Getting Incentives Right: An Impact Evaluation of District Hospital Capitation Payment in Vietnam

33 Pages Posted: 20 Apr 2016

See all articles by Ha Thi Hong Nguyen

Ha Thi Hong Nguyen

World Bank

Sarah Bales

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

Adam Wagstaff

World Bank - Development Research Group (DECRG)

Huyen Dao

Research and Development Center for Community Health Strategy

Date Written: November 1, 2013

Abstract

With the movement toward universal health coverage gaining momentum, the global health research community has made significant efforts to advance knowledge about the impact of various schemes to expand population coverage. The impacts on efficiency, quality, and gaps in service utilization of reforms to provider payment methods are less well studied and understood. The current paper contributes to this limited knowledge by evaluating the impact of a shift by Vietnam's social health insurance agency from reimbursing hospitals on a fee-for-service basis to making a capitation payment to the district hospital where the enrollee lives. The analysis uses panel data on hospitals over the period 2005-2011 and multiple cross-section data sets from the Vietnam Household Living Standards Surveys to estimate impacts on efficiency, quality, and equity. The paper finds that capitation increases hospitals' efficiency, as measured by recurrent expenditure and drug expenditure per case, but has no effect on surgery complication rates or in-hospital deaths. In response to the shift to capitation, hospitals scaled down service provision to the insured and increased provision to the uninsured (who continue to pay out-of-pocket on a fee-for-service basis). The study points to the need to anticipate the intended and unintended effects of any payment reform and the trade-offs among policy objectives.

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

Suggested Citation

Nguyen, Ha Thi Hong and Bales, Sarah and Wagstaff, Adam and Dao, Huyen, Getting Incentives Right: An Impact Evaluation of District Hospital Capitation Payment in Vietnam (November 1, 2013). World Bank Policy Research Working Paper No. 6709. Available at SSRN: https://ssrn.com/abstract=2358540

Ha Thi Hong Nguyen (Contact Author)

World Bank ( email )

1818 H Street, NW
Washington, DC 20433
United States

Sarah Bales

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

Singapore 117591
Singapore

Adam Wagstaff

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

Huyen Dao

Research and Development Center for Community Health Strategy

Hanoi
Vietnam

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