Costing of commune health station visits for provider payment reform in Vietnam

Abstract

Expanding effective coverage in Vietnam will require better use of available resources and placing higher priority on primary care. The way providers are currently paid does not give priority to primary care and does not reflect the costs of delivering services. This paper aims to estimate the unit costs of primary care visits at commune health stations (CHS) in selected areas in Vietnam. Seventy-six CHS from two provinces in northern Vietnam were studied. Costs were calculated from the perspective of the CHS using the top-down costing using the step-down cost accounting technique in order to estimate the full cost of delivering services. On average, the cost of one outpatient visit in mountainous, rural and urban CHSs was VND 49,521 (US$2.40), VND 41,375 (US$2.01) and VND 39,794 (US$1.93), respectively. Personnel costs accounted for the highest share of total costs followed by medicines. The share of operating costs was minimal. On average, CHSs recover 18.9% of their total cost for an outpatient visit from social insurance payments or fees that can be charged patients. The results provide valuable information for policy-makers as they revise the provider payment methods to better reflect the costs of services and give greater priority to primary care.

Keywords:

• Costing
• primary health care
• capitation
• provider payment

Acknowledgements

We thank the team from the Department of Health Economics and Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam, and the team from Health Strategy and Policy Institute, MoH, Hanoi, Vietnam, for their tireless data collection and analytic effort for this study. We are also grateful to the Joint Learning Network for Universal Health Coverage for both technical and financial support for this study.

Funding

Funding for this study was provided by the Joint Learning Network for Universal Health Coverage and its funder the Rockefeller Foundation [grant number 2011 THS 324].

Notes

1. The payment system is actually modified fee-for-service with a cap. The payment system is referred to as ‘capitation’ in Vietnam, although the payment system does not meet international definitions for capitation (Phuong et al., 2015).

2. One outpatient visit is equal to one-third of one bed-day or one outpatient visit.

Additional information

Funding

Funding for this study was provided by the Joint Learning Network for Universal Health Coverage and its funder the Rockefeller Foundation [grant number 2011 THS 324].