Removing financial barriers — patients will seek care earlier and more effectively
At a workshop gathering opinions on the orientation for developing the Project on the gradual implementation of the hospital fee exemption policy recently organised by the Ministry of Health, Permanent Deputy Minister of Health Vu Manh Ha said that in 2024, Viet Nam’s health insurance coverage reached 94.29% of the population. The healthcare network extends widely to the commune level, while professional capacity at specialised, basic, and initial levels has been significantly improved, and the list of medicines and medical equipment within the scope and benefits of patients having health insurance cards has been increasingly expanded.
However, out-of-pocket spending by people accounts for more than 40% of medical costs, which remains high according to the recommendations of the World Health Organization (WHO).
Along with this, the risk of impoverishment due to illness persists, especially for the poor, vulnerable groups, and those suffering from chronic diseases or long-term treatments. Financial pressure on households will increase without strong public policy interventions.
For this reason, the gradual implementation of a hospital fee exemption policy is an objective and urgent requirement. It reflects the good nature of Viet Nam’s social policy system and ensures the people's right to healthcare.
According to Permanent Deputy Minister Vu Manh Ha, the hospital fee exemption policy is not only a healthcare financing measure but also has profound humanitarian and social significance, such as reducing the financial burden on people, especially the poor and vulnerable groups; improving equity in access to healthcare services; ensuring that “no one is left behind”; and improving healthcare quality. When financial barriers are removed, patients will seek medical services earlier and more effectively, it promotes the development of a sustainable healthcare system, reducing the risks of people delaying or abandoning treatment due to cost burdens.
The Deputy Minister of Health said that in the world, many countries applying free healthcare policy or all-people health insurance have achieved positive results, such as reducing impoverishment due to medical expenses, improving access to healthcare services, effectively controlling diseases, and reducing the costs of late treatment. These are valuable experiences for Viet Nam in building a suitable model with its development conditions, resources, and healthcare system structure.
Accordingly, the policy must base on the core foundation of health insurance, with support from the state budget and implemented according to a clear roadmap. The state budget and health insurance fund will cover essential and basic healthcare services to reduce the financial burden on people, especially social policy beneficiaries, vulnerable groups, low-income earners, and other priority groups. For medical services on demand, exceeding the basic level, patients still have to pay a part to raise awareness of using services reasonably and saving costs.
“Therefore, the hospital fee exemption policy must be closely linked to all-people health insurance coverage. Everyone participates in health insurance to share risks, those with better condition support the poor, the healthy support the sick; together with support from the state budget and socialisation mobilisation sources so that patients do not have to pay additional costs when they unfortunately get diseases,” Deputy Minister Vu Manh Ha stressed.
Building a clear basic healthcare service package and expected roadmap
According to Tran Thi Trang, Head of the Health Insurance Department under the Ministry of Health, in 2024, the whole country recorded 183.6 million medical examinations and treatments, an increase of 5.6% compared with 2023. Around 40 million people regularly used health insurance, averaging about 4.5 medical examinations and treatments per person per year. Spending of the Health Insurance Fund reached around 140 trillion VND.
“According to the four-tier healthcare system applied before 2025, although the number of health insurance examinations and treatments at the district level is the highest, the expenditure at the provincial level is the highest. At the provincial level, there are about 6.8 million patient visits each year, but spending from the Health Insurance Fund accounts for one-fifth of total expenditure,” Trang said.
Notably, the financial burden on people remains high. The estimated co-payment amount for some groups is around 21.905 trillion VND, while the portion not covered by the Health Insurance Fund is about 24.8 trillion VND.
She added that the scope of the hospital fee exemption policy will be built on the foundation of all-people health insurance. Co-payment rates will be gradually reduced and ultimately eliminated for many basic services.
A basic healthcare service package within the scope of fee exemption will be clearly defined, including the list of services, diseases, medicines, and medical equipment. It will cover common diseases and prioritise essential diseases first, with the scope expanded gradually based on professional requirements and the financial capacity of the state budget and Health Insurance Fund, in combination with socialisation mobilisation sources. At the same time, it must set the maximum cost for each examination or treatment session.
Specifically, the average cost for inpatient/outpatient treatment nationwide will be adjusted annually or by period, excluding certain high-cost diseases and technical procedures. Initially, the policy will be applied at primary care and basic-level healthcare facilities, as well as public and private medical establishments.
This will be a service package that people can enjoy for free within the scope of insurance, while on-demand services will be partly paid by patients to avoid wasteful use.
Accordingly, the state budget will be increased in investment, linked to the Health–Population Target Programme for the 2026-2035 period. Health insurance premiums will also be adjusted according to the roadmap, starting from 2027, while social policy beneficiaries will continue receiving state budget support.
Other financial sources are expected to be mobilised to support the policy, such as commercial insurance and taxes on products harmful to health.
Tran Thi Trang also noted that to prepare the roadmap for basic hospital fee exemption by 2030, the Ministry of Health completed a cost-effectiveness study on some healthcare services under the Project in November 2025, conducted impact assessments, and developed a policy report.
From 2026, people will be given periodic health check-ups or free screening at least once a year according to priority groups; this will be combined with student health check-ups, occupational health check-ups, and health insurance examination and treatment to create an all-people electronic health record system.
Priority groups include near-poor households and elderly persons aged 75 and above receiving social pensions, who will enjoy 100% of their healthcare costs covered within health insurance benefits.
The Ministry of Health will increase the rate and level of health insurance payments for medicines, medical supplies, and technical services; adjust health insurance premiums from 2027 to approximately 5.1%; and ensure state budget support for social policy beneficiaries.
From 2028–2030, the goal is to reduce out-of-pocket spending to below 30%, continue to increase the rate and level of health insurance payments for medicines, medical equipment, and technical services, pilot screening for two–three cost-effective diseases, allow Health Insurance Fund payment for disease preventive services, raise health insurance coverage to over 95% of the population, adjust health insurance premiums from 2030 to 5.4%, and pilot supplementary health insurance and diversify health insurance packages, including long-term care.
By 2030, health insurance coverage will cover 100% of the population, basic hospital fees will be exempt, reducing the burden of medical costs for people, and aiming for comprehensive, equitable, and high-quality health care for all.
