The Unpaid Bills Pile Up: Ho Chi Minh City Hospitals Await Over $105 Million in Health Insurance Claims: What Does Vietnam Social Security Have to Say?

Ministry of Health Requests Provisional Payment

On August 13, the Department of Health Insurance (Ministry of Health) informed that it had sent a document to the Vietnam Social Security under the Ministry of Finance regarding the payment of medical examination and treatment costs exceeding the health insurance budget estimate and the unrecovered costs of medical technical services performed on medical equipment that had not completed the establishment of state ownership before March 4, 2023.

The Ministry of Health stated that it had received Official Letter No. 4595/SYT-KHTC dated May 5, 2025, and Official Letter No. 7082/SYT-KHTC dated June 24, 2025, from the Ho Chi Minh City Department of Health regarding this issue, which were also sent to Vietnam Social Security.

According to the information reflected, in 2023, the health insurance examination and treatment facilities in the city had medical examination and treatment costs exceeding the budget estimate by VND557.5 billion, which were appraised and audited by the Ho Chi Minh City Social Insurance and sent to the Vietnam Social Security.

In 2024, medical examination and treatment costs continued to increase, with the excess over the budget estimate being about VND1,950 billion as assigned by the Prime Minister in Decision No. 930/QD-TTg dated September 5, 2024.

At the same time, Ho Chi Minh City Social Insurance is recovering medical examination and treatment costs on medical equipment that has not completed the establishment of state ownership before March 4, 2023.

The delay in payment and the long waiting time for payment of medical examination and treatment costs exceeding the budget estimate of the medical examination and treatment facilities have caused difficulties for the units in ensuring operating funds and balancing financial revenues and expenditures when the service prices have not been properly calculated, debts to drug supply enterprises, affecting the medical examination and treatment activities of the facilities and the rights and interests of health insurance participants.

Regarding this issue, the Ministry of Health suggested: For medical examination and treatment costs of medical services performed on equipment that has not completed the establishment of state ownership, on February 27, 2025, the Ministry of Health sent Official Letter No. 1042/BYT-BH to Vietnam Social Security, proposing not to recover the medical examination and treatment costs of technical services performed on equipment that has not completed the establishment of state ownership.

At present, the Ministry of Health is consolidating and reporting to the Government on this content; it is recommended that Vietnam Social Security should not recover this cost until there is a decision of the Government and the Prime Minister.

Regarding the medical examination and treatment costs exceeding the 2023 budget estimate, according to the Ministry of Health, on May 12, 2025, the Social Security Management Board issued Resolution No. 730/NQ-HDL on the regular meeting in the first quarter of 2025. In Item 1, Section I of the Resolution, the Social Security Management Board agreed in principle on the 2023 Financial Settlement Report of Vietnam Social Security.

Therefore, it is recommended that Vietnam Social Security promptly report to the Ministry of Finance and submit to the Government for approval of the medical examination and treatment costs exceeding the 2023 budget estimate for payment to medical examination and treatment facilities, including those in Ho Chi Minh City.

Regarding medical examination and treatment costs in 2024, on July 25, 2025, the Ministry of Health issued Document No. 4922/BYT-BH on reviewing the excess of expected expenditure, accordingly, the excess of expected expenditure in 2024 shall be implemented in accordance with the Law on Health Insurance, Decree No. 146/2018/ND-CP and Decree No. 75/2023/ND-CP of the Government; it is recommended that Vietnam Social Security direct social insurance agencies of provinces and central cities to urgently implement in accordance with the Law on Health Insurance and the Government’s decrees detailing and guiding the implementation of a number of articles of the Law on Health Insurance.

Regarding the provisional payment of medical examination and treatment costs, the Ministry of Health proposed that Vietnam Social Security direct social insurance agencies of provinces and central cities to make provisional payments for medical examination and treatment costs according to the ratio and number of times of provisional payment according to Article 32 of the Law on Health Insurance to ensure funding for medical examination and treatment activities for the people.

What does Vietnam Social Security say?

