Health insurance - the "shield" between patients and escalating medical costs
Since quitting his job at a furniture company in May 2025, Mr. Nguyen Van Thi (34 years old, Dong Nai) has been involved in interruptions in insurance. When his wife became pregnant and quit her job, the worry about hospital fees forced his family to recalculate. Through research, he knows that he can continue to participate in health insurance under the household registration form.
In August 2025, my wife and I proactively contacted the Social Insurance agency to extend the family health insurance. Since having a card, every time we go to a pregnancy check-up, we feel more secure because we have received significant financial support, said Mr. Thi.
Not only Mr. Thi's family, the demand for health insurance examination and treatment at end-of-line hospitals is increasing. At Ho Chi Minh City Oncology Hospital, thousands of patients come to see and receive treatment every day, many of which are transferred to severe cases to enjoy maximum health insurance benefits.
Patient H.T.T (8 years old, Gia Lai) with leukemia is a typical example. Although supported by health insurance and benefactors, treatment costs are still a big pressure.
Without health insurance, patients like mine will have a hard time maintaining treatment, the patients mother shared.
A representative of Ho Chi Minh City Oncology Hospital said that for patients with health insurance, the hospital still requires referral papers when coming for examination and treatment, except for cases in 62 groups of diseases that are allowed to be examined directly without a referral.
At K Hospital - a leading cancer treatment facility - it receives more than 2,000 patients every day.
Prof. Dr. Le Van Quang - Director of K Hospital - affirmed: "For cancer, without health insurance, the annual treatment cost will exceed the ability of many families. Health insurance truly has a profound sense of humanity and community sharing spirit".
In the case of Mr. Le Van Ben (65 years old, Phu Tho), who has had metastatic brain lung cancer since 2018, he underwent surgery, chemotherapy, radiotherapy and targeted treatment. Health insurance has helped him reduce hundreds of millions of VND in expenses - a figure far beyond his family's ability to pay.
According to statistics from Vietnam Social Insurance, each year the health insurance fund spends over 100,000 billion VND on medical examination and treatment (KCB). In 2024 alone, the country recorded more than 186 million medical examinations and treatment, with the fund paying more than 142,900 billion VND.
Health Insurance currently pays for more than 1,000 active drugs, hundreds of traditional medicine, many biological products, high-tech - including cancer drugs, rare diseases, cardiovascular diseases worth tens to hundreds of millions of VND.
Not only drugs, health insurance also covers more than 10,000 technical services, many equipment cost hundreds of millions such as robotics, heart rate machines, joint replacements, etc.
Students are also a group that is strongly "protected" by health insurance. In the first half of 2025, the country will have more than 4.3 million medical examinations and treatments with a total expenditure of nearly 1,770 billion VND. Notably, there were 20 cases where the fund paid from 200 million to 1 billion VND.
Reviewing the drug list - expanding benefits for patients
Ms. Tran Thi Trang - Director of the Department of Health Insurance, Ministry of Health - said: The Ministry of Health is soliciting opinions on the draft circular amending the list and rates, conditions for payment of health insurance drugs. The draft is very important because it directly affects the treatment rights of tens of millions of insurance participants. The drug list is developed from the recommendations of hospitals, pharmaceutical enterprises, management agencies, experts and voters' recommendations. Drugs must be safe - effective, at reasonable costs; for expensive drugs that greatly affect the fund, the Ministry of Health carefully considers the payment rate. Drugs included in the list must have a valid circulation registration number/ import license, no safety warning and must comply with treatment instructions.
During the review, the Department of Health Insurance considered 1,037 active ingredients in 3 years, aiming for the next 5 years. List of adjustments to the rate and conditions for payment for expensive drugs, elimination of drugs that are no longer in use, no more registration numbers, have warnings or are low in effectiveness; at the same time, choose effective drugs - optimal cost in the group of the same indication. The new list is expanded to include more drugs for rare diseases and diseases with few treatment options, helping doctors have more options and patients have easier access to drugs.
For drugs with very high treatment costs, the Ministry of Health offers the highest payment level within the fund's capacity. Notably, 14 businesses have committed to reducing drug prices through price negotiations, helping to reduce co-payment costs for patients. The Ministry of Health is also proposing a mechanism to support co-payment from the State budget for some types of drugs that are especially expensive, forming a 3-sided support model: health insurance - budget - pharmaceutical enterprises.
The new item helps reduce people's out-of-pocket expenses, many drugs that used to have to be self-paid are now fully or partially covered by health insurance. At the same time, more than 340 drugs have been expanded to the commune level, helping people access treatment closer, reducing travel costs" - Ms. Trang emphasized.
