Vietnam is one of the 30 countries with the highest burden of tuberculosis and drug-resistant tuberculosis in the world. The World Health Organization estimates that in 2020, there were over 172,000 cases and 10,400 deaths from tuberculosis in Vietnam. Previously, first-line anti-tuberculosis drugs were purchased with the state budget through the Health and Population Target Program of the Ministry of Health to provide free treatment for tuberculosis patients. However, from 2021 to 2025, there will no longer be funding to pay for the purchase of first-line and second-line anti-tuberculosis drugs to provide free treatment to patients. Instead, from July 1, 2022, tuberculosis treatment facilities nationwide will provide tuberculosis drugs from the Health Insurance Fund for tuberculosis patients. This is a difficulty for poor patients, especially tuberculosis patients who do not have health insurance cards.
The burden of treatment without health insurance
Ms. Nguyen Thi T., born in 2000, from Chu Prong, Gia Lai. Ms. T. family conditions is very difficult, her father has to undergo dialysis, so she works in Da Nang city to send money back home. After a long cough and weight loss, Ms. T. was diagnosed with drug-resistant tuberculosis.
At that time, Ms. T. did not have health insurance. She was hesitant about the high cost of treatment, but because her illness was serious, she couldn't delay it. After discovering the disease, she bought health insurance. However, because the health insurance was new and not yet effective, she had to pay an advance of 2 million VND at the hospital, not to mention the cost of food and additional nutrition to help her body endure the harsh treatment regimen for drug-resistant tuberculosis.
Although inpatient treatment is covered by the National Tuberculosis Control Program, Ms. T. still has to cover indirect costs such as testing, infusion, travel, nutritional supplements, etc... In particular, because the treatment regimen lacks a type of medicine, Ms. T. has to buy it from outside at a cost of 700,000 VND per month. The situation is even more difficult because Ms. T. lost all her income when she had to take time off work to receive treatment.
The gap in health insurance coverage
In Gia Lai province, about 650 patients with all forms of tuberculosis are detected each year, including more than 400 patients with pulmonary tuberculosis.
From 2021 to 2025, many communes in Gia Lai will no longer be classified as "Region 3" - communes with special difficulties. According to state policy, ethnic minorities in these communes enjoy many support policies, one of which is subsidized health insurance cards. But once it was converted to a Region 2 commune, this policy was no longer applied, creating gaps in health insurance coverage in this area.
Ms. Ro O H'Hop from Ia Mlah commune, Krong Pa district, Gia Lai, is a person who always enthusiastically and actively participates in activities to support tuberculosis prevention in the locality.
Photo: Ms. Ro O H'Hop in a communication session on tuberculosis.
Her village is located in the "New Rural" area, so since 2022, except for the elderly, poor households, and policy beneficiaries, most people here do not have health insurance cards. People here have been used to receiving health insurance support from the state for many years, so when the subsidy is no longer available, many people do not know this information. Some people only find out when they go to the doctor. And most of them do not know what they need to do to buy health insurance and how to use it.
Most of the people here are ethnic minorities and many households are facing difficulties. If they are not eligible for support, they will have to pay a fee of 972,000 VND/year (4.5 times the basic salary) or 81,000 VND/month. With a limited income, mainly trying to make ends meet, many people do not have the funds for health care, creating a gap in health insurance coverage. They do not have enough money to buy health insurance for themselves, let alone for the whole family. There are families with more than 5 members, but no member has health insurance due to poor circumstances. There are people who are illiterate, have no means of transportation, and cannot ask for anyone's support.
“People here still have the habit of only needing health insurance when they are sick, but when they need it, it is too late to buy it,” Ms. Hop shared, “especially those who are diagnosed with TB and need to be hospitalized immediately, but not having a health insurance card will delay their treatment if they do not have support.”
Even if a patient starts buying health insurance when they are diagnosed with TB, they will still have to pay for treatment and medicine themselves while waiting for the card to take effect, which is also a significant cost for poor families.
“Because of limited communication, people are not aware of the benefits of health insurance. Many people can still afford to buy it, but they are willing to spend more than the cost of buying a year’s health insurance card for themselves to go to the doctor and buy medicine themselves,” Ms. Hop said.
Efforts to support patients in accessing health insurance
Through proactive TB screening activities conducted in Gia Lai, SCDI discovered many people with abnormal signs of suspected TB, but among them, about 1/3 of the patients did not have a health insurance card (BHYT) to examine and treat the disease.
Photo: Members of the TB prevention community group go to people's homes to communicate and encourage them to participate in health insurance.
Ms. Trinh Thi Thu Huong, specialist in charge of the community TB screening program in Gia Lai, from the Center for Supporting Community Development Initiatives (SCDI), said that through TB screening in the community, it shows that there are still many sources of infection in the community, and drug-resistant TB patients are still a difficult problem in TB prevention work in Gia Lai province. TB is a disease that requires long-term treatment, if they do not have a health insurance card, they have to pay tens of millions of VND for treatment, even hundreds of millions of VND for drug-resistant TB.
Vietnam is one of the 30 countries with the highest burden of multidrug-resistant TB in the world. Of which, 70% of people with TB are of working age, most of whom are poor. This also means countless difficulties and challenges to eliminate TB from the community, achieving the goal of ending the disease by 2035 as set out.
Health insurance is an important policy in Vietnam to increase access to health services and reduce catastrophic costs caused by the burden of disease. It is an important step in the effort to achieve Universal Health Coverage. When 100% of TB patients are supported by health insurance, TB prevention, detection, and treatment will be truly effective.
VOV.VN - Ha Nguyen
