Potential collaboration with the private sector for the provision of ambulatory care in the Mekong region, Vietnam

Figures & data

Table 1. Illustrative Statements by Participants in FGDs and IDIs

FGDs with provincial health officials

IDIs with managers of private health facilities

The role of the private health sector As you may know, the private sector has been an extended hand of the public sector and has contributed to the provision of health care services. Patients residing in disadvantaged areas where access to higher quality health facilities is limited have the opportunity to seek services from private providers which could lead to a reduction in crowding within the public sector facilities. – Ben Tre provincial health service official The private sector network extends throughout the provincial, district and community levels. Although the scale of the private providers remains medium in size, their facilities are equipped with key equipment which are able to detect and diagnose diseases in a timely manner such as dengue fever or injuries. – Tra Vinh provincial health service official Positive aspects of public-private partnerships in providing care If we could execute the collaboration, it would be a fantastic opportunity for the private sector to share the responsibility with the public sector in resolving the overcrowding problem. Moreover, a more competitive market would be an impetus for public providers to improve their quality of care because if they don't they will lose patients to private providers. It will be expected that the monopoly health market would end. Patients are afraid of using their health insurance card at a public hospital because of the long waiting time. Therefore, they would be very happy if they could use the card at private facility. – Ben Tre provincial health service official … I think we should contract out with private providers to provide healthcare for the insured, including the poor. Doing so would have potentially several benefits. First, it could resolve the overcrowding problem. Second, the government could spend less on equipment. Third, we would not need to train and recruit more personnel because the private sector have their own facilities, equipment and staff. – Tra Vinh provincial health service official Challenging aspects of public-private partnerships in providing care I personally think it is kind of difficult because fees for service are different between the public and private. Moreover, drugs are also come from different sources. Domestic medicines are provided to the public sector whilst freely purchased by the private sector. – Tien Giang provincial health service official One of the most difficult issues is price. They (private providers) invested a lot on medical equipment, so it would be difficult if the price is too low… The private providers would not probably be interested in the collaboration with the social health insurance agency if they could not be reimbursed as expected. – Ben Tre provincial health service official First, it is important to pilot in some clinics. For instance, providers that could be able to provide health services to the poor and insured should be contracted out. The scaling up will be based on experiences drawing from the pilot. – Can Tho provincial health service official

Positive aspects of public-private partnerships in providing care Providing healthcare for the insured is interesting. I am willing to join. The insured patients come to me, getting their health problems resolved and do not have to wait for a long time for services. If we could it, we would save much expenditure for the patients, especially the poor. – Owner of policlinic, Tra Vinh town, Tra Vinh province Such a collaboration will give clients more choices when choosing what they think are better providers rather than going to the public hospital. When they find their benefits increased, they will definitely buy health insurance. – Owner of policlinic, Ben Tre town, Ben Tre province If possible, let's consider it the collaboration between the community health center and private providers. The community health centre should have a pharmaceutical-in-charge person. We, the private provider, just provide the prescription….What we want to do is to be independent, meaning that we give prescriptions and social health insurance reimburse us for the consulting fee. Doing so would help the poor and insured. – Owner of pediatric clinic, Cho Gao district, Tien Giang province Challenging aspects of public-private partnerships in providing care There are two conditions that I would like the social health insurance to meet. First, paper work should be simple. Second, payment should be made quickly. – Owner of pediatric clinic, My Tho city, Tien Giang province If I am the only one in this district to participate, I would probably not survive because there are so many children under six years old. [These families}… will definitely find the clinics where services are good and the waiting time is short. Of course, they will come to me. – Owner of pediatric clinic, Can Tho city, Can Tho province Regarding the signing of a contract with them (the social health insurance agency), I am afraid of the processing payment. Even in my hospital, we designated many people to this task but still have problems with the paper work…. – Owner of internal medicine clinic, Cho Gao district, Tien Giang province The private facility must partner with a hospital. For instance, my pediatric clinic must be connected with the provincial pediatric hospital to make sure the referral system works well. Internal clinics should be linked to the provincial pediatric hospital. – Owner of pediatric clinic, Can Tho city, Can Tho province The social health insurance agency should sign a contract with private providers. Articles related to infrastructure and basic equipment should be described clearly. Moreover, the contract should provide some clauses with respect to the benefits of the contractor, how services should be delivered, and how the providers are reimbursed. If everything is acceptable, there will not be any problem at all. – Owner of pediatric clinic, Can Tho City, Can Tho province

