The importance of assessing out‐of‐pocket payments when the financing of antiretroviral therapy is transitioned to domestic funding: findings from Vietnam

Objective To assess out‐of‐pocket payments and catastrophic health expenditures among antiretroviral therapy (ART) patients in Vietnam, and to model catastrophic payments under different copayment scenarios when the primary financing of ART changes to social health insurance. Methods Cross‐sectional facility‐based survey of 843 patients at 42 health facilities representative of 87% of ART patients in 2015. Results Because of donor and government funding, no payments were made for antiretroviral drugs. Other health expenditures were about $66 per person per year (95% CI: $30–$102), of which $15 ($7–$22) were directly for HIV‐related health services, largely laboratory tests. These payments resulted in a 4.9% (95% CI: 3.1–6.8%) catastrophic payment rate and 2.5% (95% CI: 0.9–4.1%) catastrophic payment rate for HIV‐related health services. About 32% of respondents reported, they were eligible for SHI without copayments. If patients had to pay 20% of costs of ART under social health insurance, the catastrophic payment rate would increase to 8% (95% CI: 5.5–10.0%), and if patients without health insurance had to pay the full costs of ART, the catastrophic payment rate among all patients would be 24% (95% CI: 21.1–27.4%). Conclusions Health and catastrophic expenditures were substantially lower than in previous studies, although different methods may explain some of the discrepancy. The 20% copayments required by social health insurance would present a financial burden to an additional 0.6% to 5.1% of ART patients. Ensuring access to health insurance for all ART patients will prevent an even higher level of financial hardship. Objectif Evaluer les paiements directs de la poche et les dépenses de santé catastrophiques chez les patients sous traitement antirétroviral (ART) au Vietnam et modéliser les paiements catastrophiques dans différents scénarios de cotisation lorsque le financement principal de l’ART passera à l'assurance santé sociale. Méthodes Enquête transversale basée sur l’établissement, sur 843 patients dans 42 établissements de santé représentatifs de 87% des patients sous ART en 2015. Résultats Grâce aux donneurs et au financement du gouvernement, aucun paiement n’était perçu pour les médicaments antirétroviraux. Les autres dépenses de santé étaient d'environ 66 $ par personne par an (IC95%: 30 à 102 $) dont 15 $ (7 à 22 $) étaient directement pour les services de santé liés au VIH, en grande partie, des tests de laboratoire. Ces paiements entraînaie