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Estimating hi liability for treatment of hiv en

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As donor funding for HIV in Vietnam declines, the Social Health Insurance scheme is the likely solution to ensure the sustainability of an adequate response.

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Estimating hi liability for treatment of hiv en

  1. 1. THE 6TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS Estimating the Health Insurance Liability for Treatment of HIV/AIDS in Vietnam (2016-2020) Naz Todini, Benjamin Johns, Kieu Huu Hanh, Nguyen Thuy Huong, Duong Thuy Anh, Nguyen Hoang Long USAID/Health Financing Governance Project
  2. 2. The 6th National Scientific Conference on HIV/AIDS Outline 1. Background 2. Objectives 3. Methods 4. Results 5. Conclusions 6. Recommendations
  3. 3. The 6th National Scientific Conference on HIV/AIDS Introduction • Vietnam’s HIV/AIDS response is mainly financed by external sources, with 73% of spending on HIV funded by international donors for the period 2008-2010. • As donor funding is expected to decline over the coming years, it is critical for the Government of Vietnam (GVN) to identify viable solutions for sustaining HIV/AIDS activities.
  4. 4. The 6th National Scientific Conference on HIV/AIDS Introduction • The Decision No 1899/QD-TTg has identified funding HIV/AIDS services through SHI as one of the key strategies to ensure long term sustainability of HIV/AIDS treatment services. • The Model to Estimate HI Liability for Treatment of HIV/AIDS in Vietnam provides financial forecasts on the amounts of funding needed from SHI and other sources for HIV/AIDS treatment.
  5. 5. The 6th National Scientific Conference on HIV/AIDS Objectives • Estimate the liability of the national health insurance scheme for supporting the treatment of people living with HIV/AIDS. • Establish a methodology that can be adapted in the future as more data become available. • Recommend package of HIV/AIDS treatment services to be paid through VSS SHI
  6. 6. The 6th National Scientific Conference on HIV/AIDS Methodology • In order to estimate the future liability and costs for the treatment of HIV/AIDS, a deterministic model was developed in Microsoft Excel. Liability is calculated using the following formula: • [People in need of services x accessing rate x insurance coverage] x [number of services x price of service] x [1 – patient copayment rate]
  7. 7. The 6th National Scientific Conference on HIV/AIDS Methodology Number of patients Treatment rate Cost / payment for treatment Total costs (a) (b) (c) = a * b * c Service – agesa s = 1: Screening and diagnosis 2: Art 1st line 3: ART 2nd line a = 1:<6years 2: 6 to <10 years 3: Over 10 years 4:< 18 months HIV exposed Clinic visitss Laboratorys ARVss Other drugs Maintenances Clinic visitsp Laboratoryp ARVsp Other drugp Maintenancep multiplied by the proportion of those in need of services that access care for agea Where p = 1. VSS HI 2. SHI Patient 3. Non-SHI patient 4. External commitments 5. Other 6. Total costs Disaggregat ed by: services (s), age (a), and payers (p). separated into patients with insurance and patients without insurance
  8. 8. The 6th National Scientific Conference on HIV/AIDS RESULTS – HI LIABILITY FOR HIV TREATMENT
  9. 9. The 6th National Scientific Conference on HIV/AIDS Basic packages for HIV/AIDS care and treatment should be paid by HI ART (first year) ART (After first yr) 1 Testing and counseling 1.2.a PCR 1 1.2.b ELISA 1 2.1 Examination 12 12 12 6 2.2 Basic diagnosis (lab test and X-ray) 2.2.a Blood cell count, 2.00 2.00 1.00 2.2.b HbsAg, 1.00 0.50 1.00 2.2.c Anti-HCV 1.00 1.00 2.2.e Creatinine in blood, 1.00 1.40 1.00 2.2.f ALT 1.00 1.00 1.00 2.2.g CD4 1.00 1.00 0.50 2.2.h Viral Load 1.00 1.00 0.50 2.3.a TB INH Maintenance 0.70 0.35 2.3.b Cotrimoxazole Therapy 365 365 122 183 2.4 ARV 12 12 6 2.5 OI OPC treatment 0.5 0.5 0.25 ARV for pregnant women Cost componentsNo All age Exposed HIV children
