Starting July 1, 2025, a significant change in Vietnam's health insurance policy will ease the path for patients suffering from 62 rare and severe diseases. According to the amended Law on Health Insurance (BHYT), these patients will be able to seek treatment directly at specialized hospitals without the cumbersome requirement of a referral letter, and they will receive 100% coverage of their medical costs under BHYT for out-of-line treatment.
This new regulation marks a considerable step forward in expanding healthcare benefits and reducing administrative burdens for patients with complex health conditions. The 62 diseases covered span a broad spectrum, including infectious diseases, cancers, metabolic disorders, lysosomal storage diseases, neurological illnesses, cardiovascular and lung diseases, skin conditions, congenital disabilities, drug-resistant tuberculosis, war-related sequelae, and organ transplant cases.
Patients diagnosed with any of these diseases at the initial level of care can now bypass the traditional referral system and go straight to high-level medical facilities equipped to provide specialized treatment. Even those who self-refer to such facilities and receive a diagnosis within the list will be entitled to full BHYT benefits from their very first visit. However, it’s important to note that BHYT will not cover any medical services outside the specified disease list, ensuring the system remains sustainable and focused.
Images from June 2024 show patients patiently waiting for examination at Ho Chi Minh City Oncology Hospital’s second campus in Thu Duc City, highlighting the demand for specialized care in Vietnam’s rapidly evolving healthcare landscape.
Ms. Tran Thi Trang, Head of the BHYT Department, explained that carefully defining and limiting the list of diseases eligible for out-of-line treatment is crucial to balancing patient needs and the capacity of specialized hospitals. "If the list were too broad, including all cancers or common non-communicable diseases like hypertension and diabetes, large hospitals would quickly become overwhelmed," she said.
To illustrate, while there are over 1,000 cancer codes, only certain malignant tumors such as those of the pancreas, thymus, brain, and spinal cord are permitted for direct out-of-line treatment. Similarly, diabetes patients qualify only if they have severe complications like grade 2 foot ulcers, chronic kidney disease stage 3 or higher, or multiple complications affecting the heart, eyes, or nervous system.
Deputy Minister of Health Trần Văn Thuấn emphasized that these restrictions are designed to ensure rational patient flow in the healthcare system. "Limiting out-of-line treatment helps prevent overcrowding in specialized hospitals and protects the rights and care quality for other severely ill or emergency patients," he stated.
Before this amendment, patients with life-threatening diseases often faced lengthy and complicated referral procedures to access BHYT benefits, even when local facilities could not provide adequate treatment. This bureaucracy caused many to opt for private, self-paid services, forfeiting their insurance rights and adding to their financial hardship.
With the new policy, patients can save valuable time and avoid unnecessary administrative hurdles by seeking specialized care directly. This change is expected to improve treatment outcomes and enhance the overall efficiency of Vietnam’s healthcare system.
The 62 diseases eligible for this policy are grouped into several categories:
1. Tuberculosis and fungal infections: Including tuberculous meningitis (G01), tuberculous brain tumors (G07), other nervous system tuberculosis, pulmonary mycobacteria infections, acute pulmonary infections from histoplasma capsulatum, blastomyces, paracoccidioides, sporotrichum, invasive aspergillus, cryptococcus, mucor infections, and disseminated mucor infections.
2. Cancerous diseases: Malignant tumors of the pancreas, thymus, heart, mediastinum, pleura, bones, cartilage, meninges, brain, spinal cord, cranial nerves, secondary brain and meningeal malignancies, malignant lymphomas, hematopoietic and related tissues.
3. Rare metabolic disorders: Myelodysplastic syndromes, other bone marrow failures, other hypercoagulable states (antiphospholipid syndrome), infection-related hemophagocytic syndrome, insulin-dependent diabetes with multiple complications, non-insulin-dependent diabetes with multiple complications, aromatic amino acid metabolism disorders, branched-chain amino acid metabolism disorders, fatty acid metabolism disorders, and other amino acid metabolism disorders.
4. Neurological diseases: Lysosomal storage disorders such as Pompe, mucopolysaccharidoses (MPS), Gaucher, Fabry diseases; copper metabolism disorders including Wilson’s disease; powdery degeneration; recurrent depressive disorder; obsessive-compulsive disorder; encephalitis, myelitis, encephalomyelitis; multiple sclerosis; Devic’s neuromyelitis optica; myasthenia gravis; retinopathy of prematurity; heart failure; toxic epidermal necrolysis (Lyell/Stevens-Johnson syndrome).
5. Post-surgical and other conditions: Post-cardiac surgery syndrome, other cardiac post-surgical dysfunctions, interstitial lung diseases, lung and mediastinal abscess, empyema (severe lung infections), Crohn’s disease, pemphigus, livedoid vasculitis, Sweet’s syndrome, systemic lupus erythematosus with organ involvement, neonatal diabetes, congenital brain and spinal cord malformations.
6. Congenital disabilities and sequelae: Congenital cardiovascular malformations, congenital hip deformities, resistance to anti-tuberculosis drugs, war-related injuries, and organ graft conditions.
This targeted approach reflects a thoughtful balancing act: expanding access to necessary care for the most vulnerable, while managing the capacity and financial sustainability of the health insurance fund.
Vietnam’s healthcare system has also recently restructured its service tiers, moving from four levels—central, provincial, district, and commune—to three specialized levels: initial, basic, and specialized care. This reform aims to streamline patient flow and improve service quality.
Ms. Trang highlighted that this new policy will help ensure that patients with severe illnesses receive timely, specialized treatment without unnecessary delays, while also preventing the overburdening of large hospitals. Deputy Minister Thuấn echoed this sentiment, emphasizing the importance of rational patient distribution to safeguard care for all in need.
For many patients, this policy change is more than just bureaucratic simplification—it’s a lifeline. The ability to access specialized treatment promptly and with full insurance coverage can make a critical difference in outcomes for those battling severe and rare diseases.
As Vietnam continues to enhance its healthcare infrastructure and policies, such reforms underscore a commitment to patient-centered care, equity, and efficient use of resources.
