Vietnam has introduced significant changes to its health and social insurance regulations, including the removal of referral procedures for certain rare and serious diseases and new measures regarding medical examination and treatment.
The amendments, which were approved in November 2024 and January 2025, aim to enhance the accessibility and efficiency of health insurance services. These updates were discussed during a conference hosted by the Vietnam Social Security (VSS) on January 9, 2025. The event focused on new decrees, circulars, and key initiatives for the 2025 health insurance policy.
Among the key revisions are changes to the subjects of participation in health insurance, modifications to the contribution guidelines, and updates to medical examination and treatment protocols based on technical specializations. Notably, the referral process for certain rare and serious diseases has been eliminated, streamlining patient access to care.
The conference also addressed expanded responsibilities for the Ministry of Health (MOH), including the evaluation of the appropriateness of medical services provided under health insurance. Social security offices were also tasked with ensuring proper oversight of health insurance-related medical contracts.
New regulations discussed during the conference include the implementation of benefit rates for outpatient medical services at local healthcare facilities, allowing private medical establishments to apply the same health insurance rates as public facilities, based on the level of technical specialization. Additionally, a framework was introduced for paying medical service costs at state-owned healthcare institutions for services approved by relevant authorities but lacking official price listings.
Deputy Director General Nguyen Duc Hoa emphasized the importance of protecting the rights of health insurance participants, stressing the need for strict compliance with the Law on Health Insurance and related government decrees. He also urged the VSS to innovate and improve the medical claim review process, ensuring strict control over health insurance costs and preventing payments for non-compliant medical expenses.
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