HOW THE NON-STATE SECTOR ENGAGE TO
STEWARDSHIP OF MIXED SYSTEM IN
IN VIETNAM
Health Strategy and Policy Institute - Vietnam

1) Information on non-state sector in health in Vietnam
2) Models of engagement of NSP in health care system
3) Regulation for engaging NSP to the health care system

Information on non-state sector in Health in Vietnam
(1)
• Non-state health practice was officially recognized in 1989
• NSP legalized by Ordinance on
Private Pharmaceutical and
Medical practice in 1993
120
100
Non-state hospital in Vietnam
82
103
80
 1998: 19.836 private health facilities (02 non-state hospitals)
2009: > 65,000 private health facilities:
- about 30,000 private medical facilities and 93 private hospitals
- 39,172 drug retails
60
40
48
20
0
14
0
2
1993 1998 2001 2005 2008 2010

Public-private mix of providers - Vietnam

Information on non-state sector in Health in
Vietnam (2)
State and non-state hospital
1200
1000
800
600
400
200
0
3.3%
2004
1021
7.1%
2008
1081 State hospital
Non-state hospital
35 82
Proportion of total inpatients and outpatients treated by non-state hospitals
8,0%
7,0%
6,0%
5,0%
4,0%
3,0%
2,0%
1,0%
0,0%
4,8%
1,0%
2004
State and non-state hospital bed
160000
140000
120000
100000
80000
60000
40000
20000
0
State hospital
Non-state hospital
2.2%
2004
122206
2687
4.3%
2008
137813
6289
6,9%
3,2%
2008
Out-patients
In-patients

State sector is the main provider of hospital services

Non state sector engagement in delivering curative services (1)
Public hospitals • Strengths sign contract  Expand availability of services for public hospitals with private health facilities to deliver paraclinical/hightech services
•
 Increase accessibility of patients to health care services
 Reduce problem of overload in public hospitals
Limitation/constraints
 Difficult to control quality of services provided by private hospitals
 Tendency of over use of services
 Insured patients have to pay for extra-payment  increase financial burden for patients

Engage in delivering curative services (2)
Public hospitals sign contract with private facilities to deliver nonmedical services
•
Mechanism: public hospitals sign contract with private facilities in providing services e.g. cleaning, laundering, hospital keepings, foods, water…
• Strengths
 Reduce current expenditure
 Professional
 More cost-effectiveness

Engage in delivering curative services (3)
Engagement of
Non-state sector in term of investment within public hospital
• Joint activities with investors (medical equipment companies) to install machines and distribute profit gained based onthe capital pooled (investors pooled equipment and hospitals pooled their human resource, infrastructure)
• Investors installed machines and took monopoly in supplying chemicals, consumables  investors installed machines and hospitals have to procure chemicals and consumables of the investors

Engage in delivering curative services (4)
Strengths
Limitations/ unexpected impacts
• Expanding types of healthcare services in diagnosis and treatment
‒ Increase number of patient contacts (1.3-1.5 times) and hospital admissions (1.2-1.4 times)
‒ Average number of lab tests/patient (1.3-2.1 times)
•Hospital revenue increases (1.9-2.1 times)
•Hospital staff’s income increases
•Tend to have service overuse to make profit by different ways
‒ Increase use of high tech laboratory tests and equipment
‒ Increasing hospital admission for inpatient care
‒ Irrational use of medicines.
‒ Lengthening hospitalization stay
•Increase treatment costs
•Problem of “public-private mixed” in public hospitals

Engage in delivering curative services (5)
NSP
Participate in
Health
Insurance scheme
Agency signs contract with private hospitals/ clinics (1)
• 276/7,918 (3.5%) private health facilities participate in health insurance scheme
• Types of services: 93.8% outpatients, 6.2% inpatients
• Strengths
 Increase role of private sector in delivering health services
 Increase accessibility of insured patients
 Create competition between public and private health facilities
• Limitation/constraints
 Number of private health facilities participate in the HI scheme still limited
 Infrastructure, equipments, manpower of private health facilities still not adequate enough to sign contract with HI agency

Current policy and regulation related to NSP engaging in health system



-
-
Investment and establishment of Non state health care facilities
1993 : NSP recognized as a legal part of health care system (State ordinance 26, 1993, revised in 2003)
1999 : Social mobilization for health allowed private organization/individual participate in investment of health care activities  not-for profit (Decree 73/1999)
Incentive for NS hospital: free land or rent without fee, free taxation in first 4 years, decrease by 50% in next 5 years. ( Resolution No.
46-NQ/TW & Decree No. 69/2008)
Targeting the side of non-state hospital by the year 2010: 2 beds/10,000 in 2010; 5 beds/10,000 in 2020
The licensing requirements based on the Law on Medical
Examination and Treatment of 2009 that will be applied for both state and non-state providers

Current policy and regulation related to NSP engaging in health system
Policy for NSP investment in state health facilities:
 Hospital autonomy policy: Decree 10/2002, replaced by
Decree 43/2006:
1) Better health services delivery, improve quality and increase hospital revenues
2) Social mobilization of resources for health sectors in order to reduce subsidy from government to health facilities
• Social mobilization policy (Decree 73/1999, Decree No. 69/2008)
 allowed public hospital to sign contract with private firms or individuals to invest in providing services (both clinical and non-clinical services)

 Lack of regulation to enforce non-state sector to provide public services:
– Disease surveillance, preventive cares
– Policy for involving non-state sector in providing services for vulnerable group
 Lack of policy instrument to mmonitoring quality of services, patient care, satisfaction, outcomes (medical errors, overuse of services).

 Lack of mechanism to improve the engagement of non-state sector to public sector (PPP)
 Weak role of professional/consumer organisations to oversight the performance of public facility in general, particularly for non-state sector.
 Lack of health management information system for managing, monitoring and making plan for non-state sector development in the context of health system