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.

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. The 6th National Scientific Conference on HIV/AIDS
Outline
1. Background
2. Objectives
3. Methods
4. Results
5. Conclusions
6. Recommendations

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. 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. 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. 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. 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. The 6th National Scientific Conference on HIV/AIDS
RESULTS – HI LIABILITY FOR
HIV TREATMENT

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. 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. 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. 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. 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. The 6th National Scientific Conference on HIV/AIDS
RESULTS – Total resource needed

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. 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. 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. 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. 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. 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. THE 6TH
NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS
Thank you