Getting Incentives Right : An Impact Evaluation of District Hospital Capitation Payment in Vietnam

Nguyen, Ha Thi Hong ; Bales, Sarah ; Wagstaff, Adam ; Dao, Huyen

World Bank, Washington, DC

关键词: ACCESS TO HEALTH CARE;    ADVERSE EVENTS;    C-SECTION;    C-SECTIONS;    CANCER;   

DOI  :  10.1596/1813-9450-6709
RP-ID  :  WPS6709

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

With the movement toward universalhealth coverage gaining momentum, the global health researchcommunity has made significant efforts to advance knowledgeabout the impact of various schemes to expand populationcoverage. The impacts on efficiency, quality, and gaps inservice utilization of reforms to provider payment methodsare less well studied and understood. The current papercontributes to this limited knowledge by evaluating theimpact of a shift by Vietnam's social health insuranceagency from reimbursing hospitals on a fee-for-service basisto making a capitation payment to the district hospitalwhere the enrollee lives. The analysis uses panel data onhospitals over the period 2005-2011 and multiplecross-section data sets from the Vietnam Household LivingStandards Surveys to estimate impacts on efficiency,quality, and equity. The paper finds that capitationincreases hospitals' efficiency, as measured byrecurrent expenditure and drug expenditure per case, but hasno effect on surgery complication rates or in-hospitaldeaths. In response to the shift to capitation, hospitalsscaled down service provision to the insured and increasedprovision to the uninsured (who continue to payout-of-pocket on a fee-for-service basis). The study pointsto the need to anticipate the intended and unintendedeffects of any payment reform and the trade-offs amongpolicy objectives.