The Impacts of Public Hospital Autonomization : Evidence from a Quasi-Natural Experiment

Wagstaff, Adam ; Bales, Sarah

World Bank, Washington, DC

关键词: BEDS;    BIOCHEMISTRY;    C-SECTION;    C-SECTIONS;    CLINICAL GUIDELINES;   

DOI  :  10.1596/1813-9450-6137
RP-ID  :  WPS6137

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

This paper exploits the staggeredrollout of Vietnam s hospital autonomization policy toestimate its impacts on several key health sector outcomesincluding hospital efficiency, use of hospital care, andout-of-pocket spending. The authors use six years of paneldata covering all Vietnam s public hospitals, and threestacked cross-sections of household data. Autonomizationprobably led to more hospital admissions and outpatientdepartment visits, although the effects are not large. Itdid not, however, affect bed stocks or bed-occupancy rates.Nor did it increase hospital efficiency. Oddly, despite thevolume effects and the unchanged cost structure, theanalysis does not find any evidence of autonomizationleading to higher total costs. It does, however, find someevidence that autonomization led to higher out-of-pocketspending on hospital care, and higher spending per treatmentepisode; the effects vary in size depending on the datasource and hospital type, but some are quite large -- around20 percent. Autonomy did not apparently affect in-hospitaldeath rates or complications, but in lower-level hospitalsit did lead to more intensive style of care, with more labtests and imaging per case.