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This paper exploits the staggered rollout of Vietnam's hospital autonomization policy to estimate its impacts on several key health sector outcomes including hospital efficiency, use of hospital care, and out-of-pocket spending. The authors use six years of panel data covering all Vietnam's public hospitals, and three stacked cross-sections of household data. Autonomization probably led to more hospital admissions and outpatient department visits, although the effects are not large. It did not, however, affect bed stocks or bed-occupancy rates. Nor did it increase hospital efficiency. Oddly, despite the volume effects and the unchanged cost structure, the analysis does not find any evidence of autonomization leading to higher total costs. It does, however, find some evidence that autonomization led to higher out-of-pocket spending on hospital care, and higher spending per treatment episode; the effects vary in size depending on the data source and hospital type, but some are quite large-around 20 percent. Autonomy did not apparently affect in-hospital death rates or complications, but in lower-level hospitals it did lead to more intensive style of care, with more lab tests and imaging per case.
Disease Control & Prevention --- Health Law --- Health Monitoring & Evaluation --- Health Systems Development & Reform --- Hospital autonomization --- Hospital autonomy --- Hospital efficiency --- Out-of-pocket health spending --- Population Policies --- Public Sector Development --- Social Development --- Vietnam
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This analysis aims to assess the association between commune health station (CHS) service readiness and health service utilization to inform the design of a World Bank project and policies to strengthen primary health care in Vietnam. Using data drawn from the 2015 Vietnam district and commune health facility survey (DCHFS), a series of multivariate negative binomial regressions was estimated to measure the association between domains of service readiness and CHS utilization rates (average number of visits per capita). to conclude, investments in improving facility infrastructure (especially ensuring that facilities have the mandated number of rooms and building area), making available essential equipment items, and enabling the CHS to provide hypertension and diabetes services, whether made independently or together, would all likely increase CHS utilization. Investment in CHSs in zone 3 and zone 2 should be prioritized over investments in zone 1, since investments in the former would result in the highest utilization rates.
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Does the public sector overpay or underpay workers relative to what they could earn in the private sector? Usual comparisons focus on similar jobs, but in a Developing country it is more sensible to focus on similar workers, as shown by the case of Vietnam.
Civil service --- Wage surveys --- Wages --- Salaries, etc. --- Vietnam --- Officials and employees
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El presente informe versa sobre este tipo de crecimiento elevado y sostenido: sus causas, consecuencias y su dinamica interna. En el informe se senalan algunas de las caracteristicas distintivas de las economias de crecimiento elevado y se procura establecer que deben hacer otros paises en desarrollo para emularlas. El estudio revisa las 13 economias que han tenido un alto crecimiento sostenido en el periodo de posguerra y presenta los ingredientes que podria incluir una estrategia de crecimiento. Estos van desde las politicas de inversion publica y tipos de cambio, hasta las ventas de terrenos y redistribucion de la tierra. Tambien analiza desafios al crecimiento en contextos especificos de cada pais, y dedica un apartado a estudiar los desequilibrios y las nuevas tendencias globales.
Capital --- Capital Flows --- Income Level --- Poverty --- Spanish Translation
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This book examines how nine different health systems--U.S. Medicare, Australia, Thailand, Kyrgyz Republic, Germany, Estonia, Croatia, China (Beijing) and the Russian Federation--have transitioned to using case-based payments, and especially diagnosis-related groups (DRGs), as part of their provider payment mix for hospital care. It sheds light on why particular technical design choices were made, what enabling investments were pertinent, and what broader political and institutional issues needed to be considered. The strategies used to phase in DRG payment receive special attention. These nine systems have been selected because they represent a variety of different approaches and experiences in DRG transition. They include the innovators who pioneered DRG payment systems (namely the United States and Australia), mature systems (such as Thailand, Germany, and Estonia), and countries where DRG payments were only introduced within the past decade (such as the Russian Federation and China). Each system is examined in detail as a separate case study, with a synthesis distilling the cross-cutting lessons learned. This book should be helpful to those working on health systems that are considering introducing, or are in the early stages of introducing, DRG-based payments into their provider payment mix. It will enhance the reader's understanding of how other countries (or systems) have made that transition, give a sense of the decisions that lie ahead, and offer options that can be considered. It will also be useful to those working in health systems that already include DRG payments in the payment mix but have not yet achieved the anticipated results.
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Vietnam is changing rapidly economically, with parallel shifts in epidemiology and demographics. There have also been significant policy shifts in recent years, including in the health sector. The combined effects of these transitions pose some risks to the sustainability of essential public health services, and will continue to put upward pressure on health spending. This report analyzes how Vietnam can maintain a sufficient level of public spending on health to sustain and further good health outcomes and respond to new health challenges.
Accountability --- Health Finance --- Pharmaceuticals --- Public Spending
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With the movement toward universal health coverage gaining momentum, the global health research community has made significant efforts to advance knowledge about the impact of various schemes to expand population coverage. The impacts on efficiency, quality, and gaps in service utilization of reforms to provider payment methods are less well studied and understood. The current paper contributes to this limited knowledge by evaluating the impact of a shift by Vietnam's social health insurance agency from reimbursing hospitals on a fee-for-service basis to making a capitation payment to the district hospital where the enrollee lives. The analysis uses panel data on hospitals over the period 2005-2011 and multiple cross-section data sets from the Vietnam Household Living Standards Surveys to estimate impacts on efficiency, quality, and equity. The paper finds that capitation increases hospitals' efficiency, as measured by recurrent expenditure and drug expenditure per case, but has no effect on surgery complication rates or in-hospital deaths. In response to the shift to capitation, hospitals scaled down service provision to the insured and increased provision to the uninsured (who continue to pay out-of-pocket on a fee-for-service basis). The study points to the need to anticipate the intended and unintended effects of any payment reform and the trade-offs among policy objectives.
Capitation --- Disease Control & Prevention --- Health Insurance --- Health Law --- Health Monitoring & Evaluation --- Health Systems Development & Reform --- Health, Nutrition and Population --- Hospitals --- Population Policies --- Provider Payment Reform --- Purchasing
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