Implementing universal health insurance in the new stage

Directive No. 52-CT/TW was issued by Mr. Tran Cam Tu, Politburo member and Standing Secretary of the Secretariat. The content of the Directive states clearly:

After 15 years of implementing Directive No. 38-CT/TW dated September 7, 2009, of the 10th Secretariat on "Strengthening health insurance in the new context" (Directive No. 38), health insurance has achieved significant results, gradually becoming a fundamental pillar of the social security policy of the Party and the State, contributing to the implementation of the principle of sharing and financial assurance in the work of protecting, caring for, and improving the health of the people; awareness of the position, role, and significance of health insurance policy among party committees, party organizations, authorities, and the people has been enhanced; the system of policies and laws on health insurance has been gradually improved; state management of health insurance and management of the Health Insurance Fund has been emphasized; by the end of 2024, health insurance coverage reached 94.29% of the population; the application of information technology and digital transformation in the field of health insurance has been invested in and has initially shown effectiveness; the quality of medical examination and treatment under health insurance has shown positive changes; basic health indicators of the population and the community have improved.

However, the implementation of Directive No. 38 still faces shortcomings and limitations; some party committees, party organizations, and authorities have not paid adequate attention in leadership, direction, inspection, supervision, and resolution of obstacles in health insurance work; propaganda and advocacy in some areas remain formalistic and ineffective; mechanisms and policies are not yet synchronized, lack strategic vision, and have not resolved existing bottlenecks; coordination among relevant ministries and sectors is at times not tight and irregular; health insurance coverage remains unsustainable; health insurance appraisal and reimbursement for medical examination and treatment still face difficulties; the methods of health insurance payment have not been fully issued in accordance with the provisions of the Law on Health Insurance; the quality of medical examination and treatment under health insurance at grassroots health facilities and in remote, isolated, and particularly difficult areas does not meet requirements. Investment in information technology infrastructure to serve the interconnection of health insurance data is still slow…

The main causes of the above-mentioned shortcomings and limitations are due to the awareness of some party committees, authorities, and a portion of the population, workers, and enterprises regarding their obligations, rights, and responsibilities toward health insurance not being high; health insurance policies are not yet synchronized; infrastructure, equipment, and the professional capacity of health staff at grassroots levels do not meet the healthcare needs of the people; agencies and organizations implementing health insurance policies and some healthcare facilities have not fully exercised their roles, responsibilities, and coordination; health insurance contributions remain low, and the prices of medical services are not fully calculated.

To implement universal health insurance in the new phase, the Secretariat requires party committees, party organizations, authorities, and mass organizations at all levels to thoroughly grasp and effectively carry out the following tasks and measures:

Party committees, party organizations, and authorities at all levels shall strengthen leadership and direction to effectively implement policies, laws, programs, and plans on health insurance; regard this as a regular, continuous, and long-term political task and incorporate health insurance coverage targets into annual and long-term socio-economic development resolutions, programs, and plans; ensure close and synchronized coordination among state management agencies in implementing health insurance policies; focus on expanding health insurance participation and promoting household-based health insurance coverage. The State shall continue to increase support for health insurance contributions for policy beneficiaries, people in poor and near-poor households, persons with disabilities, and vulnerable groups, ensuring sustainable maintenance and increasing the proportion of the population participating in health insurance; by 2026, health insurance coverage shall reach over 95% of the population, and by 2030, achieve universal health insurance coverage.

2. Focus on amending, supplementing, and improving the system of policies and laws on health insurance to achieve the goal of universal health insurance coverage; study raising health insurance contribution levels in line with the expansion of benefits and entitlements; pilot and diversify health insurance packages and supplementary health insurance according to the needs of the population; strengthen linkage and cooperation between health insurance and health insurance provided by private insurance companies to avoid overlapping medical cost reimbursements; encourage and create favorable conditions for the development of diverse types of health insurance; mobilize, diversify, and expand revenue sources to ensure sustainability and develop the Health Insurance Fund to serve the work of protecting, caring for, and improving the health of the people.

From 2026, gradually implement increases in the rate and level of expenditures for disease prevention, early diagnosis, and treatment of certain diseases and priority groups in line with the roadmap for raising health insurance contributions and the financial capacity of the Health Insurance Fund. This includes expanding the scope of health insurance coverage for certain preventive healthcare services, nutrition, chronic disease management, periodic health check-ups, and screening according to professional requirements; study the mechanism for using part of the funds from tobacco control, alcohol, and sugary beverage taxes to cover certain preventive services, chronic disease management, periodic health check-ups, screening, diagnosis, and early detection of certain diseases, especially non-communicable diseases.

Innovate the content, forms, and methods of communication, propaganda, dissemination, and thorough implementation of the Party’s guidelines and the State’s policies and laws on health insurance, focusing on key points and tailored to each target group, in order to raise awareness and responsibility of all levels, sectors, mass organizations, institutions, and the people regarding health insurance; create a strong shift in participation in health insurance, establishing that participation in health insurance is both a right and a responsibility of every citizen and of society as a whole.

Effectively implement projects, programs, and plans on healthcare and health insurance; innovate the service style and attitude, and promote the enhancement of medical ethics among health staff to achieve patient satisfaction. Invest in infrastructure, equipment, and professional capacity to improve the quality of preventive and curative health insurance services, especially at grassroots health facilities, in remote, isolated, particularly difficult areas, borderlands, and islands. Accelerate the accurate and full calculation of medical service fees for preventive care and health insurance medical examination and treatment, while establishing mechanisms to effectively control waste, overcharging, unnecessary medical service prescriptions, and legal violations in the management and use of the Health Insurance Fund, ensuring the rights of health insurance participants. Implement measures to reduce the medical cost burden on patients.

Strengthen and enhance the capacity of state management agencies and implementing organizations on health insurance at both central and local levels; improve the mechanism for coordinated inspection, supervision, and cross-sectoral monitoring, and strictly handle violations and abuse of health insurance; diversify types of health insurance service provision; control health insurance medical examination and treatment costs in a transparent and scientific manner, while enhancing health insurance appraisal capacity. Fully implement all health insurance payment methods, determine methods for direct support to participants when using medical services; and adopt measures to prevent and combat corruption, waste, and misconduct in the payment of health insurance medical costs.

Improve infrastructure, promote administrative reform, and comprehensively implement digital transformation in health insurance operations; strengthen the application of artificial intelligence and big data to control and supervise health insurance medical services, ensuring that the national health insurance database is interconnected and that the databases of ministries, sectors, and localities are synchronized with the national health database.

7. Implementation

Provincial Party Committees, Municipal Party Committees, and Party Committees directly under the Central Committee shall direct the organization of studying, thoroughly grasping, disseminating, and widely communicating the contents of this Directive to cadres, Party members, and the people; develop programs and plans with specific tasks, solutions, and roadmaps for the implementation of the Directive, and regularly urge, inspect, and supervise its implementation.

The Party Committee of the National Assembly and the Party Committee of the Government shall lead and direct the competent agencies to review, amend, supplement, and complete policies and laws related to health insurance.

The Party Committee of the Government shall lead the Government in directing the Ministry of Health and the Ministry of Finance to coordinate closely with relevant commissions, ministries, sectors, and localities to effectively organize the implementation of this Directive.

The Party Committee of the Vietnam Fatherland Front and central-level mass organizations shall strengthen propaganda, mobilization, supervision, and social criticism during the implementation process of the Directive.

The Central Propaganda and Education Commission and the Central Mass Mobilization Commission shall take the lead and coordinate with relevant agencies in guiding, monitoring, inspecting, and urging the implementation of the Directive, and periodically report to the Secretariat.