Vietnam: Implementation of New Health Insurance Policies

Vietnam Social Security (VSS) has held a national conference to implement updated health insurance legislation and outline key tasks for 2025.

The conference highlights significant changes introduced by Decree No. 02/2025/ND-CP and Circular No. 01/2025/TT-BYT, including revised eligibility criteria, streamlined procedures for certain serious illnesses, and enhanced responsibilities for both the Ministry of Health and VSS.

VSS emphasized the importance of safeguarding participants' rights while ensuring efficient management of the Health Insurance Fund. This includes rigorous medical claim review, proactive risk analysis, and inspection of facilities with unusual cost increases.

Deputy Director General Nguyen Duc Hoa commented on the importance of the conference, "This is an important opportunity for officials and employees to listen to and discuss the regulations, ensuring the rights of health insurance participants, and fulfilling the key tasks of the entire sector in 2025."

Deputy Director General Nguyen Duc Hoa on priorities for 2025, "VSS’s units and social security offices continue to focus on the key task of ensuring the rights of health insurance participants when accessing medical care and resolutely refuse payment for medical expenses that do not comply with regulations."

Most Important Ideas/Facts:

1. Legislative Framework:

• The National Assembly passed Law No. 51/2024/QH15 amending the Law on Health Insurance, effective January 1, 2025.
• The Government issued Decree No. 02/2025/ND-CP to supplement Decree No. 146/2018/ND-CP, also effective January 1, 2025.
• The Ministry of Health issued Circular No. 01/2025/TT-BYT to guide the implementation of the updated Law on Health Insurance.

2. Key Policy Updates:

• Expanded Coverage: The legislation revises eligibility criteria and contribution responsibilities to align with the Law on Social Insurance.
• Streamlined Procedures: Referral procedures are eliminated for specific rare and serious diseases, allowing direct access to specialized care.
• Enhanced Responsibilities: Ministry of Health: Tasked with evaluating the reasonableness of medical examination and treatment services.
• VSS: Responsible for reviewing health insurance-based medical treatment contracts.
• Pricing Alignment: Private medical facilities can now apply the same health insurance-based service prices as public facilities with the same level of technical specialization.

3. Key Tasks for 2025:

• Protecting Participants' Rights: VSS emphasizes ensuring access to medical care for all insured individuals.
• Strengthening Claim Review: VSS aims to enhance the effectiveness of medical claim reviews, strictly controlling costs and rejecting payments for non-compliant expenses.
• Proactive Risk Management: VSS will focus on analysing and forecasting health insurance fund usage, proactively identifying and addressing potential cost increases and misuse.
• Increased Accountability: Provincial social security offices are directly accountable for managing the health insurance fund and ensuring proper settlement of medical expenses.

FAQS Implementation of New Health Insurance Policies

What are the latest updates to Vietnam's health insurance policies?

On January 1, 2025, new health insurance policies came into effect in Vietnam following the passage of Law No. 51/2024/QH15 and the issuance of Decree No. 02/2025/ND-CP and Circular No. 01/2025/TT-BYT. These updates include amendments to subjects of participation and contribution responsibilities, revisions to medical examination and treatment regulations, elimination of referral procedures for certain rare and serious diseases, and additional responsibilities for the Ministry of Health and social security offices in managing and regulating health insurance services.

What are some of the key changes regarding participation and contribution to health insurance?

The latest amendments to the Law on Health Insurance include updates to the subjects of participation and health insurance contribution responsibilities to synchronize with the Law on Social Insurance. These changes ensure consistency and alignment between the two laws, streamlining the process for individuals and organizations.

How are medical examination and treatment procedures being revised?

Regulations on medical examination and treatment have been revised to align with the Law on Medical Examination and Treatment. These revisions focus on aligning the procedures and requirements across different levels of healthcare, ensuring clarity and consistency for patients and medical professionals.

What changes have been made to referral procedures for rare and serious diseases?

The updated health insurance policies have eliminated referral procedures for certain rare and serious diseases. This allows patients to directly access basic and specialized medical care without unnecessary administrative steps, making it easier and faster for them to receive the necessary treatment.

What are the new responsibilities of the Ministry of Health concerning health insurance?

The Ministry of Health now has added responsibilities in evaluating the reasonableness of medical examination and treatment services provided under health insurance. This ensures that the services provided are appropriate and cost-effective, safeguarding the health insurance fund and ensuring the quality of care.

What are the social security offices' additional responsibilities in health insurance management?

Social security offices are now tasked with checking health insurance-based medical examination and treatment contracts. This measure ensures that contracts between healthcare providers and the social security system comply with regulations and protect the interests of both parties.

How are private medical facilities impacted by the new health insurance policies?

Under the new regulations, private medical facilities can apply the same health insurance-based medical examination and treatment service prices as public medical facilities according to their level of technical specialization. This creates a level playing field for both types of healthcare providers and expands access to quality healthcare services for insured individuals.

What are the key tasks and priorities for implementing health insurance policies in 2025?

The focus for 2025 is on ensuring the rights of health insurance participants when accessing medical care, strictly implementing the provisions of the Law on Health Insurance and relevant decrees and circulars, actively participating in the development and improvement of health insurance policies, innovating and enhancing the effectiveness of medical claim review, controlling health insurance-based medical care costs, and strengthening inspection of medical facilities with high-cost increases or potential signs of abuse.

Conclusion

iPMI Global CEO, Christopher Knight concludes, “The new health insurance policies implemented in Vietnam signal a commitment to expanding coverage and improving access to quality healthcare. The focus on rigorous cost control measures suggests an effort to ensure the sustainability of the Health Insurance Fund while simultaneously safeguarding the rights of participants. Continued monitoring and evaluation of these policies will be crucial to assess their effectiveness and impact on Vietnam's healthcare system.”