The Impacts of Public Hospital Autonomization: Evidence from a Quasi-Natural Experiment

43 Pages Posted: 20 Apr 2016

See all articles by Adam Wagstaff

Adam Wagstaff

World Bank - Development Research Group (DECRG)

Sarah Bales

National University of Singapore (NUS) - Lee Kuan Yew School of Public Policy

Date Written: July 1, 2012

Abstract

This paper exploits the staggered rollout of Vietnam?s hospital autonomization policy to estimate its impacts on several key health sector outcomes including hospital efficiency, use of hospital care, and out-of-pocket spending. The authors use six years of panel data covering all Vietnam?s public hospitals, and three stacked cross-sections of household data. Autonomization probably led to more hospital admissions and outpatient department visits, although the effects are not large. It did not, however, affect bed stocks or bed-occupancy rates. Nor did it increase hospital efficiency. Oddly, despite the volume effects and the unchanged cost structure, the analysis does not find any evidence of autonomization leading to higher total costs. It does, however, find some evidence that autonomization led to higher out-of-pocket spending on hospital care, and higher spending per treatment episode; the effects vary in size depending on the data source and hospital type, but some are quite large -- around 20 percent. Autonomy did not apparently affect in-hospital death rates or complications, but in lower-level hospitals it did lead to more intensive style of care, with more lab tests and imaging per case.

Keywords: Health Systems Development & Reform, Population Policies, Health Law, Health Monitoring & Evaluation, Disease Control & Prevention

Suggested Citation

Wagstaff, Adam and Bales, Sarah, The Impacts of Public Hospital Autonomization: Evidence from a Quasi-Natural Experiment (July 1, 2012). World Bank Policy Research Working Paper No. 6137. Available at SSRN: https://ssrn.com/abstract=2111868

Adam Wagstaff (Contact Author)

World Bank - Development Research Group (DECRG) ( email )

1818 H. Street, N.W.
MSN3-311
Washington, DC 20433
United States

HOME PAGE: http://econ.worldbank.org/staff/awagstaff

Sarah Bales

National University of Singapore (NUS) - Lee Kuan Yew School of Public Policy

Singapore 117591
Singapore

Register to save articles to
your library

Register

Paper statistics

Downloads
75
Abstract Views
401
rank
314,992
PlumX Metrics