Vietnam's autonomisation of public hospitals: An institutional analysis

Inspired by the New Public Management paradigm, many countries’ health care management systems have embarked on the autonomy reforms which involve reducing direct government control over public hospitals and increasing their... [ view full abstract ]

Inspired by the New Public Management paradigm, many countries’ health care management systems have embarked on the autonomy reforms which involve reducing direct government control over public hospitals and increasing their exposure to the market and market-like incentives. Vietnam’s health care management reform is no exception in this global trend. This article explores Vietnam’s autonomisation of public hospitals through the analysis of the formal autonomy rules and the empirical data about the actual autonomy practices among selected hospitals. We argue that Vietnam’s autonomisation of public hospitals underpins the increasing switch of health care costs from the state onto society alongside the transition from the universal and free service provision to a mix of state subsidy and fees-for-services. Utilised as a strategic instrument for the process, hospital autonomisation is thus reinforced in capital mobilization, use of budgeted and own-generated revenues for service-related activities, and allocation of net revenues, leaving the autonomy degrees in many other managerial dimensions increase cautiously and incrementally. Evolving along this direction, Vietnam’s hospital autonomisation has occasioned various revenue maximizing practices including the provision of “patient-requested” services within public wards for higher-fees paying patients, provider-induced supply of unnecessary services, excessive use of high-tech diagnostic equipment, overprescription of drugs, and the receipt and solicitation of informal payments. While discerning this governance modality in a country context, this paper expects to offer lessons to policy makers in developing and transitional countries which reform their health care services along the market principle. The theoretical contribution of this analysis is its conjoint application of the historical and sociological institutionalist approach to the study of policy outcomes.