Organized by the Ministry of Health (MOH), a seminar on December 1 focused on guidelines for a project to gradually implement the Universal Free Healthcare Policy under the Politburo’s Resolution 72. Many opinions on the financial resources needed to realize the policy were offered. 

This was the first time that MOH had invited experts to discuss the financial foundation for periodic checkups and universal hospital fee waivers.

Tran Thi Trang, Director of the MOH’s Health Insurance Department, said the financial burden of medical costs remains high, with citizens still paying out-of-pocket for about 40 percent of total healthcare costs. The portion not covered by the Health Insurance Fund is estimated at VND24.800 trillion per year.

“Universal hospital fee waivers will be limited to a basic service package and will expand gradually depending on available resources,” Trang said.

Nguyen Khanh Phuong, Director of the Health Strategy and Policy Institute, added that if in 2027 Vietnam increases health insurance coverage to 100 percent for near-poor households and people aged 75 and above, the Health Insurance Fund will need to spend an additional VND2.700 trillion per year. 

By 2030, waiving basic hospital fees for all citizens is expected to cost VND21.500 trillion per year, equivalent to what citizens are projected to pay out-of-pocket in 2024.

The drafting agency has set out a roadmap for implementing universal free healthcare in 3 phases: 2026–2027; 2028–2030; and after 2030.

Specifically, in 2026–2027, citizens will receive free periodic health check-ups or screenings once a year, and the entire population will have an Electronic Health Record. The near-poor group and people aged 75 and above will be covered for 100 percent of medical examination and treatment costs within the scope of Health Insurance.

The 2028–2030 phase aims to reduce out-of-pocket expenditure to below 30 percent, with screening for common diseases, and increase Health Insurance Coverage to over 95 percent. 

After 2030, the system will move towards Universal Free Healthcare within the Essential Service Package, expanding further as resources permit, while operating a smart, multi-tiered, and modern Health Insurance Payment System.

Funding sources

Deputy Minister of Health Vu Manh Ha said that hospital fee waivers must be built on the main pillar of the Health Insurance system, supported by the state budget, and implemented through a clear roadmap. 

Both the state budget and the Health Insurance Fund will cover basic and essential healthcare costs to minimize the financial burden on citizens, especially vulnerable groups, low-income individuals, and social policy beneficiaries.

Ha stressed that the fee-waiver policy must align with the goal of universal health insurance coverage, ensuring everyone participates to share risks: healthy people supporting the sick, those with resources supporting those without, together with contributions from the state and society.

Trang noted that relying solely on the state budget would make the policy unsustainable. Regardless of whether hospital fees are waived, Vietnam must still increase health insurance contributions to meet rising healthcare demands, as current contribution levels are low. 

Rapid changes in Vietnam’s disease patterns are increasing the proportion of out-of-pocket spending, requiring the Health Insurance Fund to be stronger.

To ensure stable financing, Phuong proposed diversifying revenue sources. In addition to raising heath insurance contribution rates from 4.5 percent to a maximum of 6 percent, part of the luxury tax collected from health-harming products such as cigarettes and alcohol could be allocated to support the policy.

Phuong also emphasized that hospital fee waivers must be limited to the basic service package with clear expenditure ceilings to avoid destabilizing the Health Insurance Fund. Additional resources, such as commercial health insurance and public–private partnerships in healthcare, should also be mobilized to ensure the long-term sustainability of universal hospital fee waivers.

As of the end of 2024, Vietnam had 13,395 medical facilities nationwide, including 1,665 hospitals. The number of hospital beds per 10,000 people is 34. The average life expectancy is 74.7 years, with 65.4 years of healthy life expectancy. Health insurance coverage is 94.29 percent of the population (equivalent to 95.525 million people).

Nationwide medical examinations and treatments reached 183.6 million visits, an increase of 9.7 million visits (5.6 percent) compared to 2023. About 40 million people use health insurance services regularly, averaging 4.5 visits per year. 

Total nationwide health insurance expenditure exceeded VND139.000 trillion, an increase of more than VND18.000 trillion compared to 2023.

Vo Thu