Health Insurance Expenditure Structure for Type 2 Diabetes Treatment in Vietnam by Hospital Classification, 2018-2022: A Descriptive Analysis of Claims Data From Hanoi and Ho Chi Minh City

This descriptive analysis of Vietnamese health insurance claims from 2018 to 2022 reveals that total Type 2 diabetes treatment expenditures nearly doubled, with medication costs constituting the largest share and spending heavily concentrated in Class I and II hospitals, underscoring the need to strengthen care at lower-level facilities to improve resource allocation.

The Gist

Imagine Vietnam's healthcare system as a massive, bustling city of hospitals, where every building is designed to handle different types of emergencies. Now, picture Type 2 Diabetes not as a single event, but as a long-term, slow-burning fire that requires constant attention, fuel, and care for years on end.

This paper is essentially a financial map of how much money Vietnam spent putting out that fire between 2018 and 2022. The researchers looked at the receipts from two of the country's biggest cities, Hanoi and Ho Chi Minh City, to see exactly where the money went and which "buildings" were doing the most work.

Here is the story the data tells, broken down simply:

1. The Bill is Getting Bigger

Just like a household budget that grows as you get older, the total cost of treating diabetes in these cities has nearly doubled in five years.

• 2018: The bill was about $227 million.
• 2022: The bill jumped to $425 million.
  Think of this as the "fuel" needed to keep the fire under control getting more expensive every year.

2. Where the Money is Going (The "Big Three")

When you look at the receipt for treating a diabetic patient, it's not a random mix of items. It's heavily skewed toward three main things:

• Medicine (The Heavy Lifter): This is the biggest chunk of the bill, taking up anywhere from 50% to nearly 80% of the cost.
  • Analogy: If treating diabetes is like driving a car, medicine is the gas. You can't move an inch without it, and you need to keep refilling the tank every single day. It's the most expensive part of the journey.
• Lab Tests (The Check-ups): This is the second biggest cost (about 7% to 20%).
  • Analogy: These are the oil changes and tire rotations. You have to do them regularly to make sure the car (the body) is running safely and to catch problems before they become disasters.
• Hospital Beds & Procedures: These make up a smaller slice of the pie, but they are growing slightly.

3. The "Tall Buildings" vs. The "Local Shops"

The study looked at hospitals by "tier" (Class I and II are the big, fancy, specialized hospitals; lower tiers are smaller local clinics).

• The Old Pattern: For a long time, almost everyone with diabetes went to the Tall Buildings (Class I & II). These big hospitals were doing the heavy lifting and holding the most money.
• The New Trend: While the big hospitals are still doing the most work, their share of the total bill is slowly shrinking. Meanwhile, smaller, unclassified or special clinics are starting to see more patients and spending more money.
  • Analogy: Imagine a city where everyone used to drive to the massive downtown skyscraper for a cup of coffee. Now, people are starting to visit the local corner cafes more often. The skyscraper is still busy, but the neighborhood shops are getting busier, too.

4. The Big Takeaway

The researchers are saying: "We need to change the traffic flow."

Right now, the system is a bit like a traffic jam where everyone is trying to get into the main highway (the big hospitals) for a simple check-up. The study suggests that we should build better local exits and neighborhood roads (lower-level clinics).

If we can teach people to manage their diabetes and get their "gas" (medicine) and "oil changes" (tests) at their local corner clinic, it will:

1. Clear the traffic at the big, expensive hospitals.
2. Save money in the long run.
3. Make the whole system run smoother, just like a well-planned city.

In a nutshell: Treating diabetes in Vietnam is getting more expensive, mostly because of the cost of medicine. While the big hospitals are still the main players, the system is slowly shifting toward smaller clinics. The goal is to encourage more people to get care locally so the big hospitals aren't overwhelmed, making the whole healthcare "city" more efficient.

