Parents have reacted with alarm and anger to a recent sharp rise in mandatory insurance premiums for school children.
Some say the increase, from 3% to 4.5% of the minimum wage (1,150,000 dong or US$52) puts too heavy a burden on low income families.
The government is trying to increase the premiums from students to subsidise a shortfall in the fund.
The deputy head of Social Insurance, Nguyen Dinh Khuong, provoked outrage when he conceded that insurance funds from students were in surplus. He said the government needed to balance out the deficit in premiums from the elderly.
Many complained that it was unreasonable for students, who are still living off their parents, to assist retired people in such a way.
“The new premium becomes a heavy burden to poor people like us,” said Tran Thi My Van, the mother of two children in Ho Chi Minh City, who scrapes a living working in small restaurants and as a cleaner.
Her husband suffered a stroke and cannot work.
She said that this year she was required to pay an insurance premium of 544,000 dong ($25) for each child. But she could only afford one.
“I could not afford to pay for the premium of my daughter, a 10th grader. I plan to ask the school to allow me to pay the premium later because no one could lend me enough money,” she said.
Her daughter was embarrassed when her teacher reminded her about the premium.
Mrs Van said she borrowed 4 million dong from other people to pay for her children’s school fees and other fees for the first term.
Under the revised law on health insurance for the 2015-2016 academic year, students are also required to pay the premium for 15 months, instead of 12.
The Health Insurance Department said the insurance spike aims to increase benefits for students and that part of the health insurance fund will be used to fund first medical checkups for students at school.
However, educational experts said the new premiums are too high – even higher than tuition at primary schools where students pay annual fees of 200,000 – 400,000 dong.
There are also complaints about the poor quality of the health services on offer.
College students said medical services were often unavailable or sited far from their colleges.
One hall of residence with 1,500 students run by the University of Pedagogy based in Ho Chi Minh City has not provided health care service for the past 20 years.
Students complain there are so many bureaucratic procedures before they can use their insurance that those with relatively minor conditions often don’t seek help.
Other complain that they already buy private insurance but are still obliged to pay into the government scheme as well.
“It is so unfair on us to make us pay insurance premiums even when we never get medical treatment,” said Mrs Van, adding that she buys medicines from local pharmacies for her children when they have minor illnesses and never sends them to hospitals.
She said doctors give very perfunctory examinations to those with insurance and prescribe only cheap medicines.
Observers have also questioned the way teachers are delegated to collect health premiums, rather than insurance representatives.
There are also allegations that hospitals squeeze money out of the health insurance fund with sophisticated tricks.
Some question whether insurance officials themselves are not to blame for the deficit in the fund.
In one documented case in 2013, the Hoai Duc General Hospital in Hanoi was accused of duplicating over 1,000 blood test results for 2,000 patients.
The hospital received 60 million dong (US$2700) from social insurance agencies as payment for the duplicated blood test results.
The Education and Training Ministry has announced plans to expand the health insurance program to achieve universal coverage for all students.
Only 85 per cent of the 22 million students in all levels of education are covered at the moment, according to Vietnam Social Insurance.
The Prime Minister Nguyen Tan Dung has set targets for 75 percent of the total population of 90 million to buy medical insurance by the end of 2015, and 84 percent in 2020.
By Joseph Nguyen, a freelance journalist focusing on social and religious issues in Vietnam