Health Financing and Delivery in Vietnam Figure 5.7: Variations in Speed of Adoption of Decree 10 by Type of Hospital 100% 90% 80% % facilities NOT autonomized
128
70% 60% 50% 40% 30% 20% 10% 0% 2002
2003 central
2004 provincial
2005
2006
2007
district
Source: Calculations from data provided by MOH.
the main drivers of the speed of autonomization. Provincial hospitals have a higher chance of adopting early. There are also differences across provinces in the speed of adoption. Among variables that can be measured, only GDP per capita emerges as a significant influence, with the unexpected result that richer provinces are slower to adopt. Impacts of Decrees 10 and 43 Decrees 10 and 43 made hospitals more autonomous in areas where it was argued above their autonomy was inappropriately circumscribed—for example, human resource and other input decisions. However, they have either left unchecked or have increased still further providers’ autonomy in areas where it was argued earlier they already enjoy too high a degree of autonomy—clinical decision making, price setting, the ability to benefit financially from higher hospital revenues, and so forth.