Social Health Insurance for People Living with HIV/AIDS in Ninh Binh and Dong Thap

Introduction
The survey was conducted to collect data to inform the design of a pilot model on health insurance for people living with HIV/AIDS (PLHIV) in provinces with little or no international aid for HIV/AIDS prevention and control. Specifically, the survey will find out the access and use of social health insurance (SHI) of PLHIV as well as the barriers to and limitations of PLHIV’s access to SHI in terms of health care services and finance.

Research Method
•    Method: Quantitative method was primarily used in the research, supported by qualitative analysis in combination with secondary data analysis.
•    Sample size and sampling method: Quantitative method used systematic random sampling based on the sampling frame of the list of PLHIV currently treated at all OPCs in two surveyed provinces. The total of 484 PLHIVs who currently registered at outpatient clinics (OPCs) were invited to participate in the quantitative research. For qualitative research, 38 in-depth interviews with program managers and staff providing medical services for PLHIV and managers of social insurance and health insurance agencies were conducted.
•    Limitations: (1): The findings mainly represent the group of PLHIV having registered treatment at OPCs and are not intended to be proxy of all PLHIV in the community; (2): Recall bias in the estimation of data, expenses and treatment costs over the past 12 months of the study participants.

Key findings
Both provinces have not a separate policy on health insurance support for PLHIV. The general coverage rate of SHI is 54% of which 69% in Ninh Binh and 39% in Dong Thap. Commune health stations are the place of registration for primary health care of the majority of the surveyed PLHIV in two provinces; however, over 60% of the surveyed PLHIV wish to have district or upper level hospitals as their primary health facility. 86% of PLHIV plans to participate in SHI scheme and are willing to pay for SHI cards within their financial capacity.
 
Access and use of SHI for HIV healthcare and treatment services: In Ninh Binh, SHI definitely does not pay for the services provided at OPCs because all OPCs are located in the preventive system while in Dong Thap, SHI are still paid for basic tests as regulated by the SHI but the payment is not consistent.

Access and use of SHI for health care services at health facilities other than OPCs: About 80% of PLHIV with HI cards are currently using HI for outpatient examination and treatment at medical establishments other than OPC and for inpatient treatment; There are differences in the proportion of services used, place of using health care services at health facilities other than OPC between PLHIV using SHI and not using SHI.

The expenses for health care of a PLHIV during 12 months before the date of the survey is about 20% of total expenses, and about 17% of total income. 

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