Vietnam’s public healthcare system offers affordable medical services through a structured network, and for expatriates, it’s accessible via the Vietnam Social Security (VSS) system. This article explains how the system works, how to register with VSS as a working expat, and what to expect when using public healthcare, including copayments and travel scenarios.
History of Public Healthcare in Vietnam
The public healthcare system in Vietnam started under French colonial rule in the mid-20th century, serving mostly the elite. After independence in 1945, the socialist government in North Vietnam introduced free healthcare, expanding it nationwide post-reunification in 1975. The Đổi Mới reforms of 1986 introduced user fees and social health insurance, alongside private providers.
The Structure of Public Healthcare in Vietnam
Managed by the Ministry of Health, the system operates on four levels: national, provincial, district, and commune. It includes over 1,100 public hospitals and thousands of commune health stations, forming 86% of Vietnam’s hospital network. Funding comes from government subsidies and mandatory VSS contributions from formal-sector employees. Subsidized care covers groups like the poor, ethnic minorities, children under six, and seniors over 80. Services range from basic checkups at commune stations to specialized care at national hospitals like Bach Mai in Hanoi, though overcrowding, outdated equipment, and rural staffing shortages are common.
How to Register with VSS as a Working Expat
As a working expat, registering with VSS is tied to your employment and mandatory if you have a work permit and a contract of at least one year. Here’s the process:
- Employer Registration: Your employer will handle this process (usually online) by submitting all information necessary including Work Permit.
- Contributions: Your employer pays 17.5% of your salary, and you contribute 10.5% (deducted from your pay), with 1.5% for health insurance, capped at 20 times the minimum wage (~36 million VND/month, ~$1,500 USD). This breakdown might be subject to change, ask your company for the details applied to your own compensation.
- Get Your Insurance Card: VSS assigns a 10-digit social security number and issues a health insurance card (physical or via the VssID app).
- Choose a Facility: Your employer picks a public medical facility near your work or home as your registered healthcare provider for routine care.
- Activation: The card is active immediately, usable at your registered facility or other public hospitals with conditions.
Your employer handles most paperwork in Vietnamese, and if you change jobs, your new employer updates your VSS record.
Accessing Public Healthcare as an Expat
Access Vietnam Public Healthcare with VSS Insurance
Once registered with VSS, here’s how you use the system:
Registered Facility: You start at your chosen public facility for routine care, paying little to no out-of-pocket costs for covered services.
Other Public Hospitals in Vietnam: You can visit other public hospitals, but bear in mind the following.
With Referral: Full coverage requires a referral from your registered facility for higher-tier care (e.g., provincial or national hospitals).
Without Referral: For non-emergencies, you’ll pay a copay—40% at the same/lower tier, 60% at a higher tier.
Emergencies: Go to any public hospital without a referral; coverage applies fully if documented (notify VSS/employer within 48 hours).
Access Vietnam Public Healthcare without VSS Insurance
If you’re not working in Vietnam (no social security number), you can still use public hospitals but pay full, unsubsidized rates.
Copayments and Reimbursement
Copays: If you skip the referral process for non-emergencies at a different hospital, you’ll pay 40–60% of the cost. These copays aren’t reimbursable, as they’re seen as your choice.
Reimbursable Costs: If you pay out-of-pocket for covered services (e.g., due to hospital errors or emergencies not processed correctly), you can submit receipts, medical records, and a claim to your employer or VSS within 6 months. Approval depends on VSS review, but it’s not common for standard copays.
If you’re away from your registered facility
Emergencies: Any public hospital accepts you with full coverage; submit documents later.
Non-Emergencies: At another public hospital, expect a 40–60% copay without a referral, non-reimbursable. Carry your VSS card or VssID app to reduce costs.
Temporary Transfer: For extended stays (e.g., work assignments), your employer can request VSS to switch your registered facility temporarily.
Private Option: Pay full rates at public or private hospitals if you prefer avoiding copays/paperwork.
Private Hospitals and Public Scheme
Private hospitals in cities like Hanoi and Ho Chi Minh City offer better care and English-speaking staff. Some accept VSS insurance if contracted with VSS, but most cater to private insurance or cash patients due to low public reimbursement rates.
Challenges
Urban hospitals are overcrowded (up to 200% capacity), rural ones lack resources, and extra costs for uncovered services can arise. Locals may give “appreciation envelopes” to doctors, but this rarely applies to foreigners.
Language is without a doubt a hurdle—most staff speak only Vietnamese, with limited English in urban areas and none in rural ones. Bring a translator or use an app.
Conclusion
Working expats can register with VSS through their employer to access subsidized public healthcare at a designated facility, with referrals unlocking full coverage at other hospitals and emergencies covered anywhere. Copays apply without referrals and aren’t reimbursable, while travel may require planning or private options. However, in practice, most expats working in Vietnam opt for private healthcare for more comfortable access—think English-speaking staff and shorter wait times. Prices are significantly higher, so many secure private medical insurance to cover these costs, bypassing the public system’s challenges like overcrowding and language barriers.
