Answer:

Children under 6 are entitled to 100% coverage for medical examination and treatment costs at healthcare facilities within their health insurance (HI) network. Tonsillectomies are covered under HI. The HI coverage for a tonsillectomy depends on the beneficiary group. Children under 6 belong to a prioritized group and are entitled to 100% coverage for the surgery when following HI regulations.

100% HI coverage means the Health Insurance Fund covers 100% of the costs according to the government-regulated healthcare pricing (commonly referred to as the HI price framework). Patients are responsible for any costs exceeding the framework or for services not covered by HI. Therefore, 100% HI coverage doesn't mean the entire hospital bill is covered, but rather 100% of the costs within the coverage limits and price framework set by the insurance agency.

A child's immune system is less developed than an adult's, making them more susceptible to viruses and bacteria, leading to frequent minor illnesses and infections. A tonsillectomy is recommended when tonsillitis recurs multiple times a year, in cases of abscesses, or when enlarged tonsils obstruct the upper airway. Surgery is also indicated if swollen tonsils cause sleep apnea, snoring, respiratory problems, blocked Eustachian tubes leading to middle ear infections, or sepsis.

Doctor Huong performs a tonsillectomy on a child. Photo: *Tam Anh General Hospital*

For children, a doctor's decision to recommend a tonsillectomy depends on several factors: frequency of infections (more than 7 times a year, more than 5 times a year for two consecutive years), impact on the child's health, and age. If tonsillitis has caused enlarged tonsils leading to breathing difficulties or sleep apnea, the child may need a tonsillectomy sooner. If the inflammation doesn't respond to medical treatment, is prolonged or recurrent, and causes snoring, a doctor might recommend a tonsillectomy once the child turns 4.

A tonsillectomy doesn't significantly affect a child's ability to fight off illness. However, recurrent tonsillitis can become a chronic infection site, harboring and spreading bacteria, leading to prolonged infections that are less responsive to treatment.

Tam Anh General Hospital in TP HCM provides HI-covered medical examination and treatment for all individuals nationwide, ensuring HI benefits for patients. Tonsillectomies at the hospital are covered by HI according to general regulations. You can bring your child to the hospital's Otolaryngology Department for a check-up. The doctor will then advise you on the appropriate insurance benefits based on your HI network.

MSc. MD. Nguyen Thi Huong

Otolaryngology Center

Tam Anh General Hospital