Vietnam Expands Health Insurance Benefits for Outpatients from July 1

Vietnam is set to implement new health insurance regulations on July 1, significantly enhancing benefits for patients, particularly concerning outpatient care. These updated rules aim to broaden access to medical services and reduce out-of-pocket expenses for insured individuals.

A key change allows for a 50% reimbursement of medical expenses in specific outpatient scenarios. Previously, full reimbursement was only available for basic-level outpatient visits or specialized care within designated categories. Other outpatient treatments received no coverage. The new policy expands this coverage, ensuring that even when seeking care outside of initial registration areas or without proper referral, patients can still receive partial reimbursement.

However, this 50% coverage is not universal. It applies only to specific types of healthcare facilities and diagnoses, and depends on the individual's insurance coverage scope. The Vietnam Social Security administration has outlined criteria for facilities eligible for this reimbursement, including basic-level facilities previously designated as provincial or central level, and specialized facilities previously designated as provincial level. Facilities scoring between 50 and 70 points in professional capacity assessments are also included, with exceptions for those previously designated as district level.

Officials emphasize that the "50% reimbursement" refers to 50% of the individual's insurance benefit, not 50% of the total treatment cost. For example, an individual with an 80% insurance benefit would receive 50% of that 80% for eligible treatments. This nuanced approach aims to balance expanded coverage with financial sustainability.

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50% reimbursement is not 50% of the total medical examination and treatment cost, but 50% of each person's insurance benefit and only within the scope of payable costs.