Asso. Prof. Luong Ngoc Khue g g Director of Medical Service ...

Asso. Prof. Luong g Ngoc g Khue
Director of Medical Service
Administration, Vietnam MOH

General information:
1. Area of 330.991
2.
square km
Borders China - North
3. Laos, Cambodia - West
4. East Sea – East, South
5. Population:≈86 million

Health care system
� The health care system was formed according to the
four administrative levels of the state.
� Th Thecentrallllevel, l then h the h provinces, i which hi h are iin
turn
divided into districts and communes.
�� Th The above b ffour-tier ti hhealth lth care services i system t also l
acts as a referral network in a pyramid health care
system system.

Vietnam health care system by administrative levels
MOH
•Central Central hospital
•University University y hospital p
•…
•Province Province Health Dept.
•Provincial Provincial hospital
•Medicine Medicine colleges
•……. …….
•District District Health Dept.
•District District Hospital
•District District Health Center
•Commune Commune Health Station
Hospital of other Private
Ministries hospital
Central level
Provincial level
District District level
Commune level

Nội dung Total number trình of hospital bày: and hospital beds
(health statistic. 2011)
Hospital levels Total number of hospitals Total number of
hospital beds
quantity % quantity %
Central level hospitals 39 3,4 20.924 11,3
Provincial level hos 382 32,9 92.857 50,1
District level hospitals
Public-Hospital under other
561 48,3 57.048 30,8
branches
Private hospitals
48 4,1 7.572 4,1
132 11,4 6.941 3,7
Total 1.162 100 185.342 100
Total of 185.342 bed, equally to 21,1 beds/10.000 population

Health Financing
� Since 1986: Started “the innovation” to a socialist oriented market
economy, developing multi-section goods economy
� One major element of these reforms in Health sector is a shift from
a centrally planned system where health care services were
provided to the population free of charge charge, to the decentralized and
contracted social health insurance model.
� Then, hospital fee was introduced in 1994. However:
1. Low health expenditure /GDP

Hospital Hospital autonomy
• 2002 2002: Hospital H it l autonomy t was firstly fi tl introduced i t d d
• The content of hospital autonomy:
� HHealth l h financial fi i l mobilization bili i
� Human resource development and recruitment
� Joint venture in:
� Health equipment installment
� Health service provision

Process of hospital autonomy implementation
� 2002-2006 period:
� Piloted in some hospitals in the big cities where has
higher density of population with higher living
conditions
� Up to 2006: 18 provinces with more than 50% of
hhospitals; i l others h with ihlless than h 50%
� 2007- now period: Almost100%ofhospitalatcentral
andd provincial i i l llevell iimplementing l ti thi this autonomy t
scheme
28

Process of hospital autonomy implementation
� Deviation of different hospitals in autonomy implementation:
� Level of autonomy scopes:
� Different among hospitals/ regions
�� Stronger in big/urban cities with higher living
condition compared to rural areas
� The level of autonomy scopes depends on the ability to
financial resources, resources available infrastructure and
equipment of each hospital
28

What did hospital gain from
hhospital it lautonomy t
initiative
• In the context State budget for hospitals is limited,
but with other investment resources resources, many
hospitals can have better and modern equipments
• HHospital it l budget/ b d t/ hospital h it l revenue has h been b
significantly increased
• HHospital i l directors di b become more active i i in their hi
own decision making ‐> to give more effective
activities

What did hospital gain
from hospital autonomy
initiative
• Overhead cost of hospital administration and
management has been gradually reduced
• Hospital staffs have been paid with better
supplementary income beside the fix‐monthly
increase
• Hospital heath services and hi‐tech are expanded
• Laboratory test and diagnostic image have been more
available
• TTotal l number b of f surgery cases i in all ll llevel l are iincreased d

Hospitals has been
step by step better
equipped

Side Side‐effects effects of hospital autonomy
� Guidelines, regulations are not sufficient related to:
� IInvestment ffrom private i sectors iin pubic bi hhospital i l
� Sharing benefit from joint-ventured equipment and
material investment (60:40 or 70:30; 25% paying
for tax) in the public hospitals.
� There is a big trend of overused and overprescribed
lab test test, drug drug, diagnostic images in hospital service
provision for the patient.
� Overcrowdingg at some central and provincial p
hospitals due to hospital want to attract more patients
to increase hospital revenue. Even, breaking the
referral regulation g from down to topp level.

Some SSome S solutions l ti proposed d
� Increasingg state budget g for health care through g
developing universal coverage of Health insurance
� Adjusting the fee of hospital services toward the full
payment which covering all direct and indirect costs (at
the moment all direct cost was calculated but only small
part off iindirect di costs was calculated l l diinthe h hhospital i lf fee) )
� Reforming payment mechanism toward DRG…
� Completing the legal documents for joint venture
investment

Some solutions proposed
�� Cl Clearly l separating ti public-private bli i t
� Borrowing money from banks for infrustructure and
equipment investment investment, not mobilizing fund from
hospital staffs.
�� Enhancing capacity of hospital management: Training
in hospital management, financial management,
quality q ymanagement. g
� Strengthening inspection and supervision and support.

Thank you very much!

SSeptember b 13 3 & 14, 2012 20 2 ● MeliaHotel li l ● Hanoi, i Vietnam i
Assoc. Prof. Luong Ngoc Khue,
Director of Department of Medical Service Administration,
Ministry of Health Vietnam
khuebyt@yahoo khuebyt@yahoo.com
com