Table 2. Classification of surveyed private health facilities

Province	Specialized clinic	Policlinic	General hospital	Total
Ben Tre	5	3	0	8
Can Tho	5	2	1	8
Kien Giang	7	1	1	9
Tien Giang	3	3	1	7
Tra Vinh	6	2	0	8
Total	26	11	3	40

Table 3. Volume of outpatient per week by type of provider

Provider	Mean	Min	Max	N
General hospital	2,286	360	3,500	3
Policlinic	181	35	560	11
Internal medicine clinic	112	40	400	14
Pediatric clinic	148	30	420	9
Other specialized clinics	116	50	200	3

Table 4. Inspection of health facilities

		Frequency	Percent
Ever been inspected over life time practicing	Yes	39	97.5
	No	1	2.5
Type of inspection	Spontaneous	26	66.7
	Periodic	24	61.5
Number of inspection visits received during the last 3 months	No	26	66.7
	One	11	28.2
	Two	1	2.5
	Three	1	2.5
Inspecting agency^a	Provincial health service	29	74.4
	District health office	22	56.4
	Inter-sectoral delegation	6	15.4

^aTotal is over 100% because of multiple choices.

Table 5. Characteristics of IDI participants

Characteristic		Frequency	Percent
Age	15–40	103	51.8
	41–60	60	30.2
	>61	36	18.1
Gender	Male	64	32.0
	Female	136	68.0
Education level	Did not go to school	10	5.0
	Primary school	59	29.5
	Secondary school	74	37.0
	High school	36	18.0
	College/university	21	10.5
Occupation	Unemployed	2	1.0
	Farmers	59	29.5
	Students	3	1.5
	House workers	42	21.0
	Retired	6	3.0
	Civil servants	13	6.5
	Employees	21	10.5
	Venders	43	21.5
	Fishermen, gardeners	3	1.5
	Others	8	4.0
Average income (VND)^a	<500,000	15	10.9
	500,000–1,000,000	61	44.2
	1,000,000–1,500,000	31	22.5
	1,500,000–2,000,000	12	8.7
	>2,000,000	19	13.8
Defined as poor according to local criteria	Yes	6	3.0
	No	193	96.5
Possession of a 139 card	Yes	4	66.7
	No	2	33.3
Possession of a health insurance card^b	Yes	78	39.0
	No	83	41.5

^a500,000 Vietnam Dong was approximately US$28 at the time of the study.

^b N is not equal to 200 because of missing values.

Table 6. Health seeking behaviors

Characteristic	Decision	Frequency	Percent	N
First provider sought	Yes	160	80.0	200
	No	40	20.0
Closest provider	Yes	34	17.0	200
	No	166	83.0
The nearest provider to home	Public owned	129	64.5	166
	Another private facility	34	17.0
	Traditional health facility	2	1.2
Reason for choosing facility	Proximity	33	16.5	200
	Familiarity of provider	30	15.0
	Good attitude of provider	29	14.5
	Reasonable price	11	5.5
	Convenient opening-hours	27	13.5
	Good quality service	148	74.0
	Recommended by someone	32	16.0

Table 7. Clients’ satisfaction with private providers

Criterion	Neither satisfied nor dissatified	Satisfied	Very satisfied
Cleanliness of the facility	5(2.5%)	113(56.5%)	82(41%)
Wait time for services	7(3.5%)	107(53.5%)	86(43%)
Explanation given by the provider	0(0%)	106(53%)	94(47%)
Cost of services	5(2.5%)	145(72.5%)	50(25%)
Overall perceived quality of care	1(0.5%)	104(52%)	95(47.5%)

Table 8. Clients’ satisfaction with public providers

Criterion	Very dissatisfied	Dissatisfied	Neither satisfied nor dissatified	Satisfied
Cleanliness of the facility	–	2(6.1%)	20(60.6%)	11(33%)
Wait time for services	1(3%)	18(54.5%)	8(24.%))	6(18.2%)
Explanation given by the provider	1(3%)	13(39.4%)	9(27.3%)	10(30.3%)
Cost of services	–	1(3%)	18(54.6%)	14(42.4%)
Overall perceived quality of care	–	8(24.2%)	19(57.6%	6(18.2%)