  10. 10. The 6th National Scientific Conference on HIV/AIDS Projected number of people seeking HIV treatment enrolled in HI 1,958 3,074 4,612 6,521 8,727 41,734 57,582 77,151 98,599 120,317 2,012 1,905 1,791 1,688 1,603 1,113 1,284 1,463 1,638 1,793 0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 2016 2017 2018 2019 2020 Second line ART First line ART Early infant diagnosis Patients with gov't subsidy
  11. 11. The 6th National Scientific Conference on HIV/AIDS Estimated insurance liability for treatment of HIV/AIDS (Billion VND) Category 2016 2017 2018 2019 2020 Care and treatment 181 297 507 649 800 Examinations 13 18 24 31 38 Opportunistic infections 17 24 30 35 42 Antiretroviral drugs 109 199 358 461 571 Laboratory procedures 41 57 96 122 149 Exposed children 2 2 2 2 1 Total 183 298 508 651 802
  12. 12. The 6th National Scientific Conference on HIV/AIDS Insurance liability for treatment of each patient Category 2016 2017 2018 2019 2020 Outpatient care (VND) Pregnant Women 1.095.560 1.095.560 1.215.560 1.215.560 1.215.560 ART 1st Line 3.629.641 4.346.868 5.389.251 5.287.001 5.233.649 ART Second Line 19.170.128 19.148.145 19.346.825 19.301.287 19.282.006 Exposed children 900.000 900.000 900.000 900.000 900.000 Average 4.102.068 4.891.206 5.980.062 5.999.943 6.052.526
  13. 13. The 6th National Scientific Conference on HIV/AIDS Range of projected liability based on sensitivity analyses 0 200 400 600 800 1000 1200 2016 2017 2018 2019 2020 Estimatedtotalhealthinsurance liability(VNDmillions) Year
  14. 14. The 6th National Scientific Conference on HIV/AIDS RESULTS – Total resource needed
  15. 15. The 6th National Scientific Conference on HIV/AIDS Projected number of people seeking HIV treatment 5,439 7,318 9,609 12,076 14,546 113,842 135,580 159,582 181,713 199,8652,012 1,905 1,791 1,688 1,603 3,092 3,056 3,047 3,033 2,989 - 50000.0 100000.0 150000.0 200000.0 250000.0 2015 2016 2017 2018 2019 Second line ART First line ART Early infant diagnosis Patients with gov't subsidy
  16. 16. The 6th National Scientific Conference on HIV/AIDS Estimated total costs of HIV treatment (VND billions) 43 52 61 70 78 138 165 245 279 308 623 752 900 1,045 1,173 58 69 76 81 88 2 2 2 2 1 0 200 400 600 800 1,000 1,200 1,400 1,600 1,800 2016 2017 2018 2019 2020 Early infant diagnosis Opportunistic infections Antiretroviral drugs Laboratory procedures Examiniations
  17. 17. The 6th National Scientific Conference on HIV/AIDS Who will pay? (average across 2016 to 2020) 39% 8%12% 10% 31% Social Health Insurance Copayments by patients on SHI External commitments Government, external and other People without health insurance or other support
  18. 18. The 6th National Scientific Conference on HIV/AIDS Conclusions • The insurance liability for HIV/AIDS treatment would be about VND 183 billion in 2016, rising to VND 802 billion in 2020. Based on sensitivity analyses, liability in 2020 could be as high as VND1000 billion, • The base case results presented for 2020 represent 1.2% of total SHI expenditures in 2014. Our model’s maximum liability projections for 2020 represent 1.9% of total SHI expenditures in 2014.
  19. 19. The 6th National Scientific Conference on HIV/AIDS Conclusion • Based on 2014 SHI expenditure data, the difference between high and low scenarios we presented represents much less than 1.0% of SHI expenditures. • HIV/AIDS treatment liability per person is about 5.6 times overall SHI expenditures per person. • In setting with higher HIV prevalence, such wide variations will have much larger implications for national health insurance
  20. 20. The 6th National Scientific Conference on HIV/AIDS Recommendations • We recommend that VSS include HIV/AIDS as a module in its overall actuarial projection models, and continue to refine and update their liability associated with HIV/AIDS. • Liability potentially most affected by price of ARVs; high price procurement of ARVs has most potential to increase HI liability. Solutions to reduce the price of ARV are needed.
  21. 21. THE 6TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS Thank you

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