EVALUATING PRIVATE HEALTH SECTOR PARTICIPATION IN HEALTH INSURANCE RELATED MEDICAL CARE IN HA NOI, DA NANG AND HOCHIMINH CITY
Nguyễn Khánh Phương, Hoàng Thị Phượng, Nguyễn Thị Thủy, Vương Lan Mai
Place of publication: Health Strategy and Policy Institute
Year of publication: 2009
At present the private health sector is developing quickly and plays an important role in the health system. The Vietnam’s health system has been oriented to be a health insurance based system with the goal of universal health insurance (HI) by 2014. Mobilizing private health sector to participate in providing examination and treatment for the insured is one of the effective measures to carry out the above-mentioned goal. However to date there are only about 120 private health facilities signing HI examination and treatment contract. Meanwhile, overcrowding at public hospital remains a great challenge to the health sector, which is directly linked to HI examination and treatment. Health Strategy and Policy Institute (HSPI) conducts assessment on current situation of private health facilities’ participation in health services delivery for HI card holders to learn about its difficulties and obstacles to recommend policy and organization options to stepwise expand participation of private health facilities in HI examination and treatment contracting.
To describe the current situation and analyze advantages, disadvantages private health facilities face in providing medical care services for HI card holders thereby recommending policy options to strengthen and expand services delivery network for HI card holders.
This study employs cross-sectional descriptive method in combination with desk study via collecting studies, reports related to private health sector’s operations and secondary data from private health facilities.
• Participation in HI examination and treatment of private sector remains limited. Only 65% of private hospitals and 25% of private general clinics sign contracts to provide HI examination and treatment services. Most private general clinics have insufficient conditions to deliver HI examination and treatment services.
• Registration for primary health care at private health facilities tends to increase in surveyed private facilities. HI card holders registering for HI examination and treatment at private health facilities are mainly compulsory insured (more than 70 – 80% in Ha Noi and Da Nang, and 55% in Hochiminh city (HCMC)).
• In Ha Noi and HCMC, private health facilities tend to deliver outpatient rather than inpatient services. The ratio of inpatient service utilization over outpatient is 7.6% and 10.7% in Hanoi and HCMC respectively but it is 51.2% in Da Nang.
• Private hospitals have not been classified therefore there are no specific and unified guidance on payment for private health facilities delivering HI examination and treatment services. Presently private health facilities are paid at prices equal to 2nd or 3rd grade hospitals.
• HI patients visiting private health facilities for examination and treatment must pay the fee differences according to prices set by private health facilities and that reimbursed by Health Insurance for private health facilities. Such differences are rather high due to low current user fees.
• The role of Health Insurance agency has not been strongly promoted in ensuring the service quality and the appropriateness of service prices. Besides there remain many difficulties, obstacles in implementing HI examination and treatment contract between Health Insurance agency and private health facilities in evaluation, monitoring and supervision.
• Participation of private health sector in HI examination and treatment remain limited. The private sector only provides 0.6% of total inpatient treatment services for HI patients. However primary care registration at private health facilities tends to increase.
• There are differences in terms of outpatient and inpatient examination and treatment services structure among private health facilities.
• Most HI patients visiting for examination and treatment at private health facilities must pay the fee differences according to prices set by private health facilities and that reimbursed by Health Insurance for private health facilities. In the examination and treatment costs incurred at private health facilities there is a clearly high proportion of laboratory test and diagnosis compared with public facilities.
• The poor limit their utilization of services provided by private health facilities as being afraid of paying for the user-fee differences.
• There remain many difficulties and obstacles in implementing examination and treatment contract between Health Insurance agency and private health facilities, mainly related to state governance like evaluation, monitoring, information update and irrelevant reimbursement.
• The Government and MOH need to early enact supplementary documents and improve legal documents on HI examination and treatment for both public and non-public health sectors.
• Strengthen state governance role and develop technical instruments for quality assurance and price monitoring in non-public sector to ensure service standardization and appropriateness of service prices for HI card holders.
• Early adjust hospital fees to match examination and treatment costs, helping to improve transparency and reasonability in payment for examination and treatment, in general and HI examination and treatment, in particular.
• Enhance regular and closer collaboration among HI agencies at levels and health management institutions in the area of private health facilities participating in HI examination and treatment.