Scenario: a foreign-invested private hospital wants an SHI examination contract to attract insured patients. What conditions apply, and how are SHI patients paid at private hospitals?
Conditions for SHI examination contracts
The amended Health Insurance Law 51/2024/QH15 (effective 1 July 2025) expands SHI payment mechanisms, easing private-sector participation. Medical establishments — including private and foreign-invested hospitals — may sign SHI examination contracts with social insurance agencies where meeting: valid medical operation licences; professional capacity for contracted services (service lists, personnel, equipment); acceptance of SHI payment frameworks and fund-management rules. No discrimination exists between public, private and FDI hospitals in SHI contracting — criteria are professional capacity and compliance, not ownership form.
SHI patient benefits at private hospitals
SHI cardholders examined at contracted private hospitals enjoy the same benefits as at public hospitals: the SHI fund covers examination costs within benefit scope, patients co-paying only statutory shares (by category). The amended Law 51/2024/QH15 brings patient-friendly changes: expanded coverage for telemedicine; liberalised referral tiers — patients enjoy SHI benefits at off-tier establishments in more cases than before; “reference levels” applied in payment in place of old pricing in some cases. SHI patients at private hospitals pay nothing beyond co-payments — extra unlawful collection is a violation.
Hospital duties and risks under SHI participation
SHI contracts mean accepting tight social-insurance supervision: inspections of service designation, prescribing and payment; fund-management mechanisms (capitation, case-based payment, etc., per rules); sanctions for violations — from recovery of wrongly paid amounts and administrative fines to SHI contract termination in serious cases (fund exploitation, unnecessary service designation). Private and FDI hospitals need internal SHI-designation controls: training doctors on SHI rules, prescription oversight, avoiding fund-abuse patterns. SHI participation brings stable patient flows but demands strict compliance — signing is only the beginning.
Frequently asked questions
Do SHI examinations at private hospitals incur extra “service fees”?
No, beyond statutory co-payments. Contracted hospitals may not collect extra from SHI patients beyond rules — extra collection is a violation patients may refuse and report.
May FDI hospitals sign SHI contracts?
Yes, where meeting the same conditions as all medical establishments. The law does not discriminate by ownership in SHI contracting.
May SHI patients choose private hospitals as initial providers?
It depends on initial-registration and tier rules. The amended Law 51/2024/QH15 liberalises tiers — patients gain more initial-provider choices, including qualifying private establishments.
This article has been quality-reviewed by the FLAW AI Legal Council.