Vietnam - Public hospitals prepare for autonomy

The HCM City Department of Health has encouraged public hospitals to begin preparing for full financial and managerial autonomy, following a recent requirement from the city’s Party Committee.

Financial autonomy among hospitals is designed to help reduce state expenditures so that funds can be diverted to preventive medicine and targeted community-care programmes.

Reduced state spending will also allow the state to pay for more health insurance cards for the poor, including those near the poverty line and patients covered by state policies.

Public hospitals in HCM City that have already achieved 50 per cent autonomy will be expected to implement full autonomy by January next year.

Of the 54 public hospitals in the city, seven have carried out 100 per cent financial autonomy and 44 partial financial autonomy.

The three remaining hospitals, which include a new paediatrics hospital, and two for leprosy and HIV patients, have still been subsidised by the state.

Trương Thị Xuân Liễu, chairwoman of the HCM City Medical Association and former head of the Department of Health, said that autonomy had helped hospitals identify their most important needs.

“The government’s subsidy to public hospitals had restricted their development, and full autonomy had brought benefits to both patients and the hospitals.”

However, "full autonomy brings with it added responsibilities," Liễu noted, adding that the government should develop a strict legal framework to minimise problems.

Dr Trần Văn Khanh, head of District 2 Hospital, which has carried out full autonomy since mid-May, said the state subsidy had been insufficient for hospital expenditures.

“The subsidy is based on the number of beds. This is inappropriate, especially for outpatient healthcare services,” Khanh said.

To raise money, many hospitals, with or without autonomy, often offer health exams and treatment at times outside normal working hours and give periodic check-ups to staff at local businesses.

Khanh said that funds from extra exams and services helped pay for staff salaries and allowances.

Better service quality

With full financial autonomy, hospitals are required by the state to improve the quality of healthcare services, as well as the attitudes of doctors and nurses and other staff when they are serving patients.

They also must simplify administrative procedures and shorten the waiting time so they can admit more patients.

Dr Lê Hoàng Quí, deputy head of Bình Thạnh District Hospital, which was the first district-level hospital in HCM City to carry out full autonomy in 2015, said that a long-term strategy had been created to improve quality.

“If hospitals don’t change, patients will not come,” Quí said.

In 2010, the hospital took steps to increase funding when it adopted the view that patients would be “the main source of income”.

Changes in administrative methods such as IT applications and simplification of health examination and treatment processes have also been created.

To raise funds, the hospital conducts medical exams and treatments at 6am each day and on weekends as well as holidays.

As a result, it has seen an increasing number of patients. In 2014, there were 2,000 patient turns per day, rising to 2,400 in 2015. It is expected to rise to 3,000 in 2016.

“Thanks to autonomy, better quality is available for patients,” Quí said. “The income of the hospital’s staff has risen and we now have funds to reinvest in equipment and other facilities.”

Full autonomy has also allowed the District 2 Hospital to make independent decisions on buying medical equipment and medicine, as well as hiring professionals to improve quality. This has led to increased trust from patients.

The hospital, which has 25 specialised wards, plans to set up wards for cardiac intervention, dialysis, chemotherapy for cancer, and hepatitis C by 2018.

Though the hospital has financial autonomy, it charges medical fees according to the regulations of the Ministry of Health.

“This won’t affect poor patients. The hospital in recent years has allocated VNĐ350 million-500 million a year to help poor patients,” Khanh of District 2 Hospital said.

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