Purpose – to identify the prerequisites for organizational changes of the emerging health insurance system in Vietnam.

Research methodology – comparative analysis, statistical analysis, case study.

Findings – the obligatory health insurance in Vietnam performs its functions only partially. There is still high level of out-of-pocket spending on medical services. First we identified one of the most important challenges to the health insurance system in Vietnam, namely, the population aging. Secondly, we identified and analyzed and the prerequisites (the pre-existing conditions), which can become the basis for the reorganization of the existing health insurance system without major reforms: (1) the cultural values of Asian society, which allow to build a community-based type model of living for the elderly on the basis of “equal with equal”; (2) technological advances in medicine that extend the healthy life of the elderly, (3) trust in traditional medicine, which allows widen the coverage of the poorest “elderly households”.

Practical implications – the results of the study require attention from the government and insurance providers when rethinking of organizing process for mandatory medical insurance.

Originality/Value – we have identified the ways of possible organizational changes for the health insurance system, making the most of the existing prerequisites. This can help to get closer to the goal of full coverage with health insurance services while achieving a positive social effect. The identified internal reserves make it possible to imple-ment organizational changes without major reforms of the established health insurance system. No studies have been conducted in this perspective.

https://doi.org/10.3846/cibmee.2021.640