Health Insurance Reimbursement to Hosptials in Vietnam: PolicyImplementation Results and Challenges

摘要

In Vietnam, social health insurance (SHI) benefit package has been defined in amore explicit approach with the introduction of a regulation on the list ofconditional reimbursed and non-reimbursed medical services. This paper aims toanalyze the implementation results of this regulation from an economicalperspective as well as the implementation challenges. Mix-method approach wasemployed. The quantitative component was employed to understand theimplementation results. Desk study and qualitative components (2 inteviews withkey informants from Ministry of Health; 6 discussions with key informants fromprovincial Social Security Offices and Departments of Health in Hanoi, Ho ChiMinh City, Hue, Tuyen Quang, Thai Binh and Soc Trang provinces; the other 23discussions and 31 interviews with key informants from 23 selected hospitals)was employed to summarize the implementation challenges. The regulation seems tonot able to mitigate the reimbursement of high-technology and expensive servicesin higher-level providers. There is a sign of increasing out-of-pocket paymentsfor those regulated services in higher-level providers. It has also posedgreater influence on lower-level providers in terms of the proportion ofreimbursement amount rather than to higher-level hospitals. Applying WorldHealth Organization’s 6 building blocks of health system to analyze theimplementation challenges, we provide policymakers evidence to improve theregulation, as well as point out the relating health system weakness need to bestrengthened.