Vu Lan Thi Hoang, Johns Benjamin, Bui Quyen Thi Tu, Duong Thuy Anh, Nguyen Thi Diu, Nguyen Thi Hien, Nguyen Cam Anh
Department of Epidemiology and Biostatistics, Hanoi University of Public Health, Hanoi, Vietnam.
International Health Division, Abt Associates Inc, Bethesda, MD, USA.
Health Serv Insights. 2021 Jan 21;14:1178632920988843. doi: 10.1177/1178632920988843. eCollection 2021.
This study estimates the amount antiretroviral therapy (ART) clients paid out of pocket for preventive and treatment services and the percentage of ART clients incurring catastrophic payments during the period when ART services were transitioning from donor funding to domestic social health insurance (SHI) in Vietnam. Using a cross-sectional facility-based survey in 9 provinces, a sample of 582 clients across 18 ART facilities representatives of all facilities where SHI-financed ART was being implemented were interviewed in 2019. Results indicated 13.4% (95% CI: 5.7%, 28.2%) of clients incurred a payment for outpatient ART care. The average out of pocket expenditures for outpatient visits and HIV related outpatient visits was USD $71.2 and $8 per year, respectively. The average out of pocket expenditure for inpatient admission and HIV related inpatient admission was $7.1 and $1.6, respectively. Only 0.1% clients currently experienced HIV-related catastrophic payment at the 25% of total expenditures threshold. The study confirms the transition from donor-financed ART to SHI-financed ART is not causing financial hardship for ART clients. However, more commitment from the Government of Vietnam to strengthen HIV-related services under SHI may be needed in the future, and there is still need to ensure universal SHI coverage among people with HIV/AIDs in Vietnam.
本研究估算了越南抗逆转录病毒疗法（ART）患者自掏腰包支付预防和治疗服务的费用，以及在ART服务从捐助资金过渡到国内社会医疗保险（SHI）期间，ART患者发生灾难性支出的比例。2019年，在9个省份开展了一项基于机构的横断面调查，对18个实施SHI资助ART的机构中的582名患者进行了抽样访谈，这些患者代表了所有此类机构。结果显示，13.4%（95%置信区间：5.7%，28.2%）的患者支付了门诊ART护理费用。门诊就诊和与HIV相关的门诊就诊的平均自付费用分别为每年71.2美元和8美元。住院和与HIV相关的住院的平均自付费用分别为7.1美元和1.6美元。在总支出阈值的25%水平上，目前只有0.1%的患者经历了与HIV相关的灾难性支出。该研究证实，从捐助资助的ART过渡到SHI资助的ART不会给ART患者带来经济困难。然而，未来越南政府可能需要做出更多承诺，以加强SHI下与HIV相关的服务，并且仍有必要确保越南HIV/AIDS患者能够普遍享受SHI覆盖。
