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

3. The 6 th 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 6 th 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 6 th 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 6 th 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 6 th National Scientific Conference on HIV/AIDS Methodology Number of patientsTreatment rateCost / payment for treatment Total costs (a)(b)(c)= a * b * c Service – age sa s = 1: Screening and diagnosis 2: Art 1 st line 3: ART 2 nd line a = 1:<6years 2: 6 to <10 years 3: Over 10 years 4:< 18 months HIV exposed Clinic visits s Laboratory s ARVs s Other drug s Maintenance s Clinic visits p Laboratory p ARVs p Other drug p Maintenance p multiplied by the proportion of those in need of service s that access care for age a Where p = 1.VSS HI 2.SHI Patient 3.Non-SHI patient 4.External commitments 5.Other 6.Total costs Disaggregated by: services (s), age (a), and payers (p). separated into patients with insurance and patients without insurance

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

9. The 6 th National Scientific Conference on HIV/AIDS Basic packages for HIV/AIDS care and treatment should be paid by HI

10. The 6 th National Scientific Conference on HIV/AIDS Projected number of people seeking HIV treatment enrolled in HI

11. The 6 th National Scientific Conference on HIV/AIDS Estimated insurance liability for treatment of HIV/AIDS (Billion dong) Category 20162017201820192020 Care and treatment 181297507649800 Examinations 1318243138 Opportunistic infections 1724303542 Antiretroviral drugs 109199358461571 Laboratory procedures 415796122149 Exposed children 22221 Total 183298508651802

12. The 6 th National Scientific Conference on HIV/AIDS Insurance liability for treatment of each patient Category 20162017201820192020 Outpatient care (VND) Pregnant Women 1.095.560 1.215.560 ART 1st Line 3.629.6414.346.8685.389.2515.287.0015.233.649 ART Second Line 19.170.12819.148.14519.346.82519.301.28719.282.006 Exposed children 900.000 Average 4.102.0684.891.2065.980.0625.999.9436.052.526

13. The 6 th National Scientific Conference on HIV/AIDS Range of projected liability based on sensitivity analyses

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

15. The 6 th National Scientific Conference on HIV/AIDS Projected number of people seeking HIV treatment

16. The 6 th National Scientific Conference on HIV/AIDS Estimated total costs of HIV treatment (VND billions)

17. The 6 th National Scientific Conference on HIV/AIDS Who will pay? (average across 2016 to 2020)

18. The 6 th National Scientific Conference on HIV/AIDS Conclusions The insurance liability for HIV/AIDS treatment would be about VND 138 billion in 2015, 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 2.4% of total SHI expenditures in 2014.

19. The 6 th National Scientific Conference on HIV/AIDS Conclusion Based on 2014 SHI expenditure data, the difference between high and low scenarios we presented represent 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 6 th 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 6 TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS Thank you