Is hemodialysis covered by insurance in Vietnam?

Hello, the Lawnet would like to answer as follows:

1. Is hemodialysis covered by insurance in Vietnam?

According to Article 1 of Circular 35/2016/TT-BYT, the list of medical technical services within the scope of insurance payments for health insurance participants include:

- The lists of technical qualifications related to medical examination and treatment issued together with the Circular 43/2013/TT-BYT (amended by Circular 21/2017/TT-BYT);

- The lists of classification of surgery and procedures issued together with the Circular No.50/2014/TT-BYT promulgated by the Minister of Health;

- Medical services that have been approved to be provided in medical facilities by the Minister of Health but have not been prescribed in the Circular 43/2013/TT-BYT or the Circular 50/2014/TT-BYT, Circular 21/2017/TT-BYT.

- Lists of certain medical services with the specific coverage, coinsurance percentages or payout limits issued together with Circular 35/2016/TT-BYT include:

+ The list No.1 including medical services with specific coverage, coinsurance percentages and payout limits;

+ The list No.2 including medical services with specific coverage;

+ The list No.3 including medical services not covered by health insurance.

Hemodialysis technical services include: Emergency hemodialysis, Adsorption hemodialysis with resin dialyzers and Ultrafiltration hemodialysis (Offline Hemodiafiltration: HDF ON - LINE) are in list 1 and list 2 of Circular 35/2016/TT-BYT, therefore, patients will be covered by the health insurance fund for medical examination and treatment costs covered by health insurance within the scope of benefits received when receiving dialysis according to these technical services.

Currently, Appendix III, issued with Circular 22/2023/TT-BYT, stipulates that the cost of continuous dialysis, excluding the dialyzer, wire set, and dialysate, is 2,248,000 VND.

2. Benefit levels of health insurance in Vietnam 2024

According to Article 22 of the Law on Health Insurance 2008 (amended in 2014), the benefit levels of the insured receiving medical examination and treatment in accordance with the regulations in Articles 26, 27 and 28 of the Law on Health Insurance 2008 whose medical examination and treatment expenditures are covered by the health insurance fund shall be:

- Total medical examination and treatment expenditures with regard to the insured prescribed in points a, d, e, g, h and i Clause 3 Article 12 of Law on Health Insurance 2008 (amended in 2014). The costs of the non-covered medical services of the insured prescribed in point a Clause 3 Article 12 of Law on Health Insurance 2008 (amended in 2014) shall be paid by the health insurance budget used for medical examination and treatment of these insured persons; if this budget is insufficient, the State budget shall be in charge.

- Total medical examination and treatment expenditures with regard to any medical examination and treatment at commune hospitals whose cost is lower than the cost prescribed by the Government.

- Total medical examination and treatment expenditures with regard to the at least 5-year-insured whose medical examination and treatment expenditures exceed the total amount of the base salaries in 6 months, except for the insured who go to the hospitals different from the registered hospitals;

- 95% of the medial examination and treatment expenditures with regard to the insured prescribed in point a Clause 2, point k Clause 3 and point a Clause 4 Article 12 of Law on Health Insurance 2008 (amended in 2014);

- 80 % of the medial examination and treatment expenditures with regard to other insured persons;

- In case an insured person belongs to different groups of the insured, (s)he shall be provided with the highest health insurance benefits.

3. Out-of-network health insurance benefits in Vietnam in 2024

Pursuant to Article 22 of the Law on Health Insurance 2008 (amended in 2014), in case any card holder goes to a hospital different from the registered hospital except for the insured prescribed above, his or her costs shall be covered by the health insurance fund according to the benefit levels as prescribe as follows:

- 40% of the inpatient treatment expenditures at the central hospitals.

- 10% of the inpatient treatment expenditures at the provincial hospitals.

- 100% of the medical examination and treatment expenditures at the district hospitals.

* Note: Off-line health insurance benefits according to Article 22 of the Law on Health Insurance 2008 (amended in 2014) will not apply to ethnic minorities and people from poor households participating in health insurance who are living in areas with difficult socio-economic conditions or areas with extremely difficult socio-economic conditions; health insurance participants living in island communes and island districts go for medical examination and treatment at the wrong level.

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