Assessment of systems for paying health care providers in Vietnam: Implications for equity, efficiency and expanding effective health coverage

Abstract

Provider payment arrangements are currently a core concern for Vietnam's health sector and a key lever for expanding effective coverage and improving the efficiency and equity of the health system. This study describes how different provider payment systems are designed and implemented in practice across a sample of provinces and districts in Vietnam. Key informant interviews were conducted with over 100 health policy-makers, purchasers and providers using a structured interview guide. The results of the different payment methods were scored by respondents and assessed against a set of health system performance criteria. Overall, the public health insurance agency, Vietnam Social Security (VSS), is focused on managing expenditures through a complicated set of reimbursement policies and caps, but the incentives for providers are unclear and do not consistently support Vietnam's health system objectives. The results of this study are being used by the Ministry of Health and VSS to reform the provider payment systems to be more consistent with international definitions and good practices and to better support Vietnam's health system objectives.

Keywords:

• health financing
• universal coverage
• health purchasing
• provider payment
• capitation
• Vietnam

Acknowledgements

The authors would like to acknowledge the role of the MOH of Vietnam and VSS in commissioning this study, and provincial health authorities and providers for generously sharing their views and their time. Valuable input was contributed at various stages by Kari Hurt and Helene Barroy of the World Bank, Stefan Nachuk of the Rockefeller Foundation, as well as two anonymous reviewers.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

Funding for this study was provided by the Japan-World Bank Partnership Program for Universal Health Coverage and the Rockefeller Foundation [grant number 2011 THS 324].

Notes

1. The MOF and its provincial counterparts Provincial Departments of Finance (PDF) continue to finance a large share of health service delivery in Vietnam through supply-side subsidies in the form of health facility budgets. The MOF and PDF do not use any active purchasing strategies, but their payment systems (global and line-item budgets) continue to exert a strong influence on the incentive environment faced by providers.

2. The insured population groups are as follows: (1) civil servants and formal sector employees; (2) pensioners, veterans and recipients of social assistance; (3) poor and near poor; (4) children under the age of six; (5) schoolchildren and students; and (6) other (mainly voluntary enrolees).

3. The selected provinces include Hanoi (capital city, with case-based pilot implementation), Ho Chi Minh city (south-east city, still FFS not implementing capitation yet), Dong Thap (Mekong Delta province, capitation with deficit), Dac Lak (Central Highland province with surplus), Quang Nam (Central Coastal province, capitation with deficit), Hai Duong (Red River Delta province, capitation with large surplus in 2010 and large deficit in 2011) and Thai Nguyen (Northern mountainous province, capitation with surplus).

Additional information

Funding

Funding for this study was provided by the Japan-World Bank Partnership Program for Universal Health Coverage and the Rockefeller Foundation [grant number 2011 THS 324].