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HIV/AIDS patients reluctant to buy health insurance, fear discrimination

Update: October, 30/2015 - 17:02
People living with HIV seeks consulting service at the Tropical Diseases Centre of the central Nghe An General Hospital. — Photo

Gia Loc

HCM CITY (VNS) — Health insurance has become critically important for HIV/AIDS patients as free anti-retroviral medicine and testing will no longer be readily available because of reduced international aid.

Because of Viet Nam's classification as a lower middle-income country by the UN, funds from international aids will continue to fall, and eventually, patients with HIV/AIDS will have to pay for treatment.

Nguyen Hoang Long, head of the country's HIV/AIDS Prevention Department, said that health insurance would help reduce the patients' payments.

However, only 30 per cent of patients with HIV/AIDS buy insurance, and in HCM City, the figure is 20-25 per cent, according to the city AIDS Prevention Committee.

As of this year, HCM City has 41,841 people with HIV.

Venerable Thich Dong Nguyen, director of Phap Bao Community Counseling and Support Centre, said that many HIV/AIDS patients who receive counseling at his centre wanted to buy health insurance, but had not done so because of the stigma attached to the disease.

"They're afraid that many people will find out about their disease," he said.

Most patients from other provinces and cities come to HCM City to earn a living, and many of them are casual labourers with an unstable income.

To buy health insurance, they have to have temporary residential registration papers.

Nguyen said that one patient with HIV/AIDS told him that he had to borrow papers from his landlord, who asked why he needed to do so.

The patient told him that he had HIV and needed to buy health insurance, and as a result, the landlord no longer allowed him to live there.

"Discrimination by the community and even patients with HIV/AIDS have created these problems," Nguyen said.

The amended Health Insurance Law on health insurance is also a barrier for HIV/AIDS patients.

The law, which took effect earlier this year, requires that insurance must be bought for all members of a family.

Tran Thi Phung of the Niem Tin community-based organisation (CBO), which provides healthcare and counselling to HIV patients, said that many women and children chose to stay at home or work as casual labourers because of poor health.

"They can't afford to buy health insurance cards for themselves, which cost VND600,000-700,000 ($27-31) each. It's even more difficult to buy for the whole family," she said.

At an HIV outpatient clinic in District 4, of more than 1,200 patients with HIV, only 30 per cent have health insurance cards. Most of them work, but are poor or near-poor.

Nguyen said the Ministry of Health should simplify health-insurance procedures, and allow HIV/AIDS patients to buy insurance at the HIV outpatient clinics.

Dr Tieu Thi Thu Van, head of the city's AIDS Prevention Committee, has asked the central government to streamline the policy and allow HIV/AIDS patients to buy cards on their own.

Access to benefits

In June, the Ministry of Health issued a list of medical services paid by the Social Insurance Agency, but the list still does not provide sufficient services to insured HIV/AIDS patients.

In HCM City, for example, 90 per cent of patients with HIV are treated at HIV outpatient clinics at district preventive health centres.

However, the Social Insurance Agency, under the recently amended Health Insurance Law, is not allowed to sign insurance contracts for treatment at these centres as they are not legally covered under the law. Under the law, they can only sign agreements for payments to hospitals.

As a result, insured patients with HIV treated at the centres receive no coverage.

However, district hospitals and general hospitals in HCM City can only provide testing, and do not offer treatment for these patients.

The patients are sent to specialised hospitals, such as Nhan Ai, Chi Hoa, Pham Ngoc Thach, paediatrics hospitals No.1 and 2 and the Tropical Diseases Hospital.

Social welfare centres also provide treatment for them.

Another problem under the amended law is that patients must go to a hospital that is named on their health insurance card.

To solve these discrepancies, insured patients treated at district- or commune-level health facilities will be covered by health insurance in January next year, under regulations of the amended Health Insurance Law.

HCM City plans to expand anti-retroviral (ARV) therapy to general district hospitals and private hospitals between 2016 and 2020.

At that time, the city is considering two options to solve the coverage problem.

One option involves sending patients with HIV/AIDS at district preventive centres to district general hospitals for treatment.

The city would transfer the staff specialising in HIV/AIDS at the centres to hospitals, which offer insurance coverage under the amended Health Insurance Law. Patients' treatment fees would then be paid by the Social Insurance Agency.

The second option would be to classify district preventive health centres as "health centres", which would allow the centres to sign agreements with the national Social Insurance Agency as prescribed by the amended Health Insurance law. Thus, patients with HIV/AIDS could be covered at these centres.

Under the city's proposal, social welfare centres that offer treatment now to HIV patients would be classified as satellite health facilities of district general hospitals. The patients would then qualify for insurance coverage. — VNS

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