A well-targeted policy
Hospital fee exemption is a major policy arising from profound shifts in disease patterns, population structure and healthcare financial pressures. At present, out-of-pocket payments by Vietnamese households still account for around 40% of total healthcare expenditure, significantly higher than the World Health Organisation’s recommendation of below 30%.
This is a key cause of “impoverishment due to illness”, with hundreds of thousands of people each year paying very large sums for medical examination and treatment.
According to MSc Tran Thi Trang, Director of the Health Insurance Department (Ministry of Health), in the context of rapid population ageing, with the proportion of people over 60 rising quickly and increasing needs for regular health check-ups, early screening and prolonged treatment, a well-targeted hospital fee exemption policy will help ease the financial burden on vulnerable groups (older people, poor households, near-poor households, ethnic minority areas, low-income regions and people with chronic diseases).
Initially, the policy will focus on covering basic healthcare services. Subsequent implementation will follow a phased approach for priority groups based on budget capacity.
Under the roadmap, the Health Insurance Fund will cover basic services, while patients will continue to co-pay beyond this level to encourage the use of services at lower-level facilities.
According to the draft roadmap, the Ministry of Health proposes three phases. Phase 1 (2026–2027) will focus on essential services: every citizen will receive a free annual health check-up or screening at least once a year, all citizens will also have electronic health records. Phase 2 (2028–2030) aims to reduce out-of-pocket spending to below 30%, expand screening for common diseases and raise health insurance coverage to more than 95%. Phase 3 (after 2030) will move towards universal hospital fee exemption for the basic service package, with further expansion when resources allow, while operating a smart, modern, multi-tiered health insurance payment system.
Speaking at a recent consultation workshop on the draft scheme for gradual hospital fee exemption, Permanent Deputy Minister of Health Vu Manh Ha stated that the project will gradually implement hospital fee exemption, expand health insurance benefits, reduce out-of-pocket spending on health check-ups and, after 2030, provide universal hospital fee exemption for the basic service package.
Currently, direct household healthcare costs remain high, placing substantial financial strain on families, making strong public policy interventions essential. Therefore, hospital fee exemption is both urgent and reflective of the humane nature of Viet Nam’s policy system, while ensuring people’s right to healthcare.
By reducing financial barriers, people, especially needy people and vulnerable groups, will gain fairer access to healthcare services; financial obstacles to quality care will gradually be removed, limiting delayed or abandoned treatment, and moving towards a sustainable health system where no one is left behind.
A careful and sustainable approach needed
Many experts note that despite its deeply humanitarian nature, universal hospital fee exemption is a large-scale policy requiring sustainable financial resources. The main pillar for this roadmap remains the Health Insurance Fund, not solely the state budget.
However, Viet Nam’s health insurance contribution rates are currently very low, while healthcare demand and changing disease patterns are pushing out-of-pocket spending higher. It is estimated that each year the Health Insurance Fund leaves around 24.8 trillion VND (941 million USD) unpaid, while contribution rates remain low (4.5% of the basic salary). According to the proposal, contribution rates would gradually increase to 6% after 2030.
Dr Nguyen Khanh Phuong, Director of the Health Strategy and Policy Institute (Ministry of Health), stated that hospital fee exemption will help narrow health and income gaps between vulnerable groups and regions. Everyone will have the opportunity for timely medical care, improving early detection, timely treatment, reducing complications and lowering mortality.
However, when implementing universal hospital fee exemption, coverage must be confined to the basic healthcare service package with clear cost ceilings. The main source of funding will still be the Health Insurance Fund, but additional state budget resources and social contributions, including commercial insurance or public-private partnerships, must be mobilised.
Alongside financial considerations, service quality is crucial to the policy’s success. Hospital fee exemption, if not linked to systemic reforms such as strengthening primary healthcare, improving referral systems, advancing digital transformation and reforming health insurance payment methods, will not meet expectations.
Notably, the financial challenge is not limited to revenue. Issues such as cost management, preventing service overuse, overloading at higher-level hospitals, and disparities in service quality at grassroots facilities or between regions could all place the Health Insurance Fund at risk of imbalance if broad hospital fee exemption is implemented without adequate safeguards.
The hospital fee exemption policy under Resolution No. 72-NQ/TW marks an important step in expanding access to essential healthcare services for all citizens. It is a strategic policy that contributes to sustainable poverty reduction, improves population quality and promotes health equity.
For the policy to take effect in practice, thorough preparation is required: sustainable financing, a healthcare system capable of meeting increased demand, transparent resource management and broad societal participation. When these conditions are met, they will form a crucial foundation for achieving universal health coverage as set out in Resolution No. 72-NQ/TW.
