1. Background:
In Viet Nam, health insurance (HI) is known as a right to health care of all people accompanied by obligations to contribute and share responsibility of individuals, communities, employers and the state. By 2014, it is expected that all Vietnamese citizens are accountable under health insurance coverage.
Tuberculosis is a public health concern in Vietnam and the country ranks twelfth among the 22 high-burden Tuberculosis (TB) and 14th among the 27 high-burden multi-drug resistant TB (MDR-TB) countries (WHO). TB control is mandated by MoH and implemented by the National TB Control Programme (NTP), hosted at National Lung Hospital in Hanoi. The TB control programme is one of the national target programmes which receive annual contributions from the State budget for implementation.
Currently, the State budget covers about 70% of the necessary funding for first-line anti-TB drugs and the diagnostic microscopy examination of confirmed TB patients. Other drugs and services (second-line drugs, ancillary drugs, laboratory tests, hospitalization fee) either come from HI, are donor funded or must come from out-of-pocket payment.
The financing for TB diagnosis and treatment still heavily relies on out-of-pocket payments (OPP) for everything other than first-line anti-TB drugs which are procured by the National TB control programme; it is assumed that this is a considerable financial barrier for the poor and vulnerable groups to access TB care and treatment.
In order to understand the situation of health insurance coverage and health care benefit for TB services and to analyze the barriers of access to health insurance among TB patients at the peripheral level (communes and districts) and inform policy to support TB patients, we contract two consultants to carry out a study on the obstacles to access to health insurance and health care benefit for TB diagnosis and treatment.
The study will be carried out in:
a. commune health centers of Yen Bai, Nam Dinh, Ha Nam, Lam Dong, Dong Nai, An Giang; these provinces have a mix of manpower capacity at commune level: doctor vs assistant doctor
b. district TB units (DTU) in Nam Dinh, Ha Nam and Lam Dong; here the DTU is located in district general hospitals and
c. DTU in Yen Bai, Dong Nai and An Giang where the DTU is located in the district health center.
2. Purpose/Specific Objective of the Activity
a. Overall objective: to understand the health care benefits covered under health insurance and obstacles to access to health insurance services among insured TB patients at peripheral level (commune and district)
b. Specific objectives:
- To describe the health care benefits for insured TB patients at peripheral level (communal and district) as institutionalized in current legal documents (law, decrees,
circulars, TB national programme policy)
- To estimate the direct cost of diagnosis and treatment for TB among insured patients and non-insured patients
- Compare the coverage and the barriers to access the health care insurance of TB patients between provinces (where the DTUs are located in district general hospitals vs where DTUs belong to district health center)
- To define the obstacles to access health care services (diagnosis and treatment) for insured TB patients
- To make recommendations to provide better health care services and better access for TB patients, especially for the vulnerable people and people at risk.
3. Description of activities to be carried out
- Desk review of all legal documents of all relevant authorities related to health insurance in general and especially for TB.
- To collect data on health care benefits and health insurance coverage at peripheral level (communal and district):
• % of TB patients have HI card (by type of HI: government employee, poor, pro-poor, student, voluntary)
• % of those insured TB patients have HI payment for health services apart from anti-TB drugs at these levels
• Cost for TB diagnosis and treatment at each level for insured and non-insured TB patients (anti-TB drug excluded),
• % of HI coverage and OPP for diagnosis and treatment at each level
- Through qualitative interview/FGD to explore the
• impact of HI payment policy at the peripheral levels to access to HI services and patient’s payment
• Manpower’s shortage in providing HI services for patients in need (e.g. education level of health staff at commune level triggers availability of essential medicines)
• Advantages/disadvantages of current HI service mechanism (for curative services only.)
4. Method(s) to carry out the activity
- Desk review
- Checklist to collect data
- In-depth interview and focus group discussion
- Analysis and writing report
5. Description of the tasks/process involved in carrying out the activity
- Literature review (national / international ): Review all legal documents related to HI and TB services
- Data collection at the field sites (district hospitals, district health centers and commune health posts)
- Interview experts/relevant people at commune/district/provincial/NTP/MoH/social security
- Data entry
- Analysis and writing report
6. Timeline/Duration of assignment
1 July 2013 to 31 Aug 2013 (or 2 months with starting as soon as possible)
7. Deliverable(s) to be submitted during and after the period of the assignment including manner of delivery and payment
- Data file (quantitative and qualitative)
- Full report
- Financial report
8. Required education and experiences
Vietnamese national
Education (Qualifications):
Essential: University degree in Medicine from a recognized institution with postgraduate degree in public health
Experience:
Essential: 5 years of experience in health financing / TB and/or field projects involving tuberculosis epidemiology / health insurance policies and implementation at central and peripheral levels
9. Application submission
Deadline: 20 June 2013
Address: Administrative Officer, 63 Tran Hung Dao, Hanoi, Viet Nam
Email: [email protected] [1]