Expanding Coverage and Enhancing Benefits in Health Insurance

Health insurance is one of the main pillars of Vietnam’s social security system. With humanistic and practical significance and values, it has been increasingly developed and perfected to enable all people, especially disadvantaged groups, to join and enjoy benefits, humane and practical values of this superior policy. Most people and businesses fully and promptly implement health insurance policies as they are aware that health insurance is both a right and an obligation and supports the sustainable growth of health insurance coverage.

The carefully structured health-insured medical system spans central and local levels, integrating public and private facilities to ensure convenient access and utilization of services

Health insurance coverage is sustainable

The share of health insured people has gradually increased year after year to almost reach the universal health insurance goal. In 2008, Vietnam had 39.7 million health insurance policyholders, covering 46.1% of the population. The coverage was 74.87% in 2015 and 93.35% in 2023 (93.6 million health insurance policyholders).

Although health insurance development has been tough since 2022 due to the COVID-19 pandemic, the coverage has still expanded year by year. Almost all low-income, poor and disadvantaged groups in society have health insurance, funded by the state budget, the local budget or other resources.

Higher quality of insured medical treatment

The medical network has been increasingly expanded and the quality of medical services is improved, especially at community levels, thanks to strong care and effective actions of the Party and the State.

Currently, the country has nearly 13,000 health-insured medical facilities (including about 2,897 hospitals and nearly 10,000 commune clinics). The health-insured medical system is organized from the central to local levels, including both public and private facilities, helping people conveniently access and use health-insured medical services.

The number of health-insured medical visits increases every year. In 15 years, over 2.12 billion insured medical visits, including over 174 million insured visits of over 39 million policyholders in 2023 (nearly doubling the figure in 2009).

Grassroots health facilities (at district and commune levels) account for 95% of medical facilities. In 2018-2023, medical examinations at the grassroots levels accounted for nearly 75% of total examinations covered by health insurance. These levels made up some 34% of insured medical spending. This shows the importance of grassroots healthcare and their role in improving the effect of medical services delivered.

Policyholders also enjoy many benefits and utilities from administrative procedure reform, digital transformation and Project 06 issued by the government

Health Insurance Fund: Core fund for people's healthcare

In addition to increasing the health insurance coverage and the quality of insured medical services, the Health Insurance Fund has been preserved and grown sustainably over the years amid limited resources. Expenditure is controlled and profiteering and fraudulence are resisted and prevented, while the use of the fund is optimized and the revenue and expenditure balance is ensured.

In the past 15 years, the Health Insurance Fund has paid nearly 1,000 trillion for insured medical services, including about VND123 trillion in 2023, eight times more than that in 2009. The fund has truly become an important financial source for public healthcare.

Furthermore, the payment of the fund for medical services and drugs is being increasingly expanded to meet medical needs of health insurance policyholders. Many expensive drugs and targeted drugs for cancer treatment are also included in the health insurance coverage list. Expensive replacement materials such as artificial hip joints and arterial stents are also covered by the Health Insurance Fund each year. Regarding payment levels, the revised Health Insurance Law in 2014 increased health insurance payments for the poor from 95% to 100%, the near-poor from 80% to 95%, and protected people at 100%. In 2023, the average payment for an insured retiree was VND6.3 million and socially protected people VND5 million each. Meanwhile, premium annuity for these groups is VND1.3 million a year.

In particular, the regulations on inter-level insured medical examination and treatment have greatly facilitated health insurance policyholders. From 2016, policyholders can go to any district hospital for medical examination and, from 2021, to any provincial hospital in the country, with the same benefits.

Ultimate goal: For the sake of policyholders

In addition to increasing medical benefits, policyholders also enjoy many benefits and utilities from administrative procedure reform, digital transformation and Project 06 issued by the government. This key task will be prioritized for implementation by the Vietnamese social security sector to facilitate and serve insured patients, prevent insurance profiteering, and optimize the health insurance fund.

Accordingly, the sector has minimized procedures, documents, forms, records and service time; and accelerated electronic transactions (people and businesses can interact and transact online with social security agencies around the clock): Administrative procedures reduced from 114 (in 2015) to only 25 now, with all provided online. This has helped policyholders work with social security agencies in the fastest, most streamlined and most convenient way.

Carrying out Project 06, the national insurance database developed by the Vietnam Social Security (VSS) has been integrated and interconnected with the National Population Database and relevant ministries and agencies (with more than 95 million pieces of demographic information verified with the national population database by VSS, of which about 86.6 million are insurance policyholders (social insurance policies, health insurance and unemployment insurance). This is an important basis and foundation for communication, sharing, management and reform of administrative procedures. To date, 100% of health insured medical facilities (12,851 facilities) nationwide have accepted insured treatment for policyholders using citizen identification card, thus reducing the service time and procedures and enhancing service quality on the one hand and helping manage and effectively use the health insurance fund and prevent fund profiteering on the other. Indeed, this has brought many benefits: not only simplifying procedures but also improving information confidentiality and data safety while saving time for medical facilities to provide reception and guidance and enabling the Health Insurance Fund to manage its fund effectively and prevent fund profiteering.

The Health Insurance Fund is very significant to sharing, between healthy people and sick people, between young people and old people, between high-income people and low-income people. In fact, in recent years, in addition to paying regular medical costs, many cases with serious illnesses and rare diseases are covered by the Health Insurance Fund. Most recently, patient Nguyen Quoc Trinh (19 years old, in Thanh Hoa province) was hospitalized at Bach Mai Hospital for treatment of a rare disease, Pemphigus Eurasian, and he was paid nearly VND800 million by the fund for a 7-month treatment.

Additionally, the Ministry of Health and the Vietnam Social Security have coordinated closely to build effective electronic health records, serve professional purposes of medical facilities and manage insured medical expenses. They have also integrated driver data to ease drivers to get health certificates and apply for replaced driver licenses.

The positive achievements have helped assert the importance of health insurance in social life. To successfully realize the universal health insurance goal, it is necessary to further implement consistent solutions for this purpose. This is not only the specific task of Vietnam's social security sector but also the responsibility of the community to make health insurance a golden card to protect the health of each person.

By Huong Thom, Vietnam Business Forum