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Researches Health System

Trần Thị Mai Oanh, Hoàng Thị Phượng, Nguyễn Khánh Phương, Khương Anh Tuấn, 

Nguyễn Thị Thủy, Vương Lan Mai, Đỗ Trà My et al.

Place of publication: Health Strategy and Policy Institute
Year of publication: 2011

In the context of  Vietnam’s current public– private mix health system, enhancing the coordination between public and private sector in providing health care services towards equity, efficiency and development has become a priority in health policy making. Doing research on and proposing evidence based relevant and effective Public Private Partnership (PPP) models is significant. Health Strategy and Policy Institute was assigned to conduct “Study on current situation assessment and recommended solutions to strengthening public-private partnership in Vietnam health sector” from May – December 2010 in coordination with Department of Planning – Finance under the support of Rockefeller Foundation in Vietnam. 
1) To explore pattern/model of PPP in the area of health sector and lessons learnt from international perspective
2) To review and analyze legal document related to private health services and PPP in the area of health sector 
3) To explore patterns/models of PPP in the area of health sector and to analyze strength and weakness of each pattern 
4) To analyze potentiality and conditions to establish good PPP in the area of curative care and preventive care
5) To propose solutions to strengthen PPP in healthcare  
A cross-sectional study was used in this study in combination with retrospective methods, from 2006-2009. Data was collected based on designed forms  and combined with focus group discussions (FGDs), in-depth interviews (IDIs). The participants of FGDs and IDIs were representative of health managers, social security agency and health facilities both public and private sector. The study was conducted in 4 provinces/cities: Ha Noi, Hochiminh city (HCMC), Thai Binh and Thuathien-Hue where have private health services developed most strongly in the nationwide, especially HCMC and Ha Noi.
Some main findings
Public Private Partnership  in delivery medical services
* Public Private Partnership in investment through joint ventures or partnerships in terms of facilities and equipment in public hospitals
Public hospital signed joint ventures contracts with private hospital popularly with  two forms: 1) joint venture and partnership model of medical equipment placement and profit sharing. 2) Investors self-placing medical equipment and holding monopoly in chemicals and consumables supply. Private investment in public hospitals seems only developed in areas where the hospitals have good income potentials (central level hospitals, provincial/municipal hospitals) and populous and better-off areas (HCMC, Ha Noi, Thai Binh), but less in hospitals with limited income-generating potentials. 
* Public Private Partnership in  service delivery to the health insured: Contract engagement between the Social Security and private health facilities has increasingly developed ever since, albeit only accounting for a very small percentage compared to the public health system. By the end of July 2010, there were only 276 non-public health providers having had a contract for delivery of health insurance-based services, or 12,7% of the total 2,176 health service providers having signed a contract nationwide with very few proportion of health insurance cards registered at private health providers, accounting for just 3.8% of the total health insurance cards from both public and private sectors. The health care provision, provided by private sector were mainly for out patients (93,8%).
*Public hospitals sign contract with private sector in providing para-clinical testing services: Public health facilities sign contact with private sector in  delivery of testing and hi-tech medical services for insured patients while public hospitals have not enough equipments and capacity as well as private sector. However, this pattern was very limited that only presented in Thuathien-Hue, of 4 provinces/cities in the study.
* Public Private Partnership in providing non-medical services:  The public hospitals and private firms signing agreements for provision of sanitation, laundry, security, nutrition canteens, information technology etc. Services (contracting in) as a highly common and effective form of partnership in public hospitals when implementing hospital financial autonomy (before Decree No. 10/2002/ND-CP and now Decree No. 43/2006/ND-CP).
* Public Private Partnership in providing and training human resources: i) In supplying:  Public hospitals and private sectors sign contract for supporting hospital staffs is not official exist however it is informal remain in Vietnam. According to qualitative research, almost public health staffs have extra time working in private clinics or themselves clinics. In practice, the human resources of the private sector still rely in most part on the public health sector; ii) PPP in training human resources: The public hospitals contracted training and retraining for staff of private hospitals and certification for students, but this form only comes from the needs of the private health facilities.
Public Private Partnership in preventive care:                                                                                                                                                                                                                                                                                                                         
PPP in prevention is currently implemented in Vietnam, such as: social franchising, social marketing, voucher….Most activity is a training course for private health staffs involving  in early detection, consultancy, referral and treatment that belong to national health target programs such as EPI, TB, HIV/AIDS, reproductive health and STDs…Beside, public sector has signed contract with private firms in training support on specialized staffs in non-communicable chronic conditions, asthma, COPD, cancers in women, and stroke for some provinces in the Mekong Delta. 
PPP in the field of preventive care has achieved a certain results, however, there is still very limited, small scale, fragmented and largely relies on the support of international organizations, the non-governmental organizations (NGOs), charities, churches, religious ... therefore, the sustainability of the program is not high. 
Public Private Partnership potential  in curative care and preventive care: 
In curative care: The private sector has good potentials of cooperating with the public sector in provision health care services for insured people, development of hi-tech medical equipment, infrastructure, testing, hi-tech services, training and technology transfer. 
In preventive care: Private sector has potential in implementation some activities of national health program, such as: EPI, TB, HIV/AIDS, reproductive health and STDs… 
In Vietnam, PPP in health care provision is necessary, however, Vietnam lacks of a formal legal framework, mechanisms and conditions to support or increase accountability needed to promote public-private partnership and tap the potentials of the private sector in health care, particularly in curative and preventive health care.
There are some forms of PPP in delivery of medical services and preventive care,  however, still limited. PPP in health care provisions are mostly public hospital-based financial investment and joint venture, populous and wealthy cities, and are much less found in the poorer rural areas.  
The private sector has good potentials of cooperating with the public sector in the development of hi-tech medical equipment, infrastructure, testing, hi-tech services, training and technology transfer, but much less opportunities in preventive health in Vietnam. Recommendations 
To enlarge public private partnership in health, the following solutions may be considered. 
­ Public policies 
A fully-fledged legal framework on health-specific public private partnership is needed. 
­ Ministry of Health: 
MOH needs to strengthen its supervisory role in partnerships and joint ventures for procurement of equipment in public health institutions to contain potential risks and unexpected effects based on equality and efficiency criteria. 
More outsourcing of HI-based medical care to the private sector is recommended to help relieve the workload for the public sector and contribute to accelerating the progress of universal HI. Incentives are needed to involve the private sector in delivery of medical care for the poor and vulnerable groups in the local community or remote, disadvantaged areas.
Incentives and mandatory mechanisms are needed to involve the private sector in a number of preventive health aspects on an equality and mutually beneficial basis.
A comprehensive study on public private partnership in Vietnam is recommended based on risk and payoff assessment criteria to inform policy making. 
More comprehensive evaluations on private health and experiment of public private partnership in curative and preventive health in Vietnam are needed to recommend strategic solutions to support and draw the participation of the private sector in the above mentioned two areas. 


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