I thought from July, medical examinations anywhere would be paid by health insurance
Ms. Nguyen Thi Lan (56 years old, from Ninh Binh) holding a health insurance card and personal papers came to Central Military Hospital 108 for a digestive examination because recent episodes of abdominal pain occurred continuously.
Previously, I read information on social networks about that from July 1st, people with health insurance are entitled to medical examination and treatment outside the tuyến and still enjoy benefits. Thinking that the new regulation means that they can go to any hospital for examination without a referral letter. During the summer vacation, I came from my hometown to visit my children and grandchildren, so I took advantage of going for a health check-up," Ms. Lan said.
When I arrived at the procedure place, it was explained that my case was not covered by health insurance because this hospital is not an initial registered facility or a facility applied according to the new regulations. In the end, I had to pay the entire examination fee myself," Ms. Lan shared.
Not only Ms. Lan, but also many patients in the reception area expressed surprise when medical staff explained the scope of application of the policy.
Mr. Tran Van Hung (58 years old, Hung Yen) said that he heard an acquaintance say "from July, wherever you go for examination, you will be paid by health insurance", so he decided to go to a higher-level hospital for regular heart check-ups.
I did not research the document carefully, I only heard people say that. Coming here, I learned that the regulation does not apply to all hospitals and all outpatient examinations," Mr. Hung said.
Many people expect to reduce the burden of costs
For many years, Ms. Nguyen Thu Nga (Hong Ha ward, Hanoi) has still had periodic check-ups for high blood pressure and bone and joint diseases at Thanh Nhan Hospital. Although fully participating in health insurance, she has to self-pay all costs due to outpatient examinations outside the tuyến.
From July 1, 2026, outpatients who do not need a referral form will be paid 50% of the benefit level by the Health Insurance Fund, she is very excited.
People will have more choices of suitable medical facilities without worrying about losing all health insurance benefits as before," Ms. Nga said.
Dr. Nguyen Van Thuong - Director of Thanh Nhan Hospital - said that each day the hospital receives about 1,500 outpatient visits and more than 1,100 inpatients, of which outpatients account for about 25%. From July 1, when the new policy took effect, this rate increased to 30-35%, mainly from neighboring localities of Hanoi.
To avoid overload, the hospital has reviewed the clinic system, ready to expand when needed; strengthened human resources, stockpiled medicines and medical supplies. At the same time, the reception team, nurses, and doctors are trained on the new regulations of the Health Insurance Law to provide unified advice to patients.
The hospital also upgraded its information technology system, connecting the national HI database to automatically determine the benefit level and paid costs, shortening the time to complete procedures. Currently, the unit has the capacity to handle about 2,000 visits per day.
Not every out-of-zone examination is entitled to 50% health insurance
Many patients are understanding that from July 1, 2026, when coming for outpatient examinations at specialized hospitals, the Health Insurance Fund will pay 50% of the benefit level. A representative of Military Central Hospital 108 said that this does not apply to the Hospital.
According to Clause 4, Article 19 of Decree 188/2025/ND-CP from July 1, 2026, people participating in health insurance when examining and treating outpatients at specialized level medical examination and treatment facilities will be paid 50% of the benefit level by the health insurance fund. However, this regulation only applies to facilities that are specialized level; before January 1, 2025, they were identified as provincial levels according to the old line-based system.
Central Military Hospital 108, although belonging to the specialized level, before January 1, 2025, the hospital was not identified as a provincial-level hospital according to the line-based system of the Health Insurance Law. Therefore, the regulation on the 50% benefit level when outpatient examination is not applied.
Hospitals applying the policy include Huu Nghi Hospital, Central Forensic Psychiatric Institute (Hanoi); Central Mental Hospital II, Bien Hoa Central Forensic Psychiatric Institute (Dong Nai); Central Hospital 71, Central Rehabilitation Nursing Hospital (Thanh Hoa).
In addition, there are Hue Central Hospital facility 2, Vietnam - Cuba Dong Hoi Friendship Hospital, Quy Hoa Central Leprosy and Dermatology Hospital, Central Hospital 74, Quynh Lap Central Leprosy and Dermatology Hospital, Institute of Marine Medicine, Quang Nam Central General Hospital and many practice hospitals of medical and pharmaceutical universities and 4 hospitals under the Ministry of Public Security including Hospitals 19-8, 30-4, 199 and Traditional Medicine Hospital.
