A recent amendment to Vietnam’s Health Insurance Act is bringing much-needed financial relief and improved access to healthcare for its citizens. This update expands coverage, reduces out-of-pocket expenses, and simplifies the process for accessing specialized medical care. For U.S. readers, this is akin to strengthening aspects of the Affordable Care Act (ACA) or expanding Medicare benefits.

Nguyen Tan L, a resident of Omon -gun Tuzu -gu, experienced the benefits firsthand. After a recent hospital stay at canto Central Hospital, Nguyen Tan L stated: “Recently, I had to be hospitalized for many days at Canto Central Hospital. Thanks to the health insurance, I received only about 10 million dong (VND) from the health insurance fund. if I didn’t have a health insurance card,I would have heard tens of millions of copies (VND) for treatment,and the family would have been really difficult…” This sentiment reflects the significant impact the amended law is having on families across Vietnam.

For context, 10 million VND is roughly equivalent to $400 USD. Without health insurance, Vietnamese families could face medical bills reaching thousands of dollars, a burden that can be financially devastating. This situation mirrors concerns in the U.S. where even with insurance, medical debt is a leading cause of bankruptcy.

Key Changes in the Amended Health Insurance Act

The revised law introduces several key improvements to the healthcare system:

• Nationwide Access to Primary Care: Health insurance subscribers can now access medical care and treatment at primary medical institutions across the country, regardless of their location. This is similar to the concept of a national network of providers in the U.S., ensuring greater accessibility for individuals living in rural areas or those who travel frequently.
• Expanded Coverage of Services: The guaranteed health checkup list now includes a broader range of services such as remote medical examination, home medical examination, home screening, rehabilitation, regular pregnancy screening, and childbirth. This proactive approach to healthcare aims to improve preventative care and early detection of illnesses, perhaps reducing long-term healthcare costs.
• Financial Support for Transportation: Health insurance subscribers are now eligible for reimbursement of patient transfer costs according to regulations.This provision addresses a critical need for individuals who require specialized care at facilities located far from their homes. It’s akin to covering ambulance services or travel expenses for patients who need to see specialists in different cities or states.
• Extensive Coverage of Medical Necessities: The Health insurance Fund now covers a wider range of medical technologies,drugs,blood,medical gas,medical supplies tools,and chemicals. This ensures that patients have access to the necessary resources for effective treatment without facing exorbitant out-of-pocket expenses.

The changes could be compared to expanding Medicare in the U.S.to cover more preventative services, like annual comprehensive check-ups with a broader array of screenings.Such changes aim at catching potential health issues early, leading to more effective and less costly treatments.

100% Coverage in Specific Cases

The amended law also provides 100% coverage for medical expenses in certain situations:

• Low-Cost Treatment: If the total cost of a single screening and treatment is below a specified threshold (351,000 VND, or about $14 USD), patients receive full coverage.
• Long-Term Health Insurance Subscribers: Individuals who have been enrolled in health insurance for more than five years and whose annual deductible exceeds a certain limit are also eligible for 100% coverage.
• Local Medical Facilities: Health insurance subscribers will be 100% guaranteed to receive medical treatment in facilities designated as local medical facilities before January 1, 2025.

These provisions aim to protect vulnerable populations and ensure that healthcare is affordable and accessible for all. In the U.S., similar provisions exist within Medicaid and other public assistance programs to provide healthcare coverage for low-income individuals and families.

Streamlined Access to Specialized Care

Starting in 2025, individuals with rare and severe diseases included in a list of 62 conditions published by the Ministry of Health will be able to access specialized hospitals without requiring a referral and still receive 100% health insurance benefits. This change eliminates a significant barrier to care for patients with complex medical needs.

This is similar to the “open access” plans offered by some U.S. insurers, which allow patients to see specialists without a referral from their primary care physician. The Vietnamese system goes a step further by ensuring 100% coverage for these specialized treatments.

“This policy not only shows the profound humanitarian meaning, but also helps patients to use high -quality medical services prompt, equally, and fair, and we can encourage people to be more convenient to join health insurance. I’m willing to join.”

Mrs. Letitu, the chairman of the Omon -gun Toyhoa Guatan A Regional Front Committee

Mrs. Letitu’s statement underscores the positive impact of the amended law on the community.By improving access to healthcare and reducing financial burdens, the new policy is encouraging more people to enroll in health insurance, ultimately strengthening the healthcare system as a whole.

Potential Challenges and Future Directions

While the amended health Insurance Act represents a significant step forward, there are potential challenges to consider.

• Implementation and Enforcement: Ensuring that the new provisions are effectively implemented and enforced across all healthcare facilities will be crucial. This requires clear guidelines,adequate training for healthcare providers,and robust oversight mechanisms.
• Sustainability of the Health Insurance Fund: Expanding coverage and increasing benefits may put a strain on the Health Insurance Fund. The government will need to carefully manage resources and explore options for sustainable financing to ensure the long-term viability of the system.
• Addressing Healthcare Disparities: While the amended law aims to improve access to healthcare for all, disparities may persist based on socioeconomic status, geographic location, and other factors. Targeted interventions might potentially be needed to address these disparities and ensure equitable access to care.

Moving forward, it will be significant to monitor the impact of the amended Health Insurance Act and make adjustments as needed. This includes gathering data on healthcare utilization, patient outcomes, and financial sustainability. By continuously evaluating and improving the system, Vietnam can ensure that its citizens have access to high-quality, affordable healthcare for years to come. Lessons from this vietnamese initiative could inform ongoing healthcare debates in the U.S. concerning access, affordability, and the role of government in ensuring healthcare for all citizens.