Roadmap for implementing the free hospital policy: Increasing equity in access to health services

Although the health insurance coverage rate in our country has reached 94.2% by 2024 and the medical examination and treatment network has been expanded to the commune level, people's out-of-pocket expenditure still accounts for more than 40% of total health expenditure. Therefore, the policy of exempting hospital fees is an objective and necessary requirement to ensure people's right to health care.

Free hospitalisation will promote the sustainable development of the healthcare system, reducing the risk of people delaying or abandoning treatment due to costs. (Illustration photo)

Removing financial barriers - patients will be examined and treated sooner and more effectively

At the workshop to collect opinions on the orientation of the Project to gradually implement the hospital fee exemption policy recently organized by the Ministry of Health , Permanent Deputy Minister of Health Vu Manh Ha said that by 2024, Vietnam's health insurance coverage rate will reach 94.29% of the population. The medical examination and treatment network is widespread down to the commune level, the professional capacity of the specialized, basic and initial levels has been significantly improved; the list of drugs and medical equipment within the scope and benefits of patients with health insurance cards is increasingly expanded.

However, people's out-of-pocket spending accounts for over 40% of medical examination and treatment costs, still at a high level according to the World Health Organization's recommendations.

At the same time, the risk of impoverishment due to illness still exists, especially for the poor, vulnerable groups, people with chronic diseases or long-term treatment. The financial pressure on households will be greater if there is no strong solution from public policy.

Therefore, the policy of gradually moving towards free hospital fees is an objective and urgent requirement, both demonstrating the good nature of Vietnam's social policy system and ensuring the people's right to health care.

According to Deputy Minister of Health Vu Manh Ha, the policy of exempting hospital fees helps increase fairness in access to medical services and reduces the risk of people abandoning treatment.

According to Permanent Deputy Minister Vu Manh Ha, the free hospital policy is not only a financial solution for healthcare, but also has profound social and humanitarian significance such as: reducing the financial burden for people, especially the poor and vulnerable groups; increasing equity in access to healthcare services, ensuring "no one is left behind"; improving the quality of healthcare. When financial barriers are removed, patients will be examined and treated sooner and more effectively; promoting the sustainable improvement of the healthcare system, reducing the risk of people delaying or abandoning treatment due to costs.

The Deputy Minister of Health said that in the world, many countries have applied free health care policies or universal health insurance and achieved positive results, such as reducing the rate of medical poverty, increasing access to services, effectively controlling diseases and reducing late treatment costs. These are experiences worth referencing for Vietnam to build a model suitable to the development conditions, resources and structure of the domestic health system.

Accordingly, this policy must still be based on the pillar of health insurance, with support from the state budget, and implemented with a roadmap. The state budget and the Health Insurance Fund will cover basic and essential medical expenses, minimizing the financial burden on people. First of all, social policy beneficiaries, the disadvantaged, low-income people and some other priority groups. For on-demand medical services that exceed the basic level, patients still have to pay a part to raise awareness of using services reasonably and saving costs.

“The free hospital policy must therefore be closely linked to universal health insurance coverage. Everyone participates in health insurance to share risks, the well-off take care of the poor, the healthy help the weak; along with support from the state budget and socialized resources so that patients do not have to pay extra costs when they are unfortunately sick,” Deputy Minister Vu Manh Ha emphasized.

Develop specific basic health care service packages and expected roadmap

According to Ms. Tran Thi Trang, Director of the Department of Health Insurance (Ministry of Health), in 2024, the whole country will have 183.6 million medical examinations and treatments, an increase of 5.6% compared to 2023; there will be about 40 million people with regular health insurance examinations, on average each person will go for medical examinations and treatments about 4.5 times/year; the cost from the Health Insurance Fund is about 140,000 billion VND.

"According to the system of 4 health care levels decentralized before 2025, although the number of health insurance examinations and treatments at the district level is the highest, the expenditure at the provincial level is the highest. At the provincial level, there are an average of about 6.8 million medical examinations and treatments per year, but the proportion of expenditure from the Health Insurance Fund accounts for 1/5 of the total expenditure," said Ms. Trang.

In particular, the burden of medical costs on people is still large, the co-payment rate of some subjects is estimated at 21,905 billion VND; the part that the Health Insurance Fund has not paid is estimated at 24,800 billion VND.

Ms. Tran Thi Trang, Director of the Department of Health Insurance (Ministry of Health) said that a basic health service package within the free scope will be clearly defined, including a list of services, diseases, drugs, and medical equipment.

According to the Director of the Health Insurance Department, the scope of this free hospital policy is built on the foundation of universal health insurance. Co-payment rates will be gradually reduced and eventually eliminated in many basic service groups.

A basic free health service package will be clearly defined, including a list of services, diseases, drugs, and medical equipment. Covering common diseases, prioritizing necessary diseases first, gradually expanding the scope according to professional requirements suitable to the state budget capacity, the Health Insurance Fund, combined with social mobilization. At the same time, building a maximum cost for one medical examination and treatment.

Specifically, the average cost of inpatient/outpatient medical examination and treatment nationwide is adjusted annually or periodically, except for some diseases and techniques with high costs. In the near future, it is expected to be applied at primary and basic medical examination and treatment facilities, public and private medical examination and treatment facilities.

This will be a service package that people can enjoy for free within the scope of insurance, while on-demand services will be contributed by patients to avoid wasteful use.

Accordingly, the state budget will be increased in investment, linked to the Health-Population Target Program for the period 2026-2035. Health insurance premiums will also be adjusted according to the roadmap, starting from 2027, for social policy groups that will continue to receive budget support.

Other resources are also expected to be mobilized to implement this policy such as trade insurance, taxes on products harmful to health, etc.

Ms. Tran Thi Trang also said that to prepare the roadmap for basic free hospital fees by 2030, the Ministry of Health has completed the cost-effectiveness study of a number of health services within the scope of the Project in November 2025, organized impact assessments and developed policy reports.

Accordingly, from 2026, people will be given periodic health check-ups or free screening at least once a year according to priority groups; in coordination with health check-ups for students, occupational disease check-ups and health insurance examination and treatment to establish a national electronic health book.

Priority groups include near-poor households and the elderly aged 75 and over who receive social pension benefits and receive 100% coverage of medical examination and treatment costs within the scope of health insurance benefits.

The Ministry of Health increases the rate and level of health insurance payment for drugs, medical supplies, and technical services, adjusts the health insurance contribution rate from 2027 to about 5.1%, and the budget supports social policy beneficiaries.

In the 2028-2030 period, the goal is to reduce out-of-pocket spending to below 30%, continue to increase the rate and level of health insurance payments for drugs, medical equipment, and technical services, pilot cost-effective screening for 2-3 diseases, pay from the Health Insurance Fund for disease prevention services, increase health insurance coverage to over 95% of the population, adjust health insurance contributions from 2030 to 5.4%, pilot supplementary health insurance, and diversify health insurance packages, including long-term care.

By 2030, health insurance will cover all people, exempt basic hospital fees, reduce the burden of medical costs, and move towards comprehensive, equal, and quality health care.

MINH HA

Source: https://nhandan.vn/lo-trinh-thuc-hien-chinh-sach-mien-vien-phi-tang-cong-bang-trong-tiep-can-dich-vu-y-te-post927439.html