health Insurance to address current shortcomings and limitations

Regarding health insurance premium rates, according to the Ministry of Health, the contribution rate is not balanced with the benefits and the scope of benefits for the participants. The current law stipulates a maximum monthly premium rate of up to 6 per cent of basic salary, but there is no mechanism and roadmap for the Government to have a basis for increasing the premium rate while the demand for expanding the scope of payments from the Fund is increasing, and the average premium value of Vietnam's health insurance card is much lower than many countries in the region and the world. At the same time, the law does not have provisions for insurance with multiple premium rates according to Resolution of the 13th Party National Congress on multi-tier, modern insurance, linking between State-run health insurance and commercial health insurance.

Regarding the management and use of the Health Insurance Fund, the Ministry of Health states that the Fund is centrally and consistently managed nationwide (a single fund). However, the law also stipulates the handling of surpluses or shortages in the fund for health insurance-based medical examination and treatment in provinces and cities. This leads to inconsistency and lack of uniformity in the regulatory framework. Additionally, this regulation also leads to the adjustment of the Fund and the payment of health insurance-covered medical examination and treatment costs being changed depending on the context, even varying by provinces and healthcare facilities. The allocation of funds for management costs is not clearly defined. For many years, the management costs of the Fund have been capped at around 3.5 per cent annually, so there is a need to adjust specific regulations to be in line with the reality.

According to the Ministry of Health, it is necessary to amend and supplement certain provisions of the Law on Health Insurance Law in order to address emerging difficulties and shortcomings, enhance the management and efficient use of the Health Insurance Fund, ensure consistency with the Law on Medical Examination and Treatment No 15/2023/QH15 and related laws to make it take effect from January 1, 2025. The amendment and supplementation of certain provisions of the Law on Health Insurance Law will help ensure that health insurance benefits are in line with the needs of the people for healthcare, the development of society, the payment capacity of the Health Insurance Fund; enhance the efficiency of management, operation, and use of the Health Insurance Fund; promote fairness and convenience in the supply and use of health examination and treatment services covered by health insurance; enhance the efficiency of grassroots healthcare, focus on primary healthcare, and comprehensively manage the health of the people.