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 Development

www.abtassociates.com

June

20

11

ObjectiveDescribe the level of out-of-pocket (OOP) expenditure of people living with HIV/AIDS (PLHA) and utilization of inpatient and outpatient care in Vietnam in 2010 in context of dramatic growth of donor funding for HIV/AIDS in Vietnam in past 5+ years

Methodology

Survey Clusters*

PLHA on ART have the most outpatient visits and fewest self-medication episodes; insured have more contacts of all types than uninsured

Survey of 1,200 PLHA representing 17 estimation and projection package clusters Within each cluster, one province selected with probability proportional to size Participants selected from provincial AIDS committee lists using systematic sampling Analysis adjusted for sampling weights

Main Conclusions PLHA had higher rates of utilization for HIV-related health care than

general population had for all health care products and services. Similarly, PLHA spent more per person on HIV-related health care than general population spent per person on all health care

These observations raise questions as to impact of recent substantial 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 financial burden of health care for PLHA

Sample Characteristics #/%

Sample size 1200

Urban 60.3%

Male 58.5%

OPC registered 59.3%

On ARV 20.1%

Have health insurance 29.4%

~50% general population has health insurance**

*Vietnam HIV/AIDS Estimates and Projections: 2007-2012. April 2009. Vietnam Administration of HIV/AIDS Control. Ministry of Health, Vietnam.**Source: Health Policy Planning 2008; 23: 258.

PLHA had substantially higher utilization and OOP spending for HIV-related health care than the general population had for all

health care

*Source: Vietnam Household Living Standard Survey 2008 **Outpatient contact over the past 12 months ***For HIV-related health products and services only

31.0%

6.5%

46.9%

12.8%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

Outpatient contact over past fourweeks

Hospitalization over past twelvemonths

Outpatient and inpatient healthservice utilization

General Population* PLHA***

1.5x

2.0x

394.8

115.2

1004.9

788.8

0

200

400

600

800

1000

1200

Exams and Treatment Self medication

Average annual OOPexpenditures, per person

General Population* PLHA***

2.5x

6.8x

% r

epo

rtin

g c

are

epis

od

e d

urin

g p

erio

d o

f re

call

VN

D T

hous

and

s

Largest PLHA OOP health expenditure was for self-medication, followed by

transportation to and from HIV service delivery points

Total: $94.58 for HIV-related health expenditures$131.91 incl. transportation

$2.59 (2%)

$30.56 (23%)

$20.97 (16%)

$40.45 (31%)

$37.33 (28%)

Prevention (condoms & syringes)

Outpatient care

Inpatient care

Self-medication

Transportation

*Based on 19,500:1 (VND:USD) exchange rate

Average number of HIV health service contacts per PLHA per year, by group

Contact Type Overall On ART Not on ART Urban Rural Male Female Insurance No Insurance

Outpatient visits 7.07 13.63 5.42 7.48 6.46 6.47 7.97 7.29 6.98

Inpatient visits 0.16 0.18 0.16 0.17 0.15 0.19 0.13 0.18 0.16

Self-medication episodes 10.9 6.53 12.05 11.70 9.80 10.54 11.59 12.76 10.19

OOP spending breakdown, includingtransportation

(Average annual per PLHA, 2010 USD*)