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Researches Health financing

Trần Thị Mai Oanh, Krishna Hort*, Khương Anh Tuấn, Nguyễn Thị Minh Hiếu, Trịnh Ngọc Thành

                                                                                                     * Melbourne University, Australia
Place of publication: Health Strategy and Policy Institute
Year of publication: 2011
Given the existing scarcity of literature on the private health care system, this study looks to give an overview of the current status of the management of private health system. The study also provides recommendations for improvement of governance on private health to promote strong development of the sector while meeting the indicated targets in health care of equity, efficiency and development.
In the partnership between the Health Strategy & Policy Institute and Nossal International Health Institute, Melbourne, Australia, this private health study is the first research partnership attempt between the two institutes. The study is coordinated by Nossal Institute and covers Indonesia, Papua New Guinea and Vietnam. The study spans two years and marks the inception of long-term partnership in research work between the two academic entities.
To identify areas of development and operation of private health sector (by geographical area and types of service);
To assess the implementation of  policy documents related to private health sector and private practice, particularly focusing on private hospitals. 
Identify existing gaps of the regulatory and policy framework to provide recommendations for policy improvement and study concerns.
Methodology and implementation
Mapping the public and private health network by geographic areas  and types of service to describe the allocation of public and private medical practices by geographic areas in terms of sizes, service capacity and types of service in relation to coverage.
Doing literature review  and analysis of regulatory documents related to non-state health sector, both in Vietnam and other countries.  Using systematic review and policy analysis method to identify existing gaps in policies and literature, and consolidate experience and models for private health development and management. 
Conducting field survey to assess the implementation of private health policies at private hospitals:  to identify limitations in the implementation of existing private health policies, management of private health, and issues that need more research and evidence. This survey is conducted at the national level and 03 private general hospitals in the three selected provinces (Thai Binh, Da Nang, Ho Chi Minh).
The development of private health. Between 2004 and 2008, the number of private hospitals doubled. Private hospitals, however, only account for 7% of the total number of hospitals and 4.4% of the total beds. Private hospitals are mostly situated in cities. 
The existing policies and regulatory framework reveal limitations. The development of the private sector is associated with the promotion of public private partnership and private investment in the public health system. Land and tax support policies for newly formed institutions. While various decrees encourage health providers not to emphasize too much on profit making, the reality is a different story. Regulations on the needed staffing, equipment and infrastructure of private hospitals are few. 
Case study: private hospitals in general are smaller in size than public ones, and have lower bed occupancy and shorter length of stay. Depending on local needs, private hospitals vary in terms of types of available services, hospital size, manpower, active hours and so on. Private hospitals tend to prescribe large numbers of tests and have little connection with public hospitals. 
Areas of services concentrated on by private hospitals are mostly services that the public sector has failed to fully meet the demand for, such as hi-tech procedures, tests and other special services. This, however, also leads to inequity in health.
Much evidence indicates that the efficiency of private hospitals in staff and equipment use and hospital bed use is low, while treatment cycles are shortened.
There is little evidence that private hospitals play a role in increasing equity in access to services, as the hospitals tend to accumulate too densely in cities. 

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