National Consultant – Health Insurance Landscaping Analysis

In Vietnam, the national health insurance coverage is high. The government aims to cover 92.6% population by health insurance in 2022 and 95.15% population in 2025 according to the Decree 546/QD-TTg on 29/04/2022.

Currently malaria treatment is free under the national malaria program. Malaria elimination interventions are primarily funded through external donors, particularly the Global Fund. Vietnam continues to make extraordinary gains in getting closer to malaria elimination, with under 500 cases reported in 2021, 10% of which were detected in the private sector. As efforts to transition from external donor funding to domestic resources become increasingly necessary, it is foreseeable that in future malaria treatment will be included in the health insurance payment scheme, similar to HIV and TB.

The legal framework for national health insurance currently recognizes both private and public facilities for inclusion. In practice, the requirements for participation are stringent and are the same for private providers regardless of location – urban, rural or mountainous. These requirements represent a high barrier to entry for private clinics particularly in the rural/mountainous areas, the very clinics most likely to serve the vulnerable communities most at risk for malaria. This context represents a threat to the achievement of national malaria elimination goals and the prevention of reintroduction of malaria after zero cases are achieved.

In Feb/March 2022 the PSI Vietnam team carried out a rapid review as part of program implementation.

Information from provincial health insurance department:

  • No limitation of # of clinics to sign contract with Health Insurance
  • Health insurance department have designated person to support private clinic
  • After signing the contract, health Insurance department will train the clinic to cope with the process to manage patient records, drugs, payment and reimbursement of the health insurance.

Criteria for private clinics to apply also consider as challenges:

  • At least 50% doctors are full-time
  • At least 2 specialties (internal medicine, surgery, OBGYN, pediatrics, laboratory, diagnostic imaging)
  • The clinic must be registered as a legal private company
  • Operate full-time, not only outside of working hours
  • The process to sign the contract took long period of time because the full application is complicated to prove the capability of the staff, specialties, equipment, drugs and list of approved techniques. (DOH review)
  • The clinic is assessed and evaluated monthly/quarterly by Health insurance through 100% patient records on system and 30% actual patient records at the clinic. Vietnam Health insurance department use a digital platform to receive patient record from all facilities

Objective of the Landscaping Analysis

The general objective of this assignment is to conduct a landscape analysis of the feasibility and process of including private sector health providers into national health insurance schemes for malaria treatment and other services in the benefits package to be delivered through the primary health care system in Vietnam. The consultant will work in close collaboration with a international consultant, PSI Vietnam and the PSI Global and Regional team to achieve this general objective.

Specific objectives are to:

  • Map the landscape of te national health insurance ecosystem outlining the most relevant schemes for private providers in relation to fever management, key stakeholders and relationships between the national and subnational levels.
  • Assess the current status of private sector healthcare provider’s inclusion in national health insurance scheme for malaria testing and treatment (or fever management as a proxy).
  • Document requirements needed for inclusion of private providers in national health insurance scheme.
  • Identify key stakeholders (public and private) required to facilitate private sector participation in health insurance including their role, power and influence.
  • Identify facilitators and barriers to entry for private provider’s participation in health insurance scheme in Vietnam
  • Develop a roadmap using the HSA’s Theory of Change as a framework of analysis to identify areas where PSI is primed to engage, including but not restricted to facilitating the inclusion of the private sector in the national health insurance scheme.

SCOPE OF WORK

1. Type of contract: Part-time Consultant

2. Duration: July – October 2022 and up to 25 working days.

The national consultant will contribute to the landscaping analysis by working closely with an International Consultant, PSI’s local researcher to conduct desk review and key informant interview to develop a detailed understanding of challenges faced by private provider and to identify what efforts are already going on or planned to address these challenges and develop recommendations.

Final responsibilities, deliverables and total working days will be discussed and agreed upon contract signing based on the consultant’s availability and start date.

3. Key responsibilities and deliverables might include:

4. Selection Qualifications

  • Master’s degree or higher in social science, public health and/or at least 7 years’ experience working in health, health insurance or relevant fields
  • Knowledge of the public health, social and health insurance in Viet Nam is a must
  • Good English speaking and writing is preferred

5. Deadline for proposals: July 20, 2022

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