Background <p>Innovation competency and entrepreneurial capacity have emerged as essential factors for future healthcare professionals in the context of digital transformation and complex patient demands. While global medical education has incorporated innovation training, research on innovation competency and entrepreneurial capacity among Vietnamese health students and related factors remains limited.</p> Objectives <p>This study aims to assess the current level of innovation competency and entrepreneurial capacity among Vietnamese health students and identify factors associated with their development.</p> Method <p>A cross-sectional study was conducted from May 2025 to July 2025, involving 370 students from various health-related majors across Vietnam. Participants completed an innovation competency scale based on Chell &amp; Athayde’s (2009) five domain model and a validated entrepreneurial capacity questionnaire, developed based on Turker’s (2009) methodological proposal for scale development. The innovation competency scale includes creativity, leadership, energy, self-efficacy, and risk propensity, while the entrepreneurial capacity questionnaire consists of 4 domains of entrepreneurial capacity: management and business competency, entrepreneurial capacity, human resources competency, and interpersonal competency. Data were collected via an online survey and analysed using RStudio software, applying descriptive statistics, t-tests, ANOVA and regression.</p> Results <p>The mean scores of participants’ innovation competency and entrepreneurial capacity were 137.06/217 (SD = 28.91) and 173.40/280 (SD = 35.20), respectively. Significant differences in innovation competency were observed across gender (<i>p</i> = 0.044), academic year (<i>p</i> &lt; 0.001), major (<i>p</i> = 0.043), and geographic region (<i>p</i> = 0.005). Entrepreneurial capacity differed significantly by gender (<i>p</i> &lt; 0.001) and academic year (<i>p</i> = 0.008). Linear mixed-effects model analysis revealed that participation in entrepreneurship courses, competitions, practice opportunities, and strong educational performance were positively associated with entrepreneurship education performance (<i>p</i> &lt; 0.05).</p> Conclusion <p>The findings contribute to existing research by offering one of the first integrated assessments of innovation competency and entrepreneurial capacity among health students in Vietnam amidst a rapidly transforming context of healthcare education. Overall, Vietnamese health students showed strong motivation and solid understanding in management and business; however, skills related to opportunity recognition, leadership, risk propensity, and communication remain limited. This suggests that current training emphasizes theory over practice. Educational interventions such as experiential learning, leadership training, and risk management workshops would contribute to innovation and entrepreneurial capacity among Vietnamese health students.</p>