New Outpatient Health Insurance Reimbursement Rules in Vietnam

Vietnam’s health insurance (BHYT) now covers 50% of the benefit amount for outpatient treatments of diseases not on the mandatory 100% coverage list, effective July 1. According to reports from Bao Lao Cai, this policy applies to basic-level medical facilities with a score over 50, temporary basic-level facilities, and specialized facilities categorized as provincial-level before January 1, 2025.

How does the new 50% outpatient reimbursement work?

Previously, patients seeking outpatient care for diseases not on the prescribed “100% coverage list” received no reimbursement. Now, the health insurance fund will cover 50% of the eligible benefit amount. This doesn’t mean the insurance pays half the total bill regardless of the patient’s plan; it means they pay 50% of what the insurance would have covered under the patient’s specific coverage level.

According to the health insurance authority cited by Bao Lao Cai, the calculation depends on whether the patient is in the 100% or 80% coverage group. For a 1 million VND bill:

• 100% Coverage Group: The insurance pays 500,000 VND (1,000,000 x 100% x 50%). The patient pays 500,000 VND.
• 80% Coverage Group: The insurance pays 400,000 VND (1,000,000 x 80% x 50%). The patient pays 600,000 VND.

Which medical facilities are eligible for this policy?

Not every clinic or hospital qualifies for these expanded reimbursements. The policy is strictly limited to three types of institutions, as reported by Bao Lao Cai:

1. Basic-level medical facilities with a score exceeding 50 points.
2. Facilities currently classified as temporary basic-level institutions.
3. Specialized facilities that held a provincial-level classification prior to January 1, 2025.

Patients can verify a facility’s status via the official website of the Ministry of Health’s Department of Medical Examination and Treatment, local health department portals, or the specific hospital’s website.

Why this shift in insurance coverage matters for patients

This policy marks a shift toward reducing the financial burden of outpatient care. By extending coverage to “non-listed” diseases, the system acknowledges that many chronic or unexpected conditions don’t fit into narrow categories but still require consistent medical attention. This likely aims to prevent patients from delaying treatment due to costs, which often leads to more expensive emergency care later.

Compared to the previous system—where the choice was either 100% coverage for specific lists or 0% for everything else—this “middle ground” provides a safety net for a wider range of medical issues. It effectively lowers the barrier to entry for specialized provincial-level care for those who previously couldn’t afford the full cost of outpatient visits.

What are the future trends for health insurance in Vietnam?

The expansion of outpatient benefits suggests a trend toward Universal Health Coverage (UHC). We are seeing a move away from rigid “disease lists” and toward a more flexible, benefit-based system. Future updates will likely focus on digitizing these “scores” and eligibility lists to allow patients to check coverage in real-time via mobile apps.

Industry experts suggest that as the health insurance fund evolves, more “provincial-level” services will be decentralized. This means more high-quality care will be available at the basic level, supported by these 50% reimbursement rules to keep the provincial hospitals from becoming overcrowded.

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