Brian Jeffrey
Reviewing the Health Insurance Law in Vietnam
The Ministry of Health (MOH) is currently seeking feedback on the proposed amendments to the Health Insurance Law. A recent report evaluating 15 years of the law’s implementation has highlighted several issues.
Health insurance is designed to lessen the financial burden of medical expenses for families. Yet, the participation rate in Vietnam remains relatively low, with 45% of healthcare costs still covered out-of-pocket by patients.
The increasing demand for healthcare services contributes to this problem. The MOH notes that insured individuals tend to utilize outpatient and inpatient services more frequently compared to those without insurance.
High co-payments and out-of-pocket costs for medications and non-covered services further escalate the financial strain on patients.
Additionally, the inadequate healthcare service fees do not reflect the actual costs, pushing more patients into self-payment for services.
Some hospitals struggle with procurement issues, leading to medicine shortages. An inefficient drug bidding and management process means that not all necessary medications are available in hospitals, forcing patients to purchase drugs from pharmacies.
Currently, the Health Insurance Fund only covers examination and treatment services provided within designated medical facilities. Nonetheless, other healthcare services, including those offered by pharmacies and laboratories, require additional payments.
MOH acknowledges that the quality of medical services under the health insurance scheme does not meet public expectations, especially at primary healthcare centers located in remote areas.
This situation has prompted many patients to choose provincial hospitals over local clinics, resulting in higher medical costs.
The MOH report indicates that central hospitals are often overburdened, which leads to dissatisfaction due to long wait times and complicated procedures.
Patients are also disheartened by the need to pay for medicines and supplies that should be covered by insurance because clinics do not have adequate stock.
At times, patients with insurance are directed to undergo tests and use medical equipment that is not reimbursed, despite the availability of state-funded machines, thus incurring extra fees.
While some hospitals include certain expenditures in health insurance calculations, many others require patients to pay for necessary items such as surgical gowns and injection fees out of their pockets.
The MOH has raised concerns that local clinics often retain patients for treatments rather than referring them to higher-level care when necessary, undermining the health insurance framework.
Inappropriate practices such as excessive testing and unnecessary procedures can arise, as providers might engage in these activities to obtain higher payments from the health insurance fund.
A 2022 report to the National Assembly highlighted that all public healthcare units had been granted autonomy, enabling 253 of these units to manage their own regular expenses.
The draft law aiming to amend the Health Insurance Law is set to be presented to the National Assembly in its upcoming session in October 2024, with hopes of implementation by January 1, 2025.
As of late 2023, approximately 93.3% of Vietnamese citizens are covered by health insurance. The Health Insurance Fund covers about 87-89% of total medical expenses for insured patients, leaving them responsible for 11-13% of costs.
By 2024, nearly 2,897 medical facilities were registered to provide services for patients with health insurance.
