One of the questions we most frequently receive during our health insurance awareness sessions is, "Are all diagnostic imaging and laboratory tests prescribed by a doctor fully covered by insurance?"

When our answer is "Not every test or scan prescribed by a doctor is covered by insurance," many people are still surprised. In reality, every claim assessment is based on the terms and conditions of the insurance policy as well as the medical necessity of the treatment or investigation.

Setting aside the technical aspects of insurance, there is an issue that is increasingly affecting both the healthcare system and health insurance: the overuse of diagnostic imaging and laboratory tests.

Recently, several leading medical experts have expressed concern that many young doctors are becoming increasingly reliant on diagnostic tests and imaging to make clinical decisions, rather than fully utilizing the value of physical examination and clinical assessment.

So, what are the root causes of this situation? It can be viewed from three different perspectives.

From the doctors' perspective

As medical disputes and malpractice complaints become more common, many doctors tend to prescribe additional tests or diagnostic imaging to strengthen the basis of their diagnosis and minimize legal risks. As a result, the use of diagnostic investigations continues to increase, even in cases where clinical examination alone may already provide sufficient direction.

From the patients' perspective

Easy access to medical information on the internet has led many people to self-diagnose before seeking medical attention and expect confirmation through advanced diagnostic technologies. In addition, as voluntary health insurance becomes more common, many patients actively ask their doctors to order additional tests, believing that the costs will be covered by their insurance.

From the healthcare providers' perspective

For many hospitals and clinics, particularly private facilities or financially autonomous institutions, investment in medical equipment is substantial. The need to maximize the utilization of these expensive assets can sometimes become a factor influencing the frequency of diagnostic test prescriptions.

The Impact on Voluntary Health Insurance

In this article, we focus only on voluntary corporate health insurance programs that employers provide to their employees to reduce the financial burden when illness occurs. The impact on Vietnam's compulsory public health insurance scheme has already been discussed extensively in other articles and studies.

For corporate health insurance, when insured members utilize healthcare services with elements of overuse, claim costs inevitably increase. As claim ratios rise, insurers are compelled to increase premiums at the next renewal. Consequently, employers must allocate a larger budget to maintain the same employee benefits program.

Another consequence is that insurers tend to tighten benefit coverage and adopt stricter claim assessment practices when utilization rates become excessively high.

Ultimately, this affects those who genuinely require intensive treatment, such as patients with cancer, kidney failure, or other serious illnesses. When a significant portion of the insurance budget is consumed by unnecessary healthcare utilization, there is less room to expand or enhance benefits for severe medical conditions.

What Can Insured Members Do?

From an insurance advisory perspective, we believe that raising awareness among healthcare service users is the most important solution. Some simple but effective recommendations include:

1. Proactively discuss with your doctor to better understand whether a recommended diagnostic test or imaging procedure is genuinely necessary. In some situations, it may not be necessary to immediately disclose that you have voluntary health insurance that could cover these expenses.

2. Describe your symptoms as specifically as possible. Instead of simply saying, "I feel tired," explain details such as where the pain occurs, when it occurs, whether it is related to certain positions or times of the day, and any other relevant information. This helps doctors make a more accurate clinical assessment and may reduce unnecessary screening tests.

3. Keep records of your previous medical consultations and diagnostic test results, especially those that remain clinically relevant. This enables doctors to make better-informed decisions and helps avoid repeating the same tests or imaging procedures within a short period.

Health insurance is designed to protect employees against genuine health risks. Using healthcare services appropriately not only helps maximize each individual's insurance benefits but also contributes to the long-term sustainability of the employee benefits program that employers invest in for their workforce.

If your organization is interested in understanding how to manage the impact of unnecessary diagnostic imaging and laboratory testing on your corporate health insurance program, the experts at Indochine Insurance Brokers (MGBH Indochine) are always ready to support you and share appropriate solutions.