Service Delivery
Prices and Provider Payment Part of the explanation for the growth in volume of care delivered and the growth of unit costs lies in the way providers are paid in Vietnam. They receive their income from three main sources: the budget (still the largest source of revenue), out-of-pocket payments by patients, and income from the health insurance agency, VSS. During the last 10 years or so, among hospitals, the budget has steadily shrunk as a source of revenue, and health insurance income has increased (figure 5.6). The share of revenues from user fees increased somewhat between 1998 and 2000, but then fell back. Since both fee-paying patients and VSS pay providers on a FFS basis, there has been, in effect, a gradual shift away from budgets toward FFS in the hospital sector, albeit with a third-party
Figure 5.6: Source of Hospital Revenues, Vietnam 1998–2005 100% 90%
5%
8%
13%
11%
5%
6%
6%
16%
18%
39%
37%
39%
39%
2004
2005
11%
80% 70% 35% 60%
39%
41%
50% 40% 30% 20%
47%
42%
44%
1999
2000
10% 0% 1998
other
fees
health insurance
budget
Source: Calculations from Vietnam hospital inventory.
121