Health insurance increases benefits from July 1, patients still have many worries
From July 1st, expand benefits, adjust the level of health insurance benefits. However, many people are still concerned about procedures and drug availability.
Health insurance drug supply is unstable, patients suffer losses
Suffering from diabetes for nearly 20 years, every beginning of the month, patient D. T. M (75 years old, Cau Giay ward, Hanoi) has to maintain regular insulin injections to control blood sugar. Every month, Ms. M comes to E Hospital for examination and receipt of medicine under health insurance (HI). However, in the past 6 months, the type of insulin medicine she is using has continuously fallen into a state of supply shortage.
According to the patient's reflection, previously, each time she had a periodic check-up, she was given 5 bottles of insulin, enough for 2 months. However, recently, the hospital has repeatedly announced that the medicine is out of stock, forcing her to buy it outside to avoid interrupting the treatment process.
I have to buy insulin for about 320,000 VND per bottle. This is a significant expense for elderly people with limited incomes. What worries me is that the hospital only announces that the medicine is out of stock without specifying when it will be available again, and also without specific instructions on buying medicine outside in case insurance is still paid," Ms. M shared.
Ms. M also shared that although health insurance examination procedures have improved a lot recently, she and some neighbors still take turns getting numbers early to get an early examination. "People with diabetes who do not eat and drink on time are very likely to have hypoglycemia. If you don't get your registration number early, you have to wait until almost noon to get an examination, it's very tiring," Ms. M said.
The prolonged shortage of health insurance drugs not only causes economic difficulties for patients but also raises concerns about the ability to access continuous treatment drugs, especially for patients with chronic diseases that require daily medication such as diabetes.
Mr. T.Q. K (45 years old in Vinh Hung ward, Hanoi) is concerned about using health insurance when removing crooked wisdom teeth: The patient has been examined at a public hospital under the Hanoi Department of Health and has health insurance, but after being diagnosed with tooth number 8 growing 90 degrees crooked, the hospital scheduled to remove it 10 days later. Notably, only one tooth is performed each time, causing the treatment time to be prolonged.
Because I have to wait quite a long time, I am learning about the cost of tooth extraction according to service at other facilities," Mr. K said.
Over-the-line mentality still exists
Waiting for surgery procedures at Viet Duc Friendship Hospital, Ms. Hoi (63 years old in Ninh Binh province) recounted: She had a severed shoulder tendon and was prescribed endoscopic tendon reattachment surgery by a doctor at a lower-level hospital. However, because she was not really assured of the quality of treatment, she requested to be transferred to a higher-level hospital.
Although the lower-level hospital is not far from home, while the final-level hospital is nearly 100km away, her children still advised her mother to be treated at a larger medical facility. The family accepted long travel, costly and time-consuming care, as well as facing overload and long waiting, with the desire for her to be treated in the best conditions.
Lack of confidence in the treatment capacity of lower levels is one of the common reasons why many patients apply to transfer to upper levels, even though local hospitals are fully capable of treatment," Dr. Duong Duc Hung, Director of Viet Duc Hospital, once shared about the situation of exceeding levels.
According to him, many patients in provinces want to transfer to large hospitals in Hanoi or Ho Chi Minh City because they have children and relatives living and working here, which is convenient for care during treatment. Besides, many people believe that upper-level hospitals have better medicines, more modern equipment and more tests and diagnostic imaging are performed.
Dr. Hung said that in reality, there are cases that only have appendicitis but still want to go to central hospitals to wait for surgery, while this is a technique that many district-level hospitals have implemented regularly and effectively.
Expanding benefits, adjusting health insurance benefits from July 1, 2026
Ms. Tran Thi Trang - Director of the Health Insurance Department (Ministry of Health) - said that from July 1, 2026, health insurance participants will have their benefits expanded in some cases of out-of-zone medical examination and treatment.
When performing outpatient examinations outside the tuyến at basic or specialized hospitals (formerly provincial tuyến), the health insurance fund will pay 50% of the benefit level according to the rights of the patient. For example, people with 100% benefit level will be paid 500,000 VND by health insurance on the total examination cost of 1 million VND; people with 80% benefit level will be paid 400,000 VND.
In addition, for medical examinations and treatments with total costs below 15% of the base salary (currently equivalent to 379,500 VND), patients who are examined at the right level will be fully reimbursed by the health insurance fund.
For cases of out-of-line examination, the benefit level is calculated according to the ratio stipulated by the Law on Health Insurance. Notably, this payment is calculated directly on the total cost of medical examination and treatment, without having to apply an additional co-payment ratio by group of subjects as before, helping patients significantly reduce the amount to be self-paid.
In addition, the base salary increase to 2.53 million VND/month also entails many higher health insurance benefits. Patients are paid 100% of the costs by the health insurance fund if the total cost of one-time medical examination and treatment is less than 379,500 VND. People who have participated in health insurance continuously for 5 years or more are also entitled to 100% of the costs within the scope of benefits when the amount paid together in the year exceeds 15.18 million VND.
The HI Fund will pay medical equipment costs for one technical service implementation of a maximum of 113.85 million VND. The new regulation also clarifies the level of direct payment in some special cases, ensuring the rights of patients in accordance with the fund's ability to pay.
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