Technical Summary

Study Overview

Title: Health Insurance Expenditure Structure for Type 2 Diabetes Treatment in Vietnam by Hospital Classification, 2018-2022: A Descriptive Analysis of Claims Data From Hanoi and Ho Chi Minh City.

This study addresses the critical gap in understanding the economic burden of Type 2 Diabetes Mellitus (T2DM) in Vietnam by analyzing large-scale administrative health insurance (HI) claims data. It specifically focuses on the expenditure structure across different hospital tiers in two major urban centers (Hanoi and Ho Chi Minh City) over a five-year period.

1. Problem Statement

• Rising Burden: T2DM is a chronic condition causing a significant and growing strain on Vietnam's healthcare system and society due to its rapidly increasing prevalence.
• Data Scarcity: Despite the urgency, there is a lack of empirical evidence regarding treatment expenditures derived from large administrative databases in Vietnam.
• Resource Allocation: There is an insufficient understanding of how costs are distributed across different levels of healthcare facilities (hospital classifications), which hinders effective policy-making for resource allocation and disease management.

2. Methodology

• Study Design: A cross-sectional descriptive study utilizing retrospective data.
• Data Source: Health insurance (HI) claims data collected from 2018 to 2022.
• Geographic Scope: Data was drawn from two major cities: Hanoi and Ho Chi Minh City.
• Analytical Framework:
  • Cost Components: Expenditures were disaggregated into specific categories: medications, diagnostic tests, hospital beds, diagnostic imaging, procedures/surgeries, and medical supplies.
  • Stratification: Analysis was conducted based on healthcare facility classifications (Class I, Class II, unclassified, and special-class facilities).
  • Currency Standardization: All costs were converted to 2024 USD using the CCEMG-EPPI-Centre cost converter to ensure comparability and account for inflation.

3. Key Contributions

• Comprehensive Cost Mapping: The study provides the first detailed overview of total T2DM treatment expenditures in Vietnam broken down by hospital tier and cost component over a significant time span (2018–2022).
• Structural Insight: It reveals the shifting dynamics of healthcare utilization, specifically tracking the decline in the share of spending at higher-tier hospitals versus the rising share at lower-tier or unclassified facilities.
• Policy-Relevant Evidence: By quantifying the specific cost drivers (e.g., the dominance of drug costs), the study offers a data-driven foundation for optimizing Vietnam's health insurance policies and chronic disease management strategies.

4. Key Results

• Expenditure Growth: Total T2DM treatment expenditure nearly doubled, rising from $227.17 million in 2018 to $425.53 million in 2022.
• Facility Utilization Trends:
  • Spending remains heavily concentrated in Class I and Class II (higher-tier) facilities.
  • However, the proportion of total spending attributed to these higher-tier facilities has declined over time.
  • Conversely, the proportions attributed to unclassified and special-class facilities have increased, suggesting a shift in patient flow or service delivery patterns.
• Cost Composition:
  • Medications: The dominant cost driver, accounting for 49.65% to 78.95% of total expenditure across all facility types. This reflects the long-term, continuous pharmacological requirements of T2DM.
  • Laboratory Tests: The second largest component, ranging from 7.31% to 19.89%.
  • Other Components: Hospital beds, imaging, procedures, and supplies contributed smaller shares individually but showed increasing trends in specific facility groups over the study period.

5. Significance and Implications

• Chronic Disease Management: The overwhelming share of medication costs underscores the necessity of sustainable, long-term pharmacological support for T2DM patients within the national health insurance scheme.
• Decentralization of Care: The declining share of spending in top-tier hospitals and the rise in lower-tier facility usage suggest a potential shift in care delivery. However, the study argues that strengthening diabetes screening, treatment, and follow-up at lower-level healthcare facilities is crucial.
• System Efficiency: By moving routine management to lower-level facilities, the healthcare system can reduce the burden on specialized (Class I/II) hospitals, thereby improving the overall efficiency of healthcare resource allocation and potentially lowering the long-term economic burden of the disease.