Lessons for Hospital Autonomy

The Government of Vietnam sees hospital autonomy policy as important and consistent with current development trends in Vietnam. It is based on government policies as laid out in government Decree on financial autonomy of revenue-generating public service entities; and to 2006, it is replaced by decree on professional, organizational, human resource management and financial autonomy of revenue-generating and state budget-financed public service entities. These policies apply to public service entities in all sectors, including the health sector and hospitals. This policy is an important element of public administration reform in Vietnam, helping service entities survive and develop under the socialist-oriented market mechanism. It aims to help hospitals in fulfilling assigned professional tasks by allowing them to restructure their organization and staffing. The government has also allowed public service entities to mobilize private capital and joint ventures to organize activities and services responding to social and people's needs. This study will show that since the implementation of decrees, a number of improvements have been demonstrated within hospitals with respect to physical facilities, service provision, medical techniques, service quality and staff incomes, thus creating stability and satisfaction among hospital workers. But it also describes the international evidence that implementation of hospital autonomy comes with a risk of unintended outcomes driven by powerful financial incentives from the market place to increase revenue. These include supply induced demand, cost escalation, inappropriate care. There are some indications that such risks may be emerging in Vietnam as well, although these would need further research. Fortunately, there is also international evidence about policies that can mitigate such risks, and these are also described in this report. This report will inspire further studies and encourage policymakers to think about continuous improvement of policies.

Bibliographic Details

Main Authors:	Vietnam Ministry of Health, Health Strategy and Policy Institute, World Bank, World Health Organization
Format:	Policy Note biblioteca
Language:	English en_US
Published:	World Bank, Washington, DC 2011-07
Subjects:	ABILITY TO PAY, ABUSE, ACCESS TO HEALTH SERVICES, ALLOCATIVE EFFICIENCY, BACK PAIN, BASIC HEALTH SERVICES, BEDS, CAPACITY BUILDING, CERTIFICATION, CITIES, CITIZENS, CLINICAL CARE, CLINICAL GUIDELINES, CLINICAL PRACTICE, CLINICAL RECORDS, CLINICAL SERVICES, CLINICAL STAFF, CLINICIANS, CLINICS, DECISION MAKING, DEVELOPING COUNTRIES, DIAGNOSIS, DIAGNOSTIC TESTS, DIRECT COSTS, DOCTORS, ECONOMIC DEVELOPMENT, EMPLOYMENT, ENGINEERS, EQUITY IN ACCESS, ESSENTIAL DRUGS, ESSENTIAL HEALTH SERVICES, ETHICAL CONDUCT, EXERCISES, EXPENDITURES, FEE SCHEDULE, FEE-FOR-SERVICE, FEE-FOR-SERVICE BASIS, FEE-FOR-SERVICE PAYMENTS, FINANCIAL CONTROL, FINANCIAL MANAGEMENT, GOOD GOVERNANCE, GOVERNMENT AGENCIES, GOVERNMENT CAPACITY, GOVERNMENT LEADERSHIP, GOVERNMENT POLICIES, HEALTH CARE, HEALTH CARE BUSINESSES, HEALTH CARE PROVIDERS, HEALTH CARE QUALITY, HEALTH EXPENDITURE, HEALTH FINANCING, HEALTH INFORMATION, HEALTH INFORMATION SYSTEMS, HEALTH INSURANCE, HEALTH ORGANIZATION, HEALTH REFORM, HEALTH SECTOR, HEALTH SERVICE, HEALTH SERVICE DELIVERY, HEALTH SERVICE PROVIDERS, HEALTH SERVICES, HEALTH SPECIALIST, HEALTH STRATEGY, HEALTH SYSTEM, HEALTH SYSTEM PERFORMANCE, HEALTH SYSTEMS, HEALTH WORKERS, HEALTHCARE, HEALTHCARE PROVIDERS, HEALTHCARE SERVICES, HOSPITAL ADMISSION, HOSPITAL AUTHORITIES, HOSPITAL AUTONOMY, HOSPITAL CARE, HOSPITAL MANAGEMENT, HOSPITAL MANAGERS, HOSPITAL MEDICAL STAFF, HOSPITAL PATIENTS, HOSPITAL REGULATIONS, HOSPITAL SERVICES, HOSPITAL STAFF, HOSPITAL UTILIZATION, HOSPITALS, HOSPITALS PUBLIC, HUMAN RESOURCE MANAGEMENT, HUMAN RESOURCES, INCENTIVE PAYMENTS, INCOME, INCOME INEQUALITY, INDUCED DEMAND, INFORMAL TRAINING, INPATIENT ADMISSION, INSTITUTIONAL CAPACITY, INTERVENTION, INTERVENTIONS, JOB SECURITY, LACK OF CAPACITY, LARGE CITIES, LARGE POPULATION, LEASING, LOCAL GOVERNMENTS, MANAGEMENT SYSTEMS, MARKET PLACE, MEDICAL EQUIPMENT, MEDICAL RECORDS, MEDICAL TECHNOLOGIES, MEDICINES, MENTAL HEALTH, MENTAL HOSPITAL, MENTAL HOSPITALS, MINISTRIES OF HEALTH, MINISTRY OF HEALTH, MOBILITY, MODERNIZATION, MORTALITY, OCCUPANCY, OCCUPANCY RATES, OUTPATIENT CARE, OVERCROWDING, PATIENT, PATIENT SATISFACTION, PATIENTS, PHARMACIES, POLICY MAKERS, PREGNANCIES, PREGNANCY, PRIMARY CARE, PRIMARY HEALTH CARE, PRIVATE PHARMACIES, PROVIDER PAYMENT, PROVINCIAL HOSPITALS, PUBLIC ADMINISTRATION, PUBLIC HEALTH, PUBLIC HOSPITALS, PUBLIC POLICY, PUBLIC SERVICE, PUBLIC SERVICES, QUALITATIVE INFORMATION, QUALITY IMPROVEMENT, QUALITY OF CARE, QUALITY OF SERVICES, QUALITY SERVICES, REGIONAL HOSPITAL, REGIONAL NETWORKS, RESOURCE USE, RESPECT, RETAIL PHARMACIES, RURAL AREAS, RURAL HOSPITALS, SAFETY, SERVICE PROVIDER, SERVICE PROVISION, SERVICE QUALITY, SOCIAL HEALTH INSURANCE, SOCIAL MOBILIZATION, SPORTS MEDICINE, SURGERY, TECHNICAL CAPACITY, TELEVISION, TERTIARY LEVEL, TREATMENT SERVICES, UNIONS, UNIVERSAL HEALTH INSURANCE COVERAGE, URBAN AREAS, URBAN POPULATION, USE OF HEALTH SERVICES, USE OF RESOURCES, USER FEES, WASTE, WORKERS, WORLD HEALTH ORGANIZATION,
Online Access:	http://documents.worldbank.org/curated/en/402601468126885051/Lessons-for-hospital-autonomy-implementation-in-Vietnam-from-international-experience https://hdl.handle.net/10986/27800
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