estimating hi liability for treatment of hiv en

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

The 6th National Scientific Conference on HIV/AIDS

Outline

1. Background

2. Objectives

3. Methods

4. Results

5. Conclusions

6. Recommendations


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.


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.


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


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]


MethodologyNumber of patients Treatment rate Cost / payment

for treatmentTotal costs

(a) (b) (c) = a * b * c

Service – agesa

s =1: Screening and diagnosis2: Art 1st line3: ART 2nd linea = 1:<6years2: 6 to <10 years3: Over 10 years4:< 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 HI2. SHI Patient3. Non-SHI

patient4. External

commitments

5. Other6. Total costs

Disaggregated by:

services (s), age (a), and payers

(p).

separated into patients with insurance and patients without insurance


RESULTS – HI LIABILITY FOR HIV TREATMENT


Basic packages for HIV/AIDS care and treatment should be paid by HI

ART (first year)

ART (After first yr)

1 Testing and counseling1.2.a PCR 11.2.b ELISA 12.1 Examination 12 12 12 62.2 Basic diagnosis (lab test and X-ray)

2.2.a Blood cell count, 2.00 2.00 1.002.2.b HbsAg, 1.00 0.50 1.002.2.c Anti-HCV 1.00 1.002.2.e Creatinine in blood, 1.00 1.40 1.002.2.f ALT 1.00 1.00 1.002.2.g CD4 1.00 1.00 0.502.2.h Viral Load 1.00 1.00 0.502.3.a TB INH Maintenance 0.70 0.352.3.b Cotrimoxazole Therapy 365 365 122 1832.4 ARV 12 12 62.5 OI OPC treatment 0.5 0.5 0.25

ARV for pregnant women

Cost componentsNoAll age

Exposed HIV children


Projected number of people seeking HIV treatment enrolled in HI

2016 2017 2018 2019 20200

20,000

40,000

60,000

80,000

100,000

120,000

140,000

1,958 3,074 4,612 6,521 8,727

41,73457,582

77,15198,599

120,317

2,012

1,905

1,791

1,688

1,603

1,113

1,284

1,463

1,638

1,793

Second line ART First line ARTEarly infant diagnosis Patients with gov't subsidy


Estimated insurance liability for treatment of HIV/AIDS (Billion VND)

Category 2016 2017 2018 2019 2020

Care and treatment 181 297 507 649 800Examinations 13 18 24 31 38Opportunistic

infections17 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


Insurance liability for treatment of each patient

Category 2016 2017 2018 2019 2020

Outpatient care (VND)

Pregnant Women1.095.560 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 Line19.170.128 19.148.145 19.346.825 19.301.287 19.282.006

Exposed children900.000 900.000 900.000 900.000 900.000

Average 4.102.068 4.891.206 5.980.062 5.999.943 6.052.526


Range of projected liability based on sensitivity analyses

2016 2017 2018 2019 20200

200

400

600

800

1000

1200

Year

Estim

ated

tota

l hea

lth in

sura

nce

li-ab

ility

(VN

D m

illio

ns)


RESULTS – Total resource needed


Projected number of people seeking HIV treatment

2015 2016 2017 2018 2019 2020 -

50000.000

100000.000

150000.000

200000.000

250000.000

5,439 7,318 9,609 12,076 14,546

113,842135,580

159,582181,713 199,8652,012

1,9051,791

1,6881,603

3,0923,056

3,0473,033

2,989

Second line ART First line ARTEarly infant diagnosis Patients with gov't subsidy


Estimated total costs of HIV treatment (VND billions)

2016 2017 2018 2019 20200

200

400

600

800

1,000

1,200

1,400

1,600

1,800

43 52 61 70 78138 165 245 279 308

623752

9001,045

1,17358

69

76

8188

2

2

2

21

Early infant diagnosisOpportunistic infectionsAntiretroviral drugsLaboratory proceduresExaminiations


Who will pay? (average across 2016 to 2020)

39%

8%12%

9%

31%Social Health Insurance

Copayments by patients on SHI

External commitments

Government, external and other

People without health insurance or other sup-port


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.


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


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.

THE 6TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS

Thank you

estimating hi liability for treatment of hiv en

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