Vietnam’s Ministry of Health is seeking public feedback on a draft circular that establishes social health insurance reimbursement regulations for medical examinations and treatments delivered through family medicine, home-based care, and telemedicine. According to the regulatory proposal, the state health insurance fund will cover medical costs provided by qualified family medicine facilities that hold active health insurance contracts.
Eligible providers under the draft text include dedicated family medicine examination and treatment facilities, as well as general medical facilities authorized under Article 39 of Government Decree No. 96/2023/ND-CP. To qualify, these facilities must operate at an initial or basic level and hold a licensed professional scope that includes family medicine.
Scope of Covered Family Medicine Services
Under the proposed framework, family medicine practices will deliver general internal medicine examinations alongside authorized technical services. Provincial and municipal departments of health will assign initial individual or family health insurance cards to these clinics and hospitals for residents living within their specific commune, ward, or designated special zone.
Patients who register for initial coverage at a family medicine clinic receive free periodic health checks, routine screenings, chronic disease management, and a dedicated medical record to track their healthcare journey. Attending physicians will also coordinate referrals to higher-level facilities when required by health insurance laws. The health insurance fund covers necessary medications, medical equipment, blood products, medical gases, and chemical supplies used during treatment, subject to standard benefit packages.
Reimbursement Rates and Fixed Tariffs
The health insurance reimbursement for family medicine services follows standard statutory frameworks. For approved technical services, the Vietnam Social Security fund reimburses costs based on rates approved by competent authorities. If a specific family medicine service lacks an official state-approved price, the fund reimburses based on the facility’s internal service price, capped within statutory benefit limits. Patients must pay any cost differences directly to the medical facility.
For administrative and preventive services—including the creation and updating of medical records, health management, and wellness counseling—the health insurance fund will issue a lump-sum payment to the primary care facility for each enrolled participant. Healthcare providers must establish comprehensive cost structures based on internal operating expenses, incorporating personnel, information technology, and direct administrative costs approved by the Ministry of Health.
Home-Based and Telemedicine Provisions
The draft circular also extends coverage to non-traditional care models. When family medicine practitioners deliver authorized medical examinations and treatments directly at a patient’s home, or utilize telemedicine and tele-support networks, the health insurance fund will reimburse those services according to the finalized rules in the upcoming circular. The Ministry of Health’s public consultation period allows insurers, medical providers, and patients to review the operational guidelines before final enactment.
Related reading