1. HOW THE NON-STATE SECTOR ENGAGE TO STEWARDSHIP OF MIXED SYSTEM IN IN VIETNAM Health Strategy and Policy Institute - Vietnam

2. Content 1)Information on non-state sector in health in Vietnam 2)Models of engagement of NSP in health care system 3)Regulation for engaging NSP to the health care system

3. Non-state health practice was officially recognized in 1989 NSP legalized by Ordinance on Private Pharmaceutical and Medical practice in 1993  1998: 19.836 private health facilities (02 non-state hospitals) 2009: > 65,000 private health facilities: - about 30,000 private medical facilities and 93 private hospitals - 39,172 drug retails Information on non-state sector in Health in Vietnam (1)

4. 40% public 60% private 96% public Public-private mix of providers - Vietnam

5. Proportion of total in- patients and out- patients treated by non-state hospitals  State sector is the main provider of hospital services Information on non-state sector in Health in Vietnam (2)

6. Models of engagement of NSP in health care system In the area of Curative PPP within spontaneous project In the area of Preventive Delivery clinical services Delivery para-clinical services and high-tech services Delivery non-medical services Investment in public health facilities

7. Public hospitals sign contract with private health facilities to deliver para- clinical/high- tech services Strengths Expand availability of services for public hospitals Increase accessibility of patients to health care services Reduce problem of overload in public hospitals Limitation/constraints Difficult to control quality of services provided by private hospitals Tendency of over use of services Insured patients have to pay for extra-payment  increase financial burden for patients Non state sector engagement in delivering curative services (1)

8. Public hospitals sign contract with private facilities to deliver non- medical services Mechanism: public hospitals sign contract with private facilities in providing services e.g. cleaning, laundering, hospital keepings, foods, water… Strengths Reduce current expenditure Professional More cost-effectiveness Engage in delivering curative services (2)

9. Engagement of Non-state sector in term of investment within public hospital Joint activities with investors (medical equipment companies) to install machines and distribute profit gained based onthe capital pooled (investors pooled equipment and hospitals pooled their human resource, infrastructure) Investors installed machines and took monopoly in supplying chemicals, consumables  investors installed machines and hospitals have to procure chemicals and consumables of the investors Engage in delivering curative services (3)

10. Strengths Limitations/ unexpected impacts Expanding types of healthcare services in diagnosis and treatment ‒ Increase number of patient contacts (1.3-1.5 times) and hospital admissions (1.2-1.4 times) ‒ Average number of lab tests/patient (1.3-2.1 times) Hospital revenue increases (1.9-2.1 times) Hospital staff’s income increases Tend to have service overuse to make profit by different ways ‒ Increase use of high tech laboratory tests and equipment ‒ Increasing hospital admission for inpatient care ‒ Irrational use of medicines. ‒ Lengthening hospitalization stay Increase treatment costs Problem of “public-private mixed” in public hospitals Engage in delivering curative services (4)

11. Engage in delivering curative services (5) NSP Participate in Health Insurance scheme Agency signs contract with private hospitals/ clinics (1) 276/7,918 (3.5%) private health facilities participate in health insurance scheme Types of services: 93.8% outpatients, 6.2% inpatients Strengths Increase role of private sector in delivering health services Increase accessibility of insured patients Create competition between public and private health facilities Limitation/constraints Number of private health facilities participate in the HI scheme still limited Infrastructure, equipments, manpower of private health facilities still not adequate enough to sign contract with HI agency

12. Current policy and regulation related to NSP engaging in health system Investment and establishment of Non state health care facilities - 1993: NSP recognized as a legal part of health care system (State ordinance 26, 1993, revised in 2003) - 1999: Social mobilization for health allowed private organization/individual participate in investment of health care activities  not-for profit (Decree 73/1999)  Incentive for NS hospital: free land or rent without fee, free taxation in first 4 years, decrease by 50% in next 5 years. (Resolution No. 46-NQ/TW & Decree No. 69/2008)  Targeting the side of non-state hospital by the year 2010: 2 beds/10,000 in 2010; 5 beds/10,000 in 2020  The licensing requirements based on the Law on Medical Examination and Treatment of 2009 that will be applied for both state and non-state providers

13. Current policy and regulation related to NSP engaging in health system Policy for NSP investment in state health facilities:  Hospital autonomy policy: Decree 10/2002, replaced by Decree 43/2006: 1)Better health services delivery, improve quality and increase hospital revenues 2)Social mobilization of resources for health sectors in order to reduce subsidy from government to health facilities Social mobilization policy (Decree 73/1999, Decree No. 69/2008)  allowed public hospital to sign contract with private firms or individuals to invest in providing services (both clinical and non-clinical services)

14. Constrain in regulation  Lack of regulation to enforce non-state sector to provide public services: –Disease surveillance, preventive cares –Policy for involving non-state sector in providing services for vulnerable group  Lack of policy instrument to mmonitoring quality of services, patient care, satisfaction, outcomes (medical errors, overuse of services).

15. Constrain in regulation  Lack of mechanism to improve the engagement of non-state sector to public sector (PPP)  Weak role of professional/consumer organisations to oversight the performance of public facility in general, particularly for non-state sector.  Lack of health management information system for managing, monitoring and making plan for non-state sector development in the context of health system

16. Thank you!