Measuring Health Service Utilization and Out -of Pocket Spending Among People Liveing with HIV/AIDS in Vienam


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Measuring Health Service Utilization and Out -of Pocket Spending Among People Liveing with HIV/AIDS in Vienam

  1. 1. Measuring health service utilization and out-of-pocket spending among people living with HIV/AIDS in Vietnam Douglas Glandon,1 MPH, Ha Nguyen,1 PhD, Nguyen Tuan Phong,1 MD, Nguyen Duy Tung,1 MD, Ted Hammett,1 PhD, Mai Huong Nguyen,2 MSc 1Abt Associates; 2Center for Community Health Research and DevelopmentObjective MethodologyDescribe the level of out-of-pocket (OOP) expenditure of people  Survey of 1,200 PLHA representing 17 estimation and projection package clustersliving with HIV/AIDS (PLHA) and utilization of inpatient and  Within each cluster, one province selected with probability proportional to sizeoutpatient care in Vietnam in 2010 in context of dramatic growth  Participants selected from provincial AIDS committee lists usingof donor funding for HIV/AIDS in Vietnam in past 5+ years systematic sampling  Analysis adjusted for sampling weights Survey Clusters* PLHA had substantially higher utilization and OOP spending for Largest PLHA OOP health expenditure HIV-related health care than the general population had for all was for self-medication, followed by Sample health care transportation to and from HIV service #/% Characteristics delivery points Sample size 1200 Outpatient and inpatient health Average annual OOP OOP spending breakdown, including Urban 60.3% service utilization expenditures, per person transportation General Population* PLHA*** General Population* PLHA*** (Average annual per PLHA, 2010 USD*) Male 58.5% 50.0% 1200 $2.59 (2%) 45.0% 46.9% 1004.9 OPC registered 59.3% $37.33 (28%) % reporting care episode during period of recall 1000 $30.56 (23%) 40.0% On ARV 20.1% 35.0% 1.5x 788.8 800 $20.97 (16%) VND Thousands Have health 30.0% 29.4% 31.0% $40.45 (31%) insurance 2.5x 25.0% 600 ~50% general population has health insurance** 20.0% Prevention (condoms & syringes) 394.8 400 Outpatient care 15.0% 6.8x Inpatient care 10.0% 2.0x 12.8% 200 Self-medication Total: $94.58 for HIV-related health expenditures 115.2 $131.91 incl. transportation Transportation 5.0% *Vietnam HIV/AIDS Estimates and Projections: 2007-2012. 6.5% April 2009. Vietnam Administration of HIV/AIDS Control. Ministry of Health, Vietnam. 0.0% 0 **Source: Health Policy Planning 2008; 23: 258. Outpatient contact over past four Hospitalization over past twelve Exams and Treatment Self medication weeks months *Source: Vietnam Household Living Standard Survey 2008 **Outpatient contact over the past 12 months ***For HIV-related health products and services only *Based on 19,500:1 (VND:USD) exchange ratePLHA on ART have the most outpatient visits and fewest self-medication episodes; Main Conclusionsinsured have more contacts of all types than uninsured  PLHA had higher rates of utilization for HIV-related health care than general population had for all health care products and services. Average number of HIV health service contacts per PLHA per year, by group Similarly, PLHA spent more per person on HIV-related health care than general population spent per person on all health care Not on Contact Type Overall On ART ART Urban Rural Male Female Insurance No Insurance  These observations raise questions as to impact of recent substantialOutpatient visits 7.07 13.63 5.42 7.48 6.46 6.47 7.97 7.29 6.98 increases in donor funding for HIV in Vietnam (up from US$18 million in 2004 to nearly US$90 million in 2010) in terms of reducing financialInpatient visits 0.16 0.18 0.16 0.17 0.15 0.19 0.13 0.18 0.16 burden of health care for PLHASelf-medication 10.9 6.53 12.05 11.70 9.80 10.54 11.59 12.76 10.19episodes June 2011