1. 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
Objective Methodology
Describe the level of out-of-pocket (OOP) expenditure of people  Survey of 1,200 PLHA representing 17 estimation and projection package clusters
living with HIV/AIDS (PLHA) and utilization of inpatient and  Within each cluster, one province selected with probability proportional to size
outpatient care in Vietnam in 2010 in context of dramatic growth  Participants selected from provincial AIDS committee lists using
of donor funding for HIV/AIDS in Vietnam in past 5+ years systematic sampling
 Analysis adjusted for sampling weights
Survey Clusters* PLHA had substantially higher utilization and OOP spending for Largest PLHA OOP health expenditure
HIV-related health care than the general population had for all was for self-medication, followed by
Sample health care transportation to and from HIV service
#/%
Characteristics delivery points
Sample size 1200
Outpatient and inpatient health Average annual OOP OOP spending breakdown, including
Urban 60.3% service utilization expenditures, per person transportation
General Population* PLHA*** General Population* PLHA*** (Average annual per PLHA, 2010 USD*)
Male 58.5% 50.0% 1200
$2.59 (2%)
45.0%
46.9% 1004.9
OPC registered 59.3% $37.33 (28%)
% reporting care episode during period of recall
1000 $30.56 (23%)
40.0%
On ARV 20.1% 35.0% 1.5x 788.8
800 $20.97 (16%)
VND Thousands
Have health 30.0%
29.4% 31.0% $40.45 (31%)
insurance 2.5x
25.0% 600
~50% general population has health insurance**
20.0% Prevention (condoms & syringes)
394.8
400 Outpatient care
15.0% 6.8x Inpatient care
10.0% 2.0x 12.8%
200
Self-medication
Total: $94.58 for HIV-related health expenditures
115.2 $131.91 incl. transportation Transportation
5.0%
*Vietnam HIV/AIDS Estimates and Projections: 2007-2012. 6.5%
April 2009. Vietnam Administration of HIV/AIDS Control.
Ministry of Health, Vietnam. 0.0% 0
**Source: Health Policy Planning 2008; 23: 258. Outpatient contact over past four Hospitalization over past twelve Exams and Treatment Self medication
weeks months
*Source: Vietnam Household Living Standard Survey 2008 **Outpatient contact over the past 12 months ***For HIV-related health products and services only *Based on 19,500:1 (VND:USD) exchange rate
PLHA on ART have the most outpatient visits and fewest self-medication episodes; Main Conclusions
insured have more contacts of all types than uninsured  PLHA had higher rates of utilization for HIV-related health care than
general population had for all health care products and services.
Average number of HIV health service contacts per PLHA per year, by group Similarly, PLHA spent more per person on HIV-related health care
than general population spent per person on all health care
Not on
Contact Type Overall On ART
ART
Urban Rural Male Female Insurance No Insurance  These observations raise questions as to impact of recent substantial
Outpatient visits 7.07 13.63 5.42 7.48 6.46 6.47 7.97 7.29 6.98 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
Inpatient visits 0.16 0.18 0.16 0.17 0.15 0.19 0.13 0.18 0.16 burden of health care for PLHA
Self-medication
10.9 6.53 12.05 11.70 9.80 10.54 11.59 12.76 10.19
episodes
June 2011
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