Abstract

ObjectivesThe study objective was to identify the size of different hospital financing sources for different hospital services and their impact on the uninsured.MethodsA panel dataset of 84 public general hospitals (2005–2008) with cross-section data on hospital activity and hospital revenue was created and used to calculate unit costs of different hospital services by applying multiple regression models. The resulting risk of catastrophic health expenditure (CHE) was estimated based on official income statistics.ResultsAverage user fees (UF) for outpatient visits and inpatient bed days were US$4.13 and US$20.27, while actual full costs (AFC) were US$8.41 and US$36.66, respectively. These unit costs were 2.5 times higher in hospitals at the central versus the provincial level. UF for surgical inpatient bed days were 3.6 times that of non-surgical treatments (US$47.50 vs. 12.87) and AFC 5.0 times (US$101.72 vs. 20.08). UF accounted for 44.6%-77.9% of the AFC, the rest (22.1%-55.4%) was provided by direct government support (DGS). One surgical inpatient treatment at either central or provincial hospital level and one non-surgical inpatient treatment at central hospital level, immediately pushed uninsured near-poor households at risk of CHE.ConclusionsAround 45% of hospital AFC was paid by DGS, the larger rest by UF. UF have become a great financial burden on the uninsured near-poor households, who have to pay for these out-of-pocket and therefore may not utilize even necessary services. If the rate of DGS were reduced, this would have the effect of increasing UF, but the savings to Government could be spent on subsidizing insurance to ensure that a larger part of the population can cover UF through insurance, especially the near-poor households.

Highlights

  • The Socialist Republic of Vietnam is currently in the process of implementing major health care reforms

  • From the Regression Model: A significant linear regression was found between user fees (UF) revenue and two variables of inpatient bed days (InpBD) and outpatient visits (OutpV) and accounted for 63% of the variance in UF revenue (R2 = .63)

  • Similar observations were found for total revenue in the relationship with InpBD and OutpV (R2 = .71; both variables, p < .001)

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Summary

Introduction

The Socialist Republic of Vietnam is currently in the process of implementing major health care reforms. The question remains of how much of the hospital service costs is financed by user fees and what the impacts of this are on the service users, in particular those who are uninsured and have to pay by OOP. It allows hospitals to collect a fee, according to a fee-for-service (FFS) scheme, for certain services including consultation, drugs, consumables, blood infusions, diagnostic procedures, operative procedures, and hospital bed utilization [11]. The ranges of these services’ fee were issued by the Ministry of Health, with the basic threshold determined for each relevant administrative level. The highest level of the central hospitals has a higher cost rate compared to provincial or district hospital levels for the same service [13]

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