Many emergency patients, patients with rare diseases or diseases requiring specialized treatment techniques are still required to return to lower levels to apply for referral letters, even though it is stipulated that this procedure is not required.
According to Vietnam Social Security (BHXH), in the past time, this agency has received many feedbacks from people about the fact that health insurance (BHYT) medical examination and treatment benefits have not been fully guaranteed at some medical facilities. Notably, many hospitals still require patients in emergency or groups that are not required to carry out referral procedures to present referral papers.
Faced with this situation, Vietnam Social Security has document No. 2166/BHXH-CSYT requesting local social insurance agencies to coordinate with medical examination and treatment facilities to comply with regulations, not to require emergency patients, people with rare diseases, dangerous diseases, diseases requiring surgery or using high technology and cases eligible for exemption from referrals to return to lower levels to complete referral procedures.
This move is assessed to significantly reduce waiting times, avoiding unnecessary procedures for patients who are in critical condition or need intensive treatment.
According to Circular No. 01/2025 of the Ministry of Health, from January 1, 2025, people with 62 diseases and disease groups when diagnosed and determined at qualified medical examination and treatment facilities can go directly to specialized medical examination and treatment facilities for treatment without a referral letter, and still fully enjoy health insurance benefits as prescribed.
This list includes many serious and rare diseases such as some types of cancer, blood diseases, cardiovascular disease, neurological disease, metabolic disorders, organ transplantation and many other diseases requiring intensive treatment.
In addition, Appendix II issued with the Circular also stipulates that 161 diseases and groups of diseases are examined and treated at basic-level facilities without a referral letter. Patients are still entitled to full benefits within the scope of health insurance benefits.
Not only related to referral procedures, Vietnam Social Security also recorded reflections on patients having to buy medicines, medical equipment themselves or self-pay some technical costs within the scope of payment of the Health Insurance Fund. Some medical facilities have not yet prescribed outpatient medication for more than 30 days for eligible cases.
Therefore, the social insurance agency requests localities to coordinate with medical examination and treatment facilities to ensure that patients are exempted from co-payment immediately at the hospital when they are eligible, and not to let patients have to pay an amount exceeding the prescribed level paid by the health insurance fund.
From July 1, 2026, the base salary will be increased to 2.53 million VND/month. People participating in health insurance who are eligible for co-payment exemption must have their rights resolved right away at the medical examination and treatment facility.
Vietnam Social Security also requests to strengthen the review of outpatient prescriptions for a maximum of 90 days for patients in the applied list, helping to reduce the number of re-examinations, save time, travel costs and contribute to reducing the burden on hospitals.
In particular, medical facilities must not allow patients to self-pay medical examination and treatment costs within the scope of payment by the Health Insurance Fund, except in cases where patients or legal representatives voluntarily choose services, drugs or medical equipment outside the fund's payment scope.