Vietnam Social Security said that it had received a document from the Ministry of Health on the payment of medical examination and treatment costs exceeding the budget estimate and unrecovered costs of medical technical services performed on medical equipment that had not completed the establishment of state ownership before March 4, 2023.

Regarding this issue, Vietnam Social Security has four opinions.

First, regarding the medical examination and treatment costs of services performed on medical equipment that has not completed the establishment of state ownership before March 4, 2023, the Ministry of Health proposed that while waiting for the Government’s opinion, Vietnam Social Security should direct social security agencies at all levels not to recover.

However, the Ministry of Health’s document does not state the legal basis for this proposal, according to the Government’s Decree No. 29/2018/ND-CP dated March 5, 2018, on the procedure and process for establishing state ownership of assets and handling of assets subject to state ownership establishment.

Second, regarding the medical examination and treatment costs exceeding the 2023 budget estimate, Vietnam Social Security submitted a report on October 22, 2024, to the Social Security Management Board on the 2023 financial settlement, which was approved by Resolution No. 730/NQ-HDL dated May 12, 2025.

However, the Resolution does not assign Vietnam Social Security to make provisional payments for the excess of the 2023 budget estimate.

To resolve the medical examination and treatment costs of health insurance exceeding the budget estimate assigned by the Prime Minister, the costs that have not been paid due to changes in legal regulations and difficulties in organization and implementation, the Ministry of Finance has reported to the Government leaders on the unpaid medical examination and treatment costs of health insurance.

This includes the excess of the 2023 and 2024 budget estimates.

On August 5, the Government Office issued Document No. 7282/VPCP-KGVX on the implementation of Decree No. 188/2025/ND-CP.

Deputy Prime Minister Le Thanh Long directed the Ministry of Health to coordinate with the Ministry of Finance, the Ministry of Justice, and relevant agencies to build a project to thoroughly handle the arrears of medical examination and treatment costs of health insurance from 2025 onwards.

It is necessary to clarify the situation and propose solutions, ensuring feasibility, efficiency, and compliance with regulations to overcome and thoroughly resolve the situation of arrears in settling medical examination and treatment costs in previous years, reporting to the Government in the third quarter.

A guiding document is needed.

Third, regarding the excess of the 2024 medical examination and treatment budget estimate, the Ministry of Health has sent Document No. 4922/BYT-BH, proposing that the Ministry of Finance urgently direct Vietnam Social Security to guide the social insurance agencies of provinces and central cities to take the initiative in coordinating with the Department of Health, medical examination and treatment facilities to review and determine the above content.

However, according to Vietnam Social Security, this document does not clearly guide the content of reviewing and determining the excess of the expected expenditure to be paid as proposed by the Ministry of Finance, and it is unclear for Vietnam Social Security to organize the implementation.

To ensure the effective, open, and transparent use of the Health Insurance Fund and the uniformity in determining the excess of medical examination and treatment costs of health insurance over the expected expenditure to be paid additionally, Vietnam Social Security believes that it is necessary and urgent to have a guiding document from the Ministry of Health for the implementation of the provincial Social Insurance, Department of Health, and medical examination and treatment facilities to avoid difficulties and problems.

Vietnam Social Security proposed that the Health Insurance Department advise the Ministry of Health to guide the content of reviewing and determining the excess of medical examination and treatment costs of health insurance over the expected expenditure and include it in the project report to the Government to determine the excess of the 2024 expected expenditure and the excess of the budget estimate assigned by the Prime Minister.

Fourth, regarding the provisional payment of medical examination and treatment costs, Vietnam Social Security said that it had sent a document on June 23 to the social insurance agencies of provinces and central cities, requesting the full and proper implementation of the regulations on provisional payment and payment of medical examination and treatment costs.

From July 1, the local Social Insurance implemented a one-time provisional payment of 90% of the medical examination and treatment costs of health insurance according to the quarterly settlement report of the medical examination and treatment facility within 5 working days from the date of receiving the report of the medical examination and treatment facility according to Article 32 of the Law on Health Insurance.