Lessons for Hospital Autonomy
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World Bank, Washington, DC
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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.
Palabras clave
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