Vietnam: Is it mandatory to only get health insurance at registered hospitals?

Health insurance has been and is increasingly being expanded and applied by the state throughout Vietnam. But there are still many people wondering if they can get medical examination at facility A, while they register for health insurance at facility B?

According to current Vietnam’s regulations, holders of health insurance cards register for initial medical examination and treatment at commune medical examination and treatment establishments or general clinics or district hospitals are entitled to medical examination and treatment covered by health insurance at any commune health station or general clinic, or district hospital in the same province.

In addition, the holders of the health insurance card are also entitled to referral for medical examination and treatment according to regulations on professional and technical referrals between medical examination and treatment establishments and in accordance with the provisions of Circular No. 40/2015/TT-BYT and Circular 14/2014/TT-BYT of the Ministry of Health of Vietnam.

Specifically, appropriate referrals include:

1. Each holder of health insurance card who registered for initial medical services at a health facility of commune may take a referral to a hospital of district, including grade I, II hospitals of district and hospitals of traditional medicine of province (if the hospital of district has no department of traditional medicine).

2. Each holder of health insurance card may take a referral from a hospital of district, including grade I, grade II hospital and polyclinic hospital, specialized hospital, specialized institute, specialized center of province, to a specialized center of province or polyclinic hospital, specialized hospital, specialized institute of province at the same level or lower level.

3. Emergency cases:

- A patient shall be given emergency treatment at any health facility. The doctor or physician assistant receiving the patient shall assess the emergency conditions and record in the medical record.

- After emergency treatment, the patient shall be admitted as an inpatient to the receiving facility or referred to another health facility for continuing treatment at the specialist requirements or referred to the original facility upon his/her rehabilitation.

4. Moreover, when a holder of medical insurance card goes on a business trip, studies, works or resides temporarily for a period of under 12 months in another administrative division, he/she is eligible for medical services at a health facility in the administrative division at the same level with the initiating facility specified in his/her health insurance card. If that administrative division has no equivalent heath facility, the holder of health insurance card may choose another heath facility providing initial medical services.

The above are cases of referrals that are still determined to be the appropriate medical examination and treatment lines covered by health insurance. In case of inpatient treatment at a central hospital, 40% to 60% of the treatment cost will be paid. From that, it can be drawn that, if outpatient treatment goes beyond the level, they will not be entitled to health insurance.

The above-mentioned contents are detailed in Circular No. 40/2015/TT-BYT and the Law on Health Insurance 2008 amended in 2014 of Vietnam.

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