Pilot health insurance coverage for disease prevention and cancer screening services

The Ministry of Finance will coordinate with the Ministry of Health to prepare a pilot health insurance policy to cover some disease prevention and early detection services according to the roadmap.

Thanks to early detection and treatment, the cost of treatment, travel, and temporary accommodation is saved compared to when the disease is severe, while reducing the patient's co-payment costs.

The Ministry of Finance has just issued Plan No. 3795 to implement Resolution 282 of the Government on the action program to implement Resolution 72 of the Politburo , aiming to deploy a number of breakthrough solutions to strengthen the protection, care and improvement of people's health.

According to the plan, the Ministry of Finance emphasizes the need to shift from a mindset focused on medical examination and treatment to proactive disease prevention, focusing on protecting, caring for and improving comprehensive health, continuously throughout the life cycle. At the same time, correctly identifying the position and role of preventive medicine , primary health care and traditional medicine.

The Ministry of Finance requested that units under the Ministry coordinate with the Ministry of Health, along with ministries, branches and localities, to pilot health insurance coverage for a number of disease prevention services, diagnosis and early treatment of a number of diseases for priority subjects according to the roadmap.

According to experts, if implemented effectively, people will receive financial support when using services such as chronic disease screening, early cancer detection tests, etc. These are services that are inherently expensive and often make many people reluctant to use them.

Early detection of diseases helps increase people's financial security through early detection and treatment, saving on treatment, travel, and temporary accommodation costs compared to when the disease is severe, while reducing co-payment costs for patients.

This policy also helps save costs for the health insurance fund thanks to early detection and timely treatment, reducing the cost of late-stage disease treatment and effectively solving health and social problems.

Previously, in documents sent to the Ministry of Health, voters in many localities proposed adding some common cancers such as thyroid, cervical, breast... to the list of screening diseases covered by health insurance.

Minister Dao Hong Lan said that the Ministry of Health recorded voters' opinions to synthesize and research additional services covered by health insurance, including cancer screening, to expand benefits for health insurance participants.

This supplement requires comprehensive research on related aspects such as contribution levels, benefit levels, service management to prevent abuse and profiteering, as well as ensuring harmony between preventive services guaranteed by the state budget and medical examination and treatment costs paid by the health insurance fund.

In 2023, the cost of treatment for 6 common cancer groups (breast, lung, liver, colon, stomach and prostate) from the health insurance fund is 6,186 billion VND.

The average cost of treatment for a cancer patient is about 176 million VND per year, according to statistics from K Hospital. For severe, complicated cases, the amount can be many times higher.

Not only stopping at piloting health insurance to pay for disease prevention services, the Ministry of Finance and other ministries and branches are preparing many support solutions to bring the proactive health care model into life.

First of all, the Ministry of Finance prioritizes budget allocation for preventive medicine and primary health care so that people can access vaccination, screening and regular check-up programs.

At the same time, the Ministry of Finance and the Ministry of Health will coordinate to develop a project to improve the efficiency of using the health insurance fund, along with reforming administrative procedures and saving management costs to increase direct spending on medical examination, treatment and disease prevention services.

A policy of exempting hospital fees for the poor and disadvantaged will also be considered, to protect vulnerable groups in terms of health and finances.

Regarding health insurance examination and treatment, from July 1, 2025 to October 17, 2025, Vietnam Social Security will receive all electronic data from medical facilities to ensure the synchronization, consistency and accuracy of common data nationwide.

The new list of subject codes clearly stipulates health insurance benefits for each specific case. Accordingly, patients who are examined at the original registered place will receive 100% of the cost within the scope of health insurance benefits.

People examined at other primary health facilities such as health stations, family medicine clinics, military and civilian medical clinics... are still entitled to 100% of the cost, regardless of the benefit level stated on the health insurance card.

In addition, patients who receive medical examinations based on referrals or follow-up appointment cards, organ donors, and newborns treated immediately after birth are also entitled to 100% of the costs.

In case outpatients at basic medical facilities score from 50 to under 70 points, from July 1, 2026, they will enjoy 50% of the cost; before this time, this group was not entitled to health insurance.

Patients who are not examined at the right central facility will only receive 40% of inpatient costs, and will not be paid for outpatient costs. In emergency cases, ethnic minorities and poor households living in difficult areas and island communes will receive 100% of health insurance costs.

In cases of receiving medicine according to an appointment, the authorized person receiving the medicine or when the medical facility delivers medicine to the patient in the event of a group A epidemic or force majeure situation, the patient is still guaranteed to receive 100% of the cost of medical examination and treatment according to regulations.

The Ministry of Health also noted that the code of the patient coming for medical examination and treatment will be determined by the medical facility after the examination or treatment process is completed and sent to the Social Insurance Agency's Data Receiving Portal in XML data format. In case a patient belongs to many groups, the medical facility will select the code in order of priority from top to bottom in the prescribed list.

Source: https://baodautu.vn/thi-diem-bao-hiem-y-te-chi-tra-dich-vu-phong-benh-va-tam-soat-ung-thu-d435